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At least 1,711 records · Page 95Linked to original sources
PubMed1976

Facial signs of respiratory distress after cardiac surgery. A plea for the clinical approach to mechanical ventilation.

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.

Acidosis, Respiratory↗
PubMed1980

Understanding arterial blood gases.

Arterial blood gases are useful in establishing acid-base status, determining the degree of impairment of the lungs as a gas exchanger, diagnosing such important phenomena as pulmonary emboli and implementing or adjusting oxygen therapy. The balance among H+, HCO3- and CO2 is represented by the equation H+ + HCO3- in equilibrium CO2 + H2O. Primary alterations of either component of the left-hand side of the equation result in metabolic acid-base balance disturbances; primary alterations of CO2 result in respiratory acid-base balance disturbances.

Acid-Base Imbalance↗
PubMed1998

A fatal case of acute ferric chloride poisoning.

Death from ferric chloride poisoning has never been reported in Taiwan. We report a fatality from the suicidal ingestion of ferric chloride solution used as an etching agent for printed circuitry. A 25-y-old woman presented with vomiting after ingestion of 200 ml ferric chloride solution (pH 1.0). She had hypoxemia and severe metabolic acidosis with respiratory alkalosis initially. Three hours after her ingestion she presented with drowsy consciousness, tachycardia, tachypnea and protracted vomiting. Laboratory studies showed leukocytosis, elevated glucose, aspartate aminotransferase, amylase, lactate dehydrogenase, and total bilirubin, coagulation defect and hemolysis. Aspiration pneumonia and vision loss were also noted. Four hours after ingestion cardiopulmonary arrest suddenly occurred after severe vomiting and she expired. Toxicological studies showed marked elevation of serum iron (2440 micrograms/dl); the estimated oral dose of ferric chloride was equivalent to 11.52 g (230 mg/kg) of elemental iron. This patient did not receive deferoxamine due to rapid deterioration and a late diagnosis. Deferoxamine should be given in any symptomatic patient or in the presence of anion gap metabolic acidosis with a history of ferric chloride ingestion.

Acidosis↗
PubMed1976

Ketamine for anaesthetic induction at Caesarean section.

Fifty healthy mothers, with normal placental function, were anaesthetised with ketamine (2 mg/kg body mass) for Caesarean section. Surgery was conducted with the patient in the lateral tilt position and anaesthesia was maintained with nitrous oxide, oxygen, muscle relaxants and controlled ventilation. Eight of the 50 infants delivered were clinically depressed, judged on the basis of the modified Apgar score at 2 minutes after delivery. The average time to sustained respiration was 58, 1 minutes. Studies of maternal blood gases before induction and at delivery revealed mild respiratory alkalosis, associated with an appropriate degree of compensatory metabolic acidosis. Umbilical cord blood gas analysis showed the presence of a fetal respiratory acidosis. The average derived fetal base excess levels were similar to those obtained in a previous study with thiopentone anaesthesia, but calculated mean maternal-to-fetal pH and base excess gradients were slightly greater in the present study. Prolonged induction-to-delivery intervals were associated with an increase in maternal metabolic and fetal respiratory acidosis. Slow delivery of the infant after invasion of the uterus magnified the degree of fetal metabolic acidosis, and widened the maternal-to-fetal acid-base gradients. Convincing evidence of maternal awareness during surgery was not obtained in this study. Five patients had hallucinations in the immediate postanaesthetic period. Unpleasant dreams were reported by 10% of patients. Delirium on emergence from anesthesia was not encountered. In this study, ketamine appeared to maintain fetoplacental exchange adequately, but may have been responsible for some degree of drug-induced neonatal depression. It is suggested that ketamine should be re-evaluated, using a lower dosage schedule, for Caesarean section.

Acid-Base Equilibrium↗
PubMed1977

Chronic oxygen therapy.

Chronic low flow oxygen is useful therapy for patients with chronic obstructive lung disease who are crippled by hypoxemia despite optimal programs of usual respiratory care. Patients should be considered for chronic oxygen therapy who have (a) a resting Pao2 less than 55 mm Hg while breathing room air; or (b) profound tissue hypoxemia measured by mixed venous Pao2 and suggested by symptoms such as cor pulmonale and congestive heart failure; or (c) pulmonary hypertension or polycythemia even though daytime Pao2 is greater than 55 mm Hg. Arterial blood must be obtained to demonstrate hypoxemia and assess the benefits of oxygen therapy. Patients on chronic oxygen must remain under close medical supervision. There are no absolute contraindications to chronic oxygen therapy, other than refusal of the patient to quit smoking. Complications of therapy appear to be negligible. The exciting suggestion of improved prognosis in patients with chronic obstructive lung disease on oxygen therapy and the possibility of delaying the long-term sequelae of chronic respiratory failure bear careful watching in the future.

Acidosis, Respiratory↗
PubMed1991

[Adaptation disorders in newborn animals: pathogenesis and therapy. Review article].

The sympathoadrenal system of the neonate is stimulated during parturition and immediately after birth. Endogenous opioid peptides can be regarded as partial catecholamine antagonists. They have an inhibitory action on the respiratory center but may also lead to a redistribution of cerebral blood flow in favour of certain essential brain areas. The acidosis seen in connection with neonatal asphyxia stimulates a further release of catecholamines as well as opioid peptides. The therapeutic approach should lead to a rapid normalisation of respiration.

Acid-Base Equilibrium↗