Acute mitral regurgitation: physiological and pharmacological considerations in the management of a critically ill patient.
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Acute Disease↗
Biomedical subjects
J R Dougall
Publications and source records attributed to J R Dougall.
Moral principles in withdrawing basic life support from patients in the persistent vegetative state.
Patients in a state of persistent vegetation or 'cognitive death' are an emotional drain on their family, and a financial drain on a society with limited resources. In this article, society's responsibility towards these patients and the moral and ethical issues involved in the withdrawal of fluid and nutrition are discussed.
Coma↗
Moral principles in withdrawing advanced life support.
Decisions regarding withdrawal of life support are more frequently required as our technological capabilities increase. Doctors have to recognize that in certain cases maximal use of these capabilities may be incompatible with the patient's best interests. An ethical framework may help guide doctors through these dilemmas.
Aged↗
A comparison of measurements of blood pressure, heart-rate and oxygenation during inter-hospital transport of the critically ill.
Critically ill patients transferred between hospitals are often inadequately monitored in transit, with outcome adversely affected. In 22 such patients, we compared direct and palpated measurements of systolic pressure, oscilloscopic and aneroid manometric measurements of mean pressure, ECG and palpated measurements of heart-rate and clinical and oximetric assessments of oxygenation. On average palpated readings of systolic pressure under-read direct readings by 29% and palpated readings of heart-rate under-read ECG readings by 2%. The mean difference between oscilloscopic and manometric readings of mean pressure was zero. Oxygen saturation readings did not reach a level which allowed valid comparison. If direct measurement of heart-rate and blood pressure by battery-powered monitors is not feasible, palpation of heart-rate and manometric measurement of mean arterial pressure are acceptable alternatives during secondary transport of the critically ill.
Adolescent↗
Development of a probe for the in vivo measurement of airway humidity during anaesthesia.
Airway drying can arise during long-term respiration of anaesthetic dry gases and this may have implications for the function of the airway wall. Monitoring airway humidity can identify drying trends, although previous attempts have been limited for technical reasons. The design and development of a probe to measure mid-tracheal air humidity is described. The device comprises a commercially available capacitive humidity sensor and a thermocouple. The assembled probe is catheter-like with a diameter of 9.5 mm and a length of 312 mm. Water vapour transfer response times of 1.4s (absorption) and 3.6s (desorption) were evaluated for the probe. A preliminary trial to record airway humidity in ambient air and involving six patients was performed during anaesthesia.
Adult↗
Blood pressure measurement during transport. A comparison of direct and oscillotonometric readings in critically ill patients.
This study assessed the accuracy of oscillotonometric blood pressure measurement in critically ill patients during transfer. Direct intra-arterial pressure measurements were taken in 44 transported patients as a 'gold standard' and compared with readings from four portable automatic oscillotonometers--the Dinamap 8100, Lifestat 100, Propaq 102 and Takeda UA711. All under-read systolic pressure (by 13%, 21%, 19% and 13% respectively) and over-read diastolic pressure (by 15%, 5%, 27% and 15% respectively) in comparison to direct pressure measurement. The limits of agreement for 95% of comparisons were broad. The systematic difference between direct and oscillotonometric measurements and the variability between and within patients show that direct oscillotonometric measurements are not interchangeable in these patients. Portable automatic oscillotonometers should not be substituted for direct monitoring in such circumstances.
Blood Pressure↗
Assessment of the critically ill patient.
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Critical Care↗
How to perform tracheal intubation.
Tracheal intubation is a skill that should be considered supplementary to other aspects of airway management which are of vital importance in resuscitation. Doctors involved in resuscitation should develop and retain such skills, and be aware of potential dangers.
Humans↗
Resistance to cardioplegia.
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Coronary Vessels↗