Studies in clinical shock and hypotension

Cohn, Jay N.; Tristani, Felix E.; Khatri, Ibrahim M.

doi:10.1172/jci106166

Cited by 74 publications

(1 citation statement)

References 38 publications

(26 reference statements)

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“…A total dose of chlorpromazine of 40-50 mg is usually sufficient. A few patients are found to have a low arterial pressure as measured by the Riva-Rocci method whereas intra-arterial pressure measurements show a normal or high value, the low pressure in the extremities being due to a severe peripheral constriction (Cohn and Luria, 1964). As a further guide to the effectiveness of the treatment, skin temperatures are measured on the first toe.…”

Section: Artificial Ventilationmentioning

confidence: 99%

Treatment of Patients With Pulmonary Oedema in an Intensive Therapy Department

Askrog¹,

W²,

Hagelsten³

1967

British Journal of Anaesthesia

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Fifty-three patients with pulmonary oedema were treated in an intensive therapy department. The treatment consisted of decrease in transmural pressure in the pulmonary capillaries by means of vasodilators, chlorpromazine, and in some patients intermittent positive pressure ventilation. The mortality rate of thirteen patients with coronary occlusion in connection with the pulmonary oedema, was 88 per cent Of thirty-six patients with pulmonary oedema in association with progressive heart failure none died in the department but four patients died within the next thirty days after transfer to the ward, giving a total mortality of 11 per cent. Of four patients with pulmonary oedema from other causes three died within 24 hours. The total primary mortality was 20 per cent.

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Section: Artificial Ventilationmentioning

confidence: 99%

Treatment of Patients With Pulmonary Oedema in an Intensive Therapy Department

Askrog¹,

W²,

Hagelsten³

1967

British Journal of Anaesthesia

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Pulmonary Artery Pressure Monitoring In Cardiogenic Shock

Porter¹

1971

Arch Intern Med

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The management of patients with cardiogenic shock associated with acute myocardial infarction is attended by a high mortality. Recently, measurement of left ventricular filling pressure, either directly by left heart catheterization or indirectly by recording of pulmonary artery diastolic pressure, has been performed and advocated as a guide to therapy.1-3 This communication describes a patient in whom long-term continuous monitoring of pulmonary arterial pressure was useful in determining therapy after rupture of the interventricular septum following an acute myocardial infarction. Patient SummaryA 67-year-old-male physician developed signs of acute left ventricular failure and a grade 4/6 apical holosystolic murmur four days after an acute myocardial infarction. Despite the administration of digoxin and furosemide, heart failure progressed over a ten-day period, and he was transferred to the University Hospital. Physical examination revealed a markedly ill, dyspneic white man with cool moist skin. Blood pressure was 90/60 mm Hg; pulse rate, 88 beats per minute; and respiration rate, 36 per minute. There was distention of the neck veins to the angle of the mandible at 30°. Fine crép¬ itant rales were audible over both lungs. A systolic thrill was palpated in the sixth intercostal space 2% cm medial to the an¬ terior axillary line. A rough grade 4/6 holosystolic murmur with radiation to the axilla and a loud ventricular gallop sound were heard. The liver edge was palpable 15 cm below the right costal margin. Presacral and pretibial edema was detected, and the nail beds were cyanotic. Chest x-ray films revealed moderate left ventricular enlargement and pulmo¬ nary venous distention with Kerley lines. Electrocardiogram demonstrated sinus rhythm, a QS pattern in leads V, to V" and small Q waves in leads II, III and a VF. There was ST segment elevation in leads III, a VF and V, to V5. Serum sodium level was 121 mEq/liter; serum potassium level, 6.1 mEq/liter; serum chloride level, 93 mg/100 ml; bicarbonate level, 17 mEq/liter; and blood urea nitrogen (BUN) level, 88 mg/100 ml.On the night following admission the patient became extremely dyspneic with marked increase in pulmonary rales and unobtainable blood pressure. Isoproterenol hydrochloride solution was administered with increase in blood pressure to 80/60 mm Hg. He was transferred to the Myocardial Infarction Research Unit where a right heart catheterization was performed using a No. 7 radiopaque woven Dacron catheter. A small radiolucent polytef (Teflon) tube with outer diameter 1.5 mm was inserted into the brachial artery with the Seldinger technique. A large left to right shunt consistent with ventricular septal defect and a tall "V" wave suggest¬ ing acute mitral insufficiency were found (Table). The catheters were left in the right pulmonary and brachial arteries for monitoring purposes. Over the next ten days, pulmonary and brachial arterial pressure were monitored continuously with transducers attached to the fluidfilled catheters.Small amounts of heparin...

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