R. Adams Cowley

Clinical physiology of late (refractory) gram-negative bacteremic shock.

Abstract Gram-negative bacteremic shock in late stages is characterized by relatively higher cardiac outputs and lower vascular resistance in patients with the poorest prognoses. The cuff arterial pressure is not a reflection of the actual pressure present. Lactacidemia proved to be the consistent abnormality and further served as a suggestive index of the degree of shock and patients prognosis. Hypocapnia and respiratory alkalosis were consistent features, but bore no relationship to hemodynamics and further had no bearing on the patients outcome. All patients had been referred as being in refractory shock on the basis primarily of the status of arterial pressure with respect to vasopressors and “adequate” fluid therapy. Analysis by hemodynamic and metabolic criteria indicated that less than 50 per cent were in true physiologic refractory shock. Alpha adrenergic drugs proved deceptive in patient evaluation and likely contributed to deterioration.

Hyperbaric oxygenation in the treatment of experimental shock

Abstract The effect of OHP was studied in hemorrhagic and bacteremic shock in dogs. Beneficial effects in hemorrhagic shock occurred only early in the less severe stage of shock. In bacteremic shock, direct exposure of the microorganisms to OHP appears to be necessary for growth inhibition and subsequent improvement in survival. Many problems relating to the correction of oxygen deficits and oxygen poisoning, to have an effect on host mechanisms as well as on microorganisms, require continued and expanded investigation.

A test to help diagnosis of rupture in the injured duodenum

INTRODUCTION THE duodenum is uncommonly injured in blunt abdominal trauma. Ten per cent of patients undergoing operation for blunt abdominal trauma have intestinal injuries (Cox, unpublished results). Ten per cent of these intestinal injuries are duodenal (Hawkins and Mullen, 1974). The evaluation of duodenal trauma is most difftcult because of its retroperitoneal position. The diagnosis is missed in as many as 10 -20 per cent of cases, and in those cases the mortality may be as high as 77 per cent (Kelly et al., 1978; King and Provan, 1974). The preoperative evaluation of this injury is often unrewarding. The following cases of duodenal injury are presented to show the difficulty in diagnosis as well as to suggest a method for the intraoperative delineation of the injury.

An inexpensive data acquisition system for a multi-bed intensive care unit

Abstract Automatic data acquisition offers distinct advantages over manual recording of vital sign data on critically ill patients in multi-bed intensive care units. Such automatic acquisition is not available to many hospitals because of the high operating and equipment costs of most computer systems that are used to accomplish this purpose. This paper reports an inexpensive data acquisition system which consists principally of standard commercial components including a Wang Laboratories electronic calculator as the control unit.