Sternal retraction and pulmonary artery catheter compromise.

Forty-one consecutive open-chest cardiac procedures requiring sternal retractors for visualization were prospectively studied. Chest x-rays demonstrating the course of the introducer sheaths and pulmonary artery catheters (PACs) were taken before and after sternal retractor expansion. Five different introducer sheath insertion sites were monitored (right internal jugular, left internal jugular, left subclavian, right subclavian, and right supraclavicular).

Coronary artery bypass grafting within 24 hours after intracoronary streptokinase thrombolysis.

Little specific information currently exists describing the management of patients with an evolving acute myocardial infarction (AMI) treated with direct intracoronary infusion of streptokinase (SK) followed by emergency coronary artery bypass grafting (CABG). A total of 194 patients with an evolving AMI underwent emergency coronary artery angiography with infusion of SK. Thirty-four of these patients with partial restoration of orthograde blood flow in the infarct-related coronary artery (as determined by clinical and objective evidence of myocardial salvage) were referred for emergency CABG.

Use of a lighted stylet for guided orotracheal intubation in the prehospital setting.

Management of the airway in acutely injured patients demands special skills of the emergency physician. A technique of light-guided orotracheal intubation has been described in the literature and was performed under protocol by resident physicians in an urban mobile intensive care system. The method utilizes a flexible lighted stylet to provide a guide to correct placement through transillumination of the soft tissues of the neck.