Heart & lung : the journal of critical care
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Records of all patients who developed flail chest after cardiopulmonary resuscitation at Rochester Methodist Hospital between January, 1966 and March 1976 were reviewed. Also, for comparison, records of patients with flail chest resulting from motor vehicle accidents and those of a matched group of patients who underwent cardiopulmonary resuscitation without developing flail chest were reviewed. The incidence of flail chest after cardiopulmonary resuscitation was about 5.6 per 100 survivors. ⋯ Stabilization of the flail chest required mechanical ventilation for 1 to 24 days (mean, 10.7). Flail chest did not significantly lengthen the hospitalization of patients who survived after cardiopulmonary resuscitation. The occurrence of flail chest after cardiopulmonary resuscitation did not seem to increase the mortality rate.
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Despite better prevention programs and emergency medical care, trauma continues to be the leading cause of death in children. Children present very special anatomic, physiologic, and psychological problems to the emergency room physician, and the spectrum of injury in these young patients may be significantly different from that seen in adult trauma victims. These factors make immediate diagnosis and early appropriate therapy for these young patients imperative to a successful outcome. A few unique forms of injury have been reviewed in this article and their diagnosis and management discussed.
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In an anesthetized hypoxemic animal model, 15 seconds of endotracheal suctioning, using a suction pressure of --170 mm. Hg and endotracheal tube to suction catheter ratio of 1.87 to 1, produced a 13 mm. Hg fall in arterial oxygen tension. ⋯ Giving 100 per cent oxygen before suctioning prevented suction-induced hypoxemia during and immediately after suctioning, but at 5 minutes after suctioning, oxygen tension fell below control levels. Mechanical lung hyperinflation with room air after suctioning quickly raised arterial oxygen tension above control levels. When mechanical ventilation using 100 per cent oxygen was maintained before, during, and after the suction procedure, arterial oxygen tension remained elevated at all times.