Heart & lung : the journal of critical care
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Comparative Study
Atypical presentation of acute myocardial infarction in 3 age groups.
The purpose of this study was to compare the clinical manifestations of first-time acute myocardial infarction (AMI) in 3 age groups of men and women who presented to the emergency departments of 3 acute tertiary care hospitals. ⋯ It is essential that nurses and physicians accurately assess patients with AMI, especially patients in the older age groups who may be presenting atypically. It is also important that professional and nonprofessional public health education initiatives include information regarding both typical and atypical presentation of AMI, particularly in the older patient.
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With the clinical use of cold cardioplegia, or total body hypothermia, it is crucial that critical care physicians and nurses be aware of the electrocardiographic changes related to hypothermia. Similar changes also occur with accidental exposure to cold. We report and discuss a patient who presented with typical electrocardiographic changes upon accidental exposure to cold.
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The purpose of this study is to identify independent preoperative, intraoperative, and postoperative determinants of intensive care unit (ICU) length of stay in patients undergoing coronary artery bypass graft (CABG) surgery and to evaluate the usefulness of a mortality risk scoring system, the Parsonnet score, as a prognostic indicator of ICU length of stay after CABG. ⋯ Preoperative and postoperative variables explained a large portion of the variance in ICU stay after CABG. Although the Parsonnet score was not helpful in identifying patients who require only a short ICU stay, it may help clinicians screen for patients likely to require stays >1 day and plan appropriate use of resources in the ICU.
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Dyspnea is the most common symptom among patients with heart failure (HF) who present to the emergency department (ED), but it is not clear which dimensions of the symptom prompt ED visits, or whether dyspnea characteristics are related to visit disposition. ⋯ Subjects reported high levels of distress and intensity at Decision, regardless of dyspnea duration. Differences in recalled duration were associated with 2 distinct patterns in distress and intensity ratings but were not associated with admission. Dyspnea duration does not appear to be a valid criterion for judging condition severity in HF-related visits to the ED.
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Comparative Study
Comparison of pulmonary artery and central venous pressure waveform measurements via digital and graphic measurement methods.
Techniques to measure pulmonary artery (PA) pressure waveforms include digital measurement, graphic measurement, and freeze-cursor measurement. Previous studies reported the inaccuracy of digital and freeze-cursor measurements. However, many of the previous studies were small and did not thoroughly examine the circumstances of when digital measurements might be inaccurate. ⋯ There were instances in which the monitor's digital measurement was substantially different from the graphically measured value. This difference has the potential to mislead interpretation of clinical situations. The monitor's ability to occasionally give digital measurement values similar to the graphic measurements may lead to a false sense of security in clinicians. Because the accuracy of the monitor is inconsistent, the bedside clinician should interpret waveforms through use of a graphic recording rather than rely on the digital measurement on the monitor.