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Read e-book online Acute Coronary Care 1987 PDF

By A. A. Jennifer Adgey, John Anderson (auth.), Robert M. Califf M.D., Galen S. Wagner (eds.)

During the 25 years in view that acute coronary care used to be centred into Coronary Care devices there were 3 significant stages: I. prevention of demise because of arrhythmias; II. prevention of demise as a result of myocardial failure; and III. challenge of infarct dimension. within the latter levels, there was infringement upon the time commemorated proposal of a protracted interval of relaxation for the sufferer quite often and the center particularly to reduce myocardial metabolic calls for. through the moment section of coronary care, sufferers with myocardial failure bought competitive measures to extend cardiac paintings through elevate in preload, reduce in afterload, and direct elevate in inotropy. It used to be believed that precise cardiogenic surprise used to be so irreversible that it may be avoided by way of energetic efforts to enhance the cardiac output regardless of the chance of extending the world of ischemic myocardium. besides the fact that, section II produced minimum total relief in mortality. within the preliminary a part of section III, myocardial infarct (MI) dimension obstacle used to be tried by way of lowering myocardial metabolic calls for through both beta adrenergic or calcium channel blocking off brokers. we're at present a number of years into the second one a part of section III of coronary care the place the main technique of proscribing MI dimension is recovery of coronary blood flow.

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In one misdiagnosis case, a fifteen year old girl was seen in an emergency room complaining of severe chest pain. Physical examination showed a fever and a pulse of 100. The patient was seen by a physician trained in internal medicine who did a brief (5 minutes) history and physical exam and ordered an ECG and chest x-ray. The physician made a diagnosis of pleurodynia, prescribed aspirin, and sent the patient home. The patient subsequently died and an autopsy revealed a diffuse myocarditis. In the ensuing malpractice case, the physician was found to have breached his duty of care by misdiagnosing the patient's condition and failing to hospitalize her for observation and monitoring.

CPR is not indicated in certain situations, such as in cases of terminal irreversible illness where death is not unexpected or where prolonged cardiac arrest dictates the futility of resuscitation efforts. It is now a common practice for physicians to write "Do Not Resuscitate" (DNR) or "NO CPR" on orders for terminally ill patients. The risk of legal liability arising from failure to resuscitate is much less when there is a written order in the patient's chart. The written order documents that the decision was made, by whom it was made, and communicates the decision to the staff.

O'Neill LS, Timmis GC, Bourdillon PO, Lai P, Ganghadarhan V, Walton J Jr, Ramos R, Laufer N, Gordon S, Silork A, Pitt B: A prospective randomized clinical trial of intracoronary streptokinase versus coronary angioplasty for acute myocardial infarction. N Engl J Med 314:812-818, 1986. YUSuf S, Collins R, Peto R, Furberg C, Stampfer MJ, Goldhaber SZ, Hennekens CH: Intravenous and intracoronary fibrinolytic therapy in acute myocardial infarction: overview of results on mortality, reinfarction and side-effects from 33 randomized controlled trials.

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