Kesavan Kutty

Cardiopulmonary Resuscitation in Elderly Patients Hospitalized In The 1990s: A Favorable Outcome

Objective: To compare the clinical characteristics and survival of elderly and younger hospitalized patients who sustain cardiac arrest and receive cardiopulmonary resuscitation (CPR) in the 1990s and to assess predictors of survival.

Sleep and chronic obstructive pulmonary disease.

Purpose of review Sleep disorders are pervasive in patients with chronic obstructive pulmonary disease (COPD). The patient with COPD is especially vulnerable to sleep-induced gas exchange aberrations. Most sleep disturbances affect the quality of life and some potentially affect survival in these patients. These issues impact treatment of these patients. Recent findings Insomnia is very common in COPD but might respond to inhaled anticholinergic agents. The use of hypnotics in the hypercapnic patient with severe COPD might be dangerous. The incidence of sleep apnea in COPD patients is allegedly very high, but recent studies suggest this association to be artifactual. Nocturnal oxygen desaturation, which is common in these patients, occurs even in mild COPD. This clinical complication might reflect sleep-disordered breathing or REM sleep-related hypoventilation. We need cost-effective and reliable methods to help distinguish between these causes without routinely resorting to formal polysomnography. Summary Development of sound clinical algorithms to address this clinical dilemma is indeed a focus for future research. Some of these patients might require continuous positive pressure therapy, whereas others might need long-term oxygen therapy. Although oxygen therapy in COPD patients with only mild hypoxemia and nocturnal desaturation has not uniformly been shown to be beneficial, it is perhaps too soon to abandon this important clinical intervention in these patients.

Pulmonary embolism. How to 'nail down' the diagnosis.

Pulmonary embolism is a common problem in hospitalized patients. Because its initial symptoms may be nonspecific, pulmonary embolism may be difficult to diagnose. A high index of suspicion, together with careful selection of diagnostic tests, is essential. An algorithm for clinical assessment of suspected pulmonary embolism is presented here.

Chronic obstructive pulmonary disease. Reversing airflow obstruction from chronic bronchitis and emphysema.

Chronic obstructive pulmonary disease (COPD) describes a group of disorders that cause obstruction to expiratory airflow. COPD should be suspected in a patient who has cough, sputum production, wheezing, and/or inappropriate dyspnea on exertion in the setting of prolonged exposure to cigarette smoke. With smoking cessation, avoidance of occupational and other bronchial irritants, and use of bronchodilators, antibiotics, and long-term oxygen when appropriate, the patient can minimize limitations on activity and complications.