From nose to mouth in breathlessness.
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Biomedical subjects
Publications and source records attributed to A Gilston.
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Two adult patients with severe heart disease regained full consciousness a few hours after circulatory arrest at normal temperature which lasted up to eighteen minutes, though both eventually died. Whilst the reason for their unusual cerebral recovery cannot be clearly established, it may have been primarily due to the cause of the circulatory arrest, exsanguinating haemorrhage during cardiac surgery, together with subsequent circulatory support. Several other factors may also have contributed to this outcome, but a review of present evidence suggests they were of much less importance.
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The effect of positive and expiratory pressure (PEEP) on arterial oxygenation depends on many factors. Two of the most important are the "quality" and the "quantity" of the physiological shunt. The "quality" depends on the mixed venous oxygen tension, and the "quantity" on the shunt fraction. Each of these factors may rise or fall with PEEP, depending on the pulmonary and circulatory state of the patient. Their ultimate balance influences the change in arterial oxygen tension.
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The face is a rich source of information about the respiratory, cardiovascular and neurological state of the patient. These systems are particularly affected in the adult respiratory distress syndrome (ARDS) after cardiac surgery. It is possible to make firm decisions about mechanical ventilation by scrupulously careful clinical examination, without blood-gas analysis or measurement of respiratory dynamics. The method is also applicable to many other conditions.