RESUMEN
Pneumothorax as a complication of pleural catheter insertion could be very dangerous in patients under mechanical ventilation. In ICU patients, physical examination and supine chest x-ray [CXR] are poorly sensitive in diagnosis of pneumothorax. Moreover, CT scan has also disadvantages, such as radiation, high cost, time consuming and need for patient transfer to radiology suit. In comparison to CXR and CT scan, ultrasonography is an available tool for early and rapid detection of this complication. In this study, we reported a 21-year-old woman, a victim of trauma, undergone pleural catheter insertion for drainage of hemothorax. She developed pneumothorax after the procedure. We discuss the usefulness of ultrasonography after pleural catheter insertion and concluded its adequacy and effectiveness in early diagnosis and also follow-up of pneumothorax
RESUMEN
Objectives: To determine the correlation between the success rates of the cardiopulmonary cerebral resuscitation [CPCR] and the team's leader education and skill level in Shiraz, southern Iran
Method: This cross-sectional study was conducted during a 6-month period from October 2007 to March 2008 in Nemazee hospital of Shiraz. We included all the patients who underwent CPCR due to cardiopulmonary arrest in emergency room of Nemazee hospital during the study period. We recorded the rates of return of spontaneous circulation [ROSC] and discharge rate [DR] of all the patients. The correlation between these two parameters and the team leader's education and skill level was evaluated
Results: Overall we included total number 600 patients among whom there were 349 men [58.1%] and 251 [41.8%] women with mean age of 58.9 +/- 42.6. We found that 270 [45.1%] patients had ROSC, while 330 [54.9%] patients died. Overall 18 [6.6%] patients were discharged from hospital [3% of all participants]. We found that the ROSC was significantly higher in those with specialist leader [anesthesiologist or pediatrician] when compared to those in whom CPCR was conducted by technicians [55.2% vs. 30.7%; p=0.001]
Conclusion: Conducting CPCR by persons with higher medical degrees resulted in higher rate of ROSC but not in more discharge rate. Inspite of the fact that the rate of ROSC following CPCR was closely analogous to that of developed countries, discharge rate was lower. This indicates that in our region, much more attention needs to be paid to post-resuscitation care and organizing training programs and to cover more resuscitation by CPCR team, conducted by the specialists