Klinische Wochenschrift
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Klinische Wochenschrift · Jan 1991
Case Reports[Diagnosis of suspected acute myocardial infarct in acute regional myocarditis].
We report on 4 patients in whom acute myocardial infarction was suspected due to acute onset of chest pain and elevation of the ST-segment. Furthermore in 2 patients the echocardiography revealed regional abnormal wall motion on admission, the others later. Coronary angiography showed normal coronary arteries in all cases. ⋯ Sometimes regional myocarditis might imitate an acute myocardial infarction. Both, the exact anamnesis and coronary angiography are necessary. The performance of an endomyocardial biopsy is desirable.
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Klinische Wochenschrift · Jan 1991
Randomized Controlled Trial Clinical Trial[Prevention with pseudomonas immune globulin in burn injury patients with inhalation trauma: does it have an effect on lung function and outcome?].
In an evaluation of the effect of prophylactic application of Pseudomonas immunoglobulin on the immunoglobulin serum concentration, infection rate, lung function and mortality in major burn-trauma patients, a clinical, prospective, controlled and randomized trial along with an extensive literature review was carried out in the intensive care unit (ICU) of a major burn-trauma center at a major municipal hospital in the Federal Republic of Germany. A total of 60 patients suffering from major burn trauma were studied. Some of them exhibited inhalation injury as a secondary trauma. ⋯ The target value of pulmonary function was the O2 quotient (P(ALV)O2-P(ART)O2/P(ALV)O2), which was significantly closer to the normal value in the PIG-SUBGRP. Mortality was lower in the PIG-SUBGRP (34.8%, 8 patients) than in the CON-SUBGRP (50%, 8 subjects). In conclusion, prophylaxis with Pseudomonas immunoglobulin does not appear to be beneficial to burn trauma patients in general; however, it was shown to be effective in burn-trauma patients exhibiting inhalation injury.
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Seven different schemes for analgesic anaesthesia were investigated for their clinical applicability, potential side effects, and impacts on circulation parameters of the systemic and pulmonary (peripheral) circulation as well as on the intracranial pressure. In all, so patients per group were treated. The results revealed different reactions of patients, such as a higher incidence of disturbances of the autonomic nervous system and excitation after medication withdrawal. ⋯ In several instances, a clear increase in the right atrial and the pulmonary arterial mean pressure as well as the intracranial pressure was observed during ketamine/flunitrazepam therapy. The combinations pethidine/promethazine or pethidine/flunitrazepam also showed clear side effects on the circulation and evoked an increase in the intracranial pressure. Fentanyl/midazolam or alfentanil/midazolam treatments were the most favourable combinations for most of the patients who were artificially respirated.
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The realization that many intensive care patients develop psychoreactive problems ranging from confusion to depression to frank mutism led us to include Dehydrobenzperidol (DHB) in our analgesia and sedation scheme. The early prophylactic administration of this drug was found to be particularly effective in the prevention of delirium following an alcohol and/or drug overdose.
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The surgeon uses the scalpel rather than the prescription pad, but this fact is deceptive. Analysis of the development of surgical history yields an impressive insight into the interaction between medication and operative treatment. ⋯ With regard to drugs, intensive care medicine confronts the surgeon with an inconceivable complex of interactions, side effects and dose adaptations. In addition, human suggestibility influences the outcome of operative interventions no less than medical drugs.