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Biomedical subjects

R F Wilson

Publications and source records attributed to R F Wilson.

At least 217 records · Page 12Linked to original sources
PubMed1987

Diagnostic and treatment problems in renal injuries.

The case records of 112 patients with 116 renal injuries seen at Detroit Receiving Hospital (July 1980 to June 1985) were reviewed. Eighty-three (74%) of the injuries were caused by gunshot wounds, 18 (16%) by stab wounds, and 11 (10%) by blunt trauma. Of 102 patients who had a urinalysis (U/A) in the Emergency Department (ED), 12 had a normal U/A. Five of these 12 patients had severe renal pedicle injuries. Of 75 excretory urograms (IVPs) performed preoperatively, 21 (28%) were normal including seven in patients with major renal injuries requiring surgical treatment. The incidence of shock was 38 per cent in patients with injuries not requiring renal explorations, 69 per cent in patients with renal parenchymal injuries requiring surgery, and 93 per cent in patients with pedicle injuries requiring repair or nephrectomy. Although it is generally believed that traumatic perirenal hematomas should not be explored, there was an increased incidence of complications with this approach in this series. Of 65 stable renal injuries treated conservatively (without exploration of the renal parenchyma), there were nine (14%) complications including three reoperation for missed injuries and three perinephric abscesses. In 46 injuries that were explored (38 for bleeding and eight without bleeding), there were only two complications (5%), including a perinephric abscess.

Acute Kidney Injury↗
PubMed1987

Problems with 20 or more blood transfusions in 24 hours.

The case records of 128 patients receiving 129 transfusions of 20 or more units of blood within a 24-hour period at Detroit Receiving Hospital, between August 1980 and August 1985, were reviewed. In patients receiving 20 to 49 units of blood, without pre-existing disease or prolonged shock, the mortality rate was 36 per cent (15/42). In similar patients who had prolonged shock, the mortality rate was 61 per cent (27/44). If the patient had pre-existing disease and prolonged shock, the mortality rate with 20 to 49 units of blood was 92 per cent (12/13). All 13 patients receiving 50 or more units of blood died. Platelet counts were less than 50,000/microL in 50 per cent (51/102). The prothrombin time (PT) was prolonged by 5 or more seconds in 54 per cent (51/92). The partial thromboplastin time (PTT) was prolonged to more than 60 seconds in 45 per cent (42/94). There was no correlation between the PT, PTT, and amount of fresh frozen plasma (FFP) given. A coagulopathy was diagnosed clinically in 43 patients, but this did not correlate well with laboratory coagulation studies. The average core temperature of the patients was 32.9 +/- 1.7 C. Severe hypocalcemia with total calcium levels less than 6.0 mg/dL was found in 53 per cent (33/62). Ionized calcium levels Ca++ were less than 0.70 mmol/L in 56 per cent (24/43). Of the 82 deaths, 32 (38%) occurred in the operating room and 31 (38%) occurred within 48 hours from continued bleeding and/or shock. Twelve deaths (15%), from severe infections, occurred after 30 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1987

Measurement of maximal coronary flow reserve: a technique for assessing the physiologic significance of coronary arterial lesions in humans.

Recent studies suggest that angiographic measurements of coronary arterial stenosis are poorly correlated with direct measurements of the capacity of the artery to conduct hyperemic blood flow. Direct measurement of coronary blood flow and the flow reserve capacity of individual coronary vessels in conscious humans, however, has been hampered by methodologic limitations. We have developed and validated a coronary Doppler catheter capable of subselectively measuring coronary blood flow velocity at the time of cardiac catheterization. Studies in seven calves demonstrated that measurements of the change in coronary blood flow velocity assessed using the Doppler catheter were highly correlated with simultaneous measurements of the change in coronary sinus blood flow (r = 0.97, slope = 1.06) and changes in blood flow velocity assessed using an epicardial Doppler probe (r = 0.95, slope = 1.04). Additional studies demonstrated that the catheter did not produce physiologically significant obstruction to coronary blood flow. Subsequent studies in 215 humans undergoing catheterization have shown that acceptable signals of phasic coronary blood flow velocity could be recorded in 176 patients. Subsequent dose response kinetic studies demonstrated that intracoronary administration of papaverine can rapidly produce maximal coronary hyperemia, equivalent in magnitude to intravenous dipyridamole, but short enough in duration to permit multiple measurements of coronary flow reserve during a single catheterization. Measurements of coronary flow reserve in patients with obstructive coronary artery disease have permitted characterization of the physiologic significance of individual obstructive coronary lesions. The development of this coronary Doppler catheter system and technique for measurement of maximal coronary flow reserve should facilitate characterization of the physiologic impact of coronary arterial lesions on coronary blood flow and studies of the coronary circulation in conscious humans.

Animals↗
PubMed1987

Cardiopulmonary complications after major surgery: a role for epidural analgesia?

Improvement in postoperative pulmonary mechanics with epidural analgesia has been described. Data on the hemodynamic effects of this technique are absent from the surgical literature. To provide such data we have evaluated two groups of patients undergoing aortic reconstruction: group I (n = 25), general anesthesia and group II (n = 6), general anesthesia with adjunctive epidural analgesia. The groups were comparable preoperatively as judged by the incidence of cardiac history, preoperative ejection fraction, and measured hemodynamic parameters. Postoperatively there were no significant differences in the pressure-related parameters; however, rate-related factors including heart rate and double product were significantly decreased in group II with no reduction in cardiac index. Postoperative increases in total body oxygen consumption were also markedly attenuated by epidural analgesia. Epidural analgesia reduces the hemodynamic demands on the heart after major surgery and is a useful adjunct, especially in patients with coronary artery disease.

Aged↗
PubMed1987

Injuries to the abdominal vascular system: how much does aggressive resuscitation and prelaparotomy thoracotomy really help?

The records of 154 patients with 254 abdominal vascular injuries seen over 5 years (1980 to 1985) were reviewed. The overall mortality rate (MR) was 46%. This included 100% (5/5) for blunt injuries, 49% (59/119) for gunshot wounds, and 23% (7/30) for stab wounds. The most common venous injuries and the MRs were: inferior vena cava, 59% (33/56) and iliac veins, 65% (10/16). The most common arterial injuries and the MRs were: aorta, 68% (15/22), iliac artery, 57% (12/21), and superior mesenteric artery, 67% (8/12). Of 84 patients who presented to the emergency department (ED) with a blood pressure (BP) less than 70 mm Hg, 60 (71%) died, and of 64 patients with four or more associated injuries, 41 (64%) died. Failure to reduce the duration of shock, amount of bleeding, or severity of hypotension before surgery is highly lethal. Of the 42 patients who had shock for more than 30 minutes, 38 (90%) died. Of the 93 patients who received more than 10 U of blood in the ED and operating room (OR) 60 (64%) died. Of the 60 patients presenting to the OR with a systolic BP less than 70 mm Hg, 52 (87%) died. Prelaparotomy cross-clamping of the thoracic aorta for persistent shock is controversial. However, of the 26 patients with this procedure, 12 responded with a sustained increase in systolic BP greater than 90 with five (42%) survivors. Of the 14 no responders, none survived. Of 17 patients with persistent shock without a prelaparotomy thoracotomy, only one (6%) survived. In the high-risk group (admission systolic BP less than 70 mm Hg and four or more associated injuries), if shock was kept to less than 30 minutes and bleeding to 10 U of blood or less, the MR was reduced from 92% (24/26) to 0% (0/12). In patients presenting to the OR with a BP less than 70, a prelaparotomy cross-clamping of the aorta should be considered. In those patients not responding, prolonged surgical efforts are futile.

Abdominal Injuries↗
PubMed1986

Single-antibiotic use for penetrating abdominal trauma.

A prospective randomized study compared the use of moxalactam disodium vs clindamycin phosphate and tobramycin sulfate for treatment of 190 patients with penetrating abdominal trauma. Twenty-seven patients were disqualified because of early death or failure to follow the protocol. The patients in each group were comparable regarding the cause and severity of injury. No significant difference was seen in the incidence of intra-abdominal infection between the moxalactam-treated group (13%) and the clindamycin- and tobramycin-treated group (9%). The intra-abdominal infection rate in patients with colon injuries (21%) was significantly increased when compared with the patients without colon injuries (6%), but the antibiotic regimen did not significantly change the infection rate. No evidence of bleeding problems from moxalactam were noted. Changes in prothrombin and partial thromboplastin times appeared to be related to shock rather than the use of moxalactam. The most severe coagulopathies occurred prior to moxalactam therapy and were seen only in those patients who had shock requiring 10 or more units of blood. Moxalactam is as effective as combination (clindamycin and tobramycin) antimicrobial therapy in patients with penetrating abdominal trauma.

Abdominal Injuries↗
PubMed1986

Antithrombin, prekallikrein, and fibronectin levels in surgical patients.

Antithrombin (AT), prekallikrein (PK), and fibronectin (FN) levels were measured in the plasma of 290 patients. The mean (+/- SD) lowest AT level measured in 287 patients was 70% +/- 18% (normal, 75% to 120% of control). The mean lowest AT level in 81 septic patients (49% +/- 17%) was significantly lower than in the 206 patients without sepsis (78% +/- 22%). The mean AT level in 60 patients who died (42% +/- 22%) was significantly lower than in 227 patients who lived (78% +/- 19%). The mean lowest PK level measured in 71 patients was 42% +/- 17% (normal, 80% to 120%). The mean PK level in 32 septic patients (26% +/- 12%) was significantly lower than in 39 patients who were not septic (54% +/- 19%). The mean lowest FN level measured in 45 patients was 193 +/- 86 micrograms/mL (normal, 160 to 240 micrograms/mL). The mean FN level in 15 septic patients (128 +/- 72 micrograms/mL) was significantly lower than in the 30 nonseptic patients (266 +/- 84 micrograms/mL). Following AT, PK, and FN levels in critically ill surgical patients may allow earlier diagnosis and more effective treatment of sepsis.

Antithrombins↗
PubMed1986

Abdominal venous injuries.

To improve our understanding of this frequently lethal, but potentially salvageable problem, the case records of 105 patients with 138 major intra-abdominal venous injuries seen over a 4 year period (1980-1984) were reviewed. The overall mortality rate was 54%. The most frequent abdominal venous injuries and their mortality rates were inferior vena cava, 54% (28/52); portal venous system, 51% (16/31); iliac veins, 71% (20/28); renal veins, 58% (11/19); and hepatic veins, 88% (7/8). Several important prognostic factors were identified. Of 48 patients who presented to the emergency department with no obtainable blood pressure, 41 (85%) died. Forty patients presented to the operating room with a systolic pressure less than 70 mm Hg and 36 (90%) died. Of 39 patients in hypovolemic shock for more than 15 minutes initially in the ED and operating room, 31 (79%) died. Of 71 patients who received 10 or more units of blood pre- and perioperatively, 48 (68%) died. Of 41 patients with five or more associated injuries, 30 (73%) died. Seventeen had a thoracotomy before laparotomy to cross-clamp the aorta for persistent severe shock; six responded with a substantial increase in blood pressure and three survived. Of 14 others with severe persistent shock who did not have a prior thoracotomy, only one survived. Atrial-caval shunts were attempted for severe retrohepatic bleeding in six patients with no survivors. Review of these cases suggests that improved survival might be obtained with: more vigorous administration of fluids in the emergency department and operating room; quicker movement to the operating room to control bleeding; and earlier definitive management for controlling bleeding--especially with iliac and/or retrohepatic injuries. A thoracotomy to cross-clamp the aorta prior to laparotomy with severe persisting shock should be considered.

Abdominal Injuries↗
PubMed1986

Effect of Osmotic Stress on Ion Transport Processes and Phospholipid Composition of Wheat (Triticum aestivum L.) Mitochondria.

The effect of osmotic stress on wheat (Triticum aestivum L.) mitochondrial activity and phospholipid composition was investigated. Preliminary growth measurements showed that osmotic stress (-0.25 or -0.5 megapascal external water potential) inhibited the rate of shoot dry matter accumulation while root dry matter accumulation was less sensitive. We have determined that differences in sensitivity to osmotic stress existed between tissues at the mitochondrial level. Mitochondria isolated from roots or shoots of stressed seedlings showed respiratory control and ADP/O ratios similar to control seedlings which indicates that stressed mitochondria were well coupled. However, under passive swelling conditions in a KCl reaction mixture, the rate and extent of valinomycin-induced swelling of shoot mitochondria were increased by osmotic stress while root mitochondria were largely unaffected. Active ion transport studies showed efflux transport by stressed-shoot mitochondria to be partially inhibited since mitochondrial contraction required the addition of N-ethylmaleimide or nigericin. Efflux ion transport by root mitochondria was not inhibited by osmotic stress which indicates that stress-induced changes in ion transport were largely limited to shoot mitochondria. Characterization of mitochondrial fatty acid and phospholipid composition showed an increase in the percentage of phosphatidylcholine in stressed shoot mitochondria compared to the control. Mitochondrial fatty acid composition was not markedly altered by stress. No significant changes in either the phospholipid or fatty acid composition of stressed root mitochondria were observed. Hence, these results suggest that a tissue-specific response to osmotic stress exists at the mitochondrial level.

Journal Article↗
PubMed1986

Quantitative angiographic morphology of coronary stenoses leading to myocardial infarction or unstable angina.

Identification of a characteristic morphology of a coronary stenosis likely to result in myocardial infarction would facilitate the prospective evaluation of infarct prevention strategies and identification of high-risk patients. We postulated that coronary lesions associated with recent myocardial infarction or unstable angina would have an angiographic morphology suggesting disruption of an atherosclerotic plaque and would appear morphologically different from lesions associated with chronic stable angina. To test this hypothesis, quantitative coronary angiography (Brown-Dodge method) was performed in 15 patients 4 to 30 days after myocardial infarction, in 10 patients with the abrupt onset of unstable angina and single-vessel coronary disease, and in 15 patients with chronic stable angina without prior myocardial infarction. Serial arterial diameters (20 to 40) within each lesion were determined and the degree of luminal irregularity was quantitated by calculation of an "ulceration" index. The majority of all lesions analyzed resulted in severe luminal stenosis (mean 78% area stenosis, all groups). Despite small differences in mean lesion severity among groups, overlap in the degree of luminal compromise prevented precise classification of lesions associated with myocardial infarction or unstable angina based on percent stenosis or minimum luminal cross-sectional area. The mean ulceration index of lesions in patients with unstable angina and in the infarct-related vessel in those with acute myocardial infarction was 0.62 +/- 0.05 (+/- SEM) and 0.61 +/- 0.03, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina, Unstable↗
PubMed1986

Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans.

An ideal coronary vasodilator for studying coronary flow reserve in humans would rapidly produce maximal coronary vasodilation, be short acting to permit repeated measurements, and not alter systemic hemodynamics. The two commonly used vasodilators (dipyridamole and meglumine diatrizoate) do not satisfy these criteria; meglumine diatrizoate does not produce maximal hyperemia and dipyridamole has a long duration of effect (greater than 30 min). In this study we used a subselective coronary Doppler catheter to measure the dose-response kinetics of a shorter acting vasodilator, intracoronary papaverine. In 10 patients with normal coronary vessels, the maximal vasodilator response to papaverine was compared with that to intravenous dipyridamole (0.56 mg/kg infused over 4 min) and intracoronary meglumine diatrizoate. The increase in coronary blood flow velocity after the maximal dose of papaverine (4.8 +/- 0.4 peak/resting velocity ratio, mean +/- SEM) was nearly identical to that seen after infusion of dipyridamole (4.8 +/- 0.6) and was significantly greater than that after meglumine diatrizoate (3.1 +/- 0.2, p less than .01). At maximal hyperemia, mean arterial blood pressure fell 9 +/- 2% (mean +/- SEM) after intracoronary papaverine, 8 +/- 4% after dipyridamole, and 3 +/- 3% after meglumine diatrizoate. The dose-response kinetics of intracoronary papaverine were studied in 13 patients with normal coronary arteries. In the left coronary artery, maximal vasodilation (5.4 +/- 0.6) was achieved with 8 mg in six of eight patients and with 12 mg in all patients. In the right coronary artery, maximal vasodilation (4.8 +/- 0.7) was achieved with 6 mg in four or five patients and with 8 mg in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1986

Partial cardiopulmonary bypass for core rewarming in profound accidental hypothermia.

Six cases of treatment of severe accidental hypothermia using cardiopulmonary bypass for core rewarming are reported and eleven cases from the literature are analyzed. Thirteen patients survived. Overall survival was more likely in patients who had vital signs initially. Initial mean core temperatures in the new cases was 22.8 C. Surface and conventional core rewarming methods resulted in an average temperature increase of 2.4 C per hr. Electrical defibrillation was generally without success until the core temperature had been raised to above 30 C. Between one and six hours after admission, partial femoral-femoral cardiopulmonary bypass (CPB) for core rewarming was started, causing a mean temperature increase of 9.5 C per hr. Four patients required a thoracotomy. Two patients had a massively dilated heart with contusions, and could not be weaned off bypass. None of the four long-term survivors had a demonstrable central nervous system (CNS) deficit. All patients developed temporary pulmonary problems; two developed wound infections. The average hospital stay was 21 days. CPB for core rewarming allows circulatory support while avoiding myocardial damage from prolonged external cardiac massage; rapidly increases the myocardial temperature and counteracts myocardial temperature gradients so that DC electroversion is successful; avoids "rewarming shock"; and improves microcirculatory flow. A prospective randomized trial to compare rapid surface rewarming and CPB rewarming is suggested. Immediate CPB for rewarming is recommended for patients in ventricular fibrillation with core temperatures below 30 C. Prolonged external cardiac massage (ECM) should not be used. The value of surface rewarming and non-CPB core rewarming methods remains undefined.

Accidents↗
PubMed1986

Acute injuries of the diaphragm. An analysis of 165 cases.

The records of 165 patients with diaphragmatic injuries seen at Detroit Receiving Hospital from July 1980 through June 1985 were reviewed. Causes included gunshot wounds in 89 patients, stab wounds in 65, and blunt trauma in 11. Mortality rates were 18%, 5%, and 27%, respectively, deaths being caused primarily by bleeding from associated injuries. Operations on these patients included laparotomy in 123 (75%), thoracotomy in four (2%), and both in 38 (23%). The mortality rates for these operations were 0%, 50%, and 53%, respectively. A presumptive preoperative diagnosis of diaphragmatic injury from chest x-ray findings was possible in only 24 (15%) patients. Of 42 thoracotomies, five were performed in the emergency department for cardiac arrest, with three (60%) deaths. Of 37 thoracotomies performed in the operating room, 17 were for thoracic injuries with six (35%) deaths and 20 were for resuscitation for abdominal injuries with 13 (65%) deaths. In most patients, the diaphragmatic injury was critical only in warning the surgeon that severe injuries might be present in both the chest and abdomen. Of 43 patients admitted with a blood pressure of less than 70 mm Hg or four or more associated injuries, 22 died. However, even in these high-risk patients, if resuscitation raised the initial operating room blood pressure to more than 70 mm Hg, reduced the shock time to less than 30 minutes, and kept blood loss below 10 units, the mortality was only 8% (1/12). In contrast, if none of these conditions could be met, the mortality in this high-risk group was 100% (16/16). Thus more aggressive resuscitative efforts and earlier control of bleeding seem to provide the best chance for improved survival.

Adolescent↗
PubMed1985

Primary mucinous adenocarcinoma of the trachea: the case for complete surgical resection.

Adenocarcinomas of the trachea are rare but important because the only reported treatment in the past (radiation) has resulted in uniformly poor results. The authors recently had the opportunity to treat a young woman with a mucin-producing adenocarcinoma of the trachea. A sleeve resection of the involved trachea with reanastomosis was successful, and the patient is alive and well with no evidence of tumor four years later. Thus, primary resection should be strongly considered for adenocarcinoma of the trachea whenever possible.

Adenocarcinoma↗
PubMed1985

Emergency thoracotomy: a four-year review.

The case records of 200 patients who had emergency thoracotomy for penetrating trauma were reviewed. The mortality was 47% (93/200) for the entire series, 27% (21/79) for stab wounds and 60% (72/121) for gunshot wounds. Of 55 patients who underwent thoracotomy in the emergency department, 8 (15%) survived. Twelve patients "dead" at the scene could not be resuscitated. Nineteen patients sustained cardiac arrest in the ambulance, 3 (16%) of whom survived. Of 19 who had cardiac arrest in the emergency department, 5 (26%) survived. Of 38 patients who had cardiac arrest in the ambulance or emergency department, 14 with stab wounds had a 43% survival and 24 with gunshot wounds had a survival of only 8%. Patients who underwent thoracotomy in the operating room (OR) had a higher survival, 68% (99/145). For those with thoracic, extremity, or neck injuries, survival was 81% (93/115). For those who had an OR thoracotomy for aortic cross-clamping because of abdominal injuries, survival was only 17% (5/30). Early thoracotomy has a place in the management of patients who have cardiac arrest in the ambulance or emergency department because of penetrating chest, neck, or extremity injuries, especially if caused by stab wounds. Cross-clamping of the thoracic aorta for massive abdominal bleeding should be applied selectively.

Adolescent↗
PubMed1985

Special problems in the diagnosis and treatment of surgical sepsis.

Since sepsis is the most frequent single cause of death after surgery and trauma, its development should be anticipated in elderly patients or those with disease or trauma causing intestinal leaks, particularly if the patient had massive transfusions or was in shock. Diagnosis may be extremely difficult, particularly if the infection is intraperitoneal. Furthermore, patients with impaired host defenses may show only a failure to thrive and then a progressive MOF. Physical examination is usually not very helpful. Gallium and indium scans and ultrasonography are only about 50 to 60 per cent accurate. Ultrasonography followed by HIDA and PIPIDA scans may be very useful in diagnosing acute acalculous cholecystitis, which appears to be an increasingly frequent problem in these patients. Computerized tomographic scans are at least 80 to 90 per cent accurate in diagnosing intra-abdominal abscesses, but the diagnosis of peritonitis is still largely clinically based. Even without clear evidence of infection, the critically ill patient with MOF and previous abdominal trauma, surgery, or disease should probably have the abdomen explored (that is, a blind laparotomy). If generalized peritonitis is found, it may be wise to leave the abdomen open and re-explore and débride it daily until it is clean. Percutaneous drainage of abdominal abscesses is being performed increasingly and is of special value in the 30 to 50 per cent of patients with single bacterial abscesses in which the drainage tract does not cross bowel or peritoneum and there is no underlying intestinal leak. Antibiotics are only a second line of defense, and their use should be directed by smear and culture results when possible. For abdominal infections, coverage for gram-negative anaerobes and Bacteroides fragilis is essential. If the infection persists for more than 2 to 3 weeks, infection by enterococci and fungi must be considered. If shock develops, maintaining an O2 consumption of at least 130 to 160 ml per minute per m2 is a particularly important part of the resuscitation. Although controversial, raising the hematocrit to 40 to 45 per cent or higher is often of value.

Abdomen↗
PubMed1985

Science and shock: a clinical perspective.

In spite of all the scientific and technical advances in recent years, shock that is not rapidly correctable with fluid can have a morbidity rate exceeding 80%. Consequently awareness of such precipitating factors as sepsis and early diagnosis and treatment are essential. Treatment should be rapid and should follow a previously outlined protocol. Such protocols should include correction of the precipitating problem and aggressive resuscitation to assure adequate ventilation and oxygenation of the blood and optimal oxygen delivery to the tissues. Fluid and blood should be given as needed until filling pressures begin to rise rapidly with further fluid infusion. With hemorrhagic shock in previously healthy individuals, a hemoglobin level of 10.0 g/dL is usually adequate. In older, septic, or cardiogenic shock patients, a hemoglobin level of 12.5 to 14.0 may be preferable. If an optimal preload does not increase cardiac output to normal or higher levels, inotropic agents should be used. If shock still persists, one must be sure that the arterial pH is not excessively high or low. Glucocorticoids may then be given in low dose (200 mg hydrocortisone) in case some degree of adrenal insufficiency is present. They can also be given in high doses (equivalent to 150 mg/kg hydrocortisone) early in septic shock primarily to prevent excess complement activation and to preserve membrane integrity. Vasopressors may occasionally be required if there is excessive vasodilation, especially if there is persistent hypotension in the presence of high-grade coronary or cerebral artery stenosis. Vasodilators may be used to try to correct myocardial ischemia (nitroglycerin), excessive preload (nitroglycerin), or excessive afterload (nitroprusside or hydralazine). Combinations of vasodilators and inotropic agents may be required in some patients with high systemic vascular resistance and persistently low cardiac outputs. Mechanical assist with IABP can be of great value in persistent cardiogenic shock. Diuretics may occasionally help prevent renal failure in patients who are persistently oliguric after blood flow and pressure are restored. Heparin is occasionally of value if DIC develops with no concomitant fibrinolysis. Antibiotics are important in septic shock and may also be important if persistent shock has reduced gastrointestinal mucosal integrity so that bacteria and bacterial products can enter the portal system.(ABSTRACT TRUNCATED AT 400 WORDS)

Acidosis, Respiratory↗