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Biomedical subjects

R B McGrath

Publications and source records attributed to R B McGrath.

16 recordsLinked to original sources
PubMed1990

Problem solving.

Students and physicians sometimes struggle with the bedside decision-making process. The following text details a problem-solving algorithm that has evolved and has been tailored to and by clinical practice.

Adult↗
PubMed1989

Decision to withhold or withdraw support.

This decision-making process is inherently uncomfortable. The recognition and open discussions of the issues are relatively new. There is legal and practice precedent for withholding and withdrawing therapies and support. Institutions must now abide by Joint Commission guidelines while individual physicians are permitted to practice within their own conscience. Patients' best interests must be served, but it should be accepted that permitting the dying process to evolve while attending to comfort is not only an acceptable but desirable strategy. Finally, physicians must play an active and pivotal role as the facilitators of proper care. The details of proper medical care should be physician prescribed.

Decision Making↗
PubMed1987

In-house cardiopulmonary resuscitation--after a quarter of a century.

Several variables could have influenced the results of resuscitation after two and one-half decades--selection of resuscitation candidates, resuscitation mechanics, pharmacologic interventions, and post-resuscitation management. However, the outcome of CPR remains consistently poor. It appears that only dramatic changes in candidacy or technique will change the likelihood of survival following in-house CPR.

Electric Countershock↗
PubMed1986

Inadvertent gastric balloon inflation within the chest in the management of esophageal varices.

Balloon tamponade of esophageal variceal hemorrhage is palliative therapy which is associated with a certain incidence of morbidity, perhaps mortality. Three cases of intrathoracic inflation of the gastric balloon of such tubes are described. The precise mechanism of thoracic placement remains uncertain. Fluoroscopy or chest x-ray should be used to confirm appropriate tube tip placement.

Esophageal Perforation↗
PubMed1984

Secondary myocardial injuries.

This study identifies a subgroup of critically ill patients most likely to develop at least creatine kinase-myocardial isoenzyme (CK-MB) evidence of acute myocardial injury. This group is composed of patients with shock syndromes associated with some combination of anemia, hypoxemia, hypercarbia, acidemia, lactic acidosis, and hypotension. The mechanism of this secondary myocardial injury in shock is not clear but may be multifactorial. Certainly subgroups of patients admitted with critical illnesses may have CK-MB abnormalities usually associated with acute myocardial injury.

Adult↗
PubMed1983

Gastroesophageal lacerations. A fatal complication of closed chest cardiopulmonary resuscitation.

A case of fatal gastrointestinal hemorrhage from gastric mucosal lacerations related to the closed chest cardiac compression of cardiopulmonary resuscitation is reported. Previous autopsy series suggest that gastroesophageal lacerations may occur in 12 percent of cases not surviving cardiopulmonary resuscitation (CPR). In the presence of increasing out-of-hospital and lay-initiated resuscitation, recognition of this complication of closed chest compression seems to be of particular importance. Attention to the technique of chest compression and ventilation, including early intubation and gastric decompression, may help to minimize the incidence of gastric mucosal laceration occurring during CPR.

Aged↗
PubMedDate not supplied

Inotropic and vasoactive drugs for management of the critically ill.

I have reviewed the identifiable hemodynamic effects of selected inotropic and vasoactive agents in the context of several clinical patient subsets. Knowledge of relative hemodynamic effects of various agents permits the selection of those that are best in specific clinical circumstances. Combining drugs may only occasionally be advisable to supplement a desired effect or to attenuate an unwanted one.

Cardiotonic Agents↗