ACCIDENTAL SEVERE HYPERCAPNIA DURING ANAESTHESIA: A Case Report and Review of some Physiological Effects

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ACCIDENTAL SEVERE HYPERCAPNIA DURING ANAESTHESIA: A Case Report and Review of some Physiological Effects

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Reliability of point-of-care testing for glucose measurement in critically ill adults*
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Glycemic control is increasingly being recognized as a priority in the treatment of critically ill patients. Titration and monitoring of insulin infusions involve frequent blood glucose measurement to achieve target glucose ranges and prevent adverse events related to hypoglycemia. Therefore, it is imperative that bedside glucose testing methods be safe and accurate. To determine the accuracy and clinical impact of three common methods of bedside point-of-care testing for glucose measurements in critically ill patients receiving insulin infusions. Prospective observational study. A 21-bed mixed medical/surgical intensive care unit of a tertiary care teaching hospital. Thirty consecutive critically ill patients who were vasopressor-dependent (n = 10), had significant peripheral edema (n = 10), or were admitted following major surgery (n = 10). Findings from three different methods of glucose measurement were compared with central laboratory measurements: (1) glucose meter analysis of capillary blood (fingerstick); (2) glucose meter analysis of arterial blood; and (3) blood gas/chemistry analysis of arterial blood. Patients were enrolled for a maximum of 3 days and had a maximum of nine sets of measurements determined during this time. Clinical agreement with the central laboratory was significantly better with arterial blood analysis (69.9% and 76.5% for glucose meter and blood gas/chemistry analysis, respectively) than with capillary blood analysis (56.8%; p = .039 and .001, respectively). During hypoglycemia, clinical agreement was only 26.3% with capillary blood analysis and 55.6% and 64.9% for glucose meter and blood gas/chemistry analysis of arterial blood (p = .010 and <.001, respectively). Glucose meter analysis of both arterial and capillary blood tended to provide higher glucose values, whereas blood gas/chemistry analysis of arterial blood tended to yield lower glucose values. The magnitude of the differences in the glucose values offered by the four different methods of glucose measurement led to frequent clinical disagreements regarding insulin dose titration in the context of an insulin infusion protocol for aggressive glucose control.

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Transport and Permeation Properties of a Ternary Gas Mixture in a Medium-Size Polysulfone Hollow Fiber Permeator
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Permeation properties were analyzed for a mixture of CO2, O2, and N2 in a medium-size polysulfone hollow fiber permeator with a net permeation area of 4.22 m2. Measurements were conducted as a function of feed composition, reject flow rate, and feed pressure. Results included variations in species permeability, separation factor, permeate enrichment, reject depletion, and stage cut as a function of system parameters. Variations in permeation properties show strong dependence on feed composition, reject flow rate, and feed pressure. Permeability of carbon dioxide was higher at larger feed pressures and higher carbon dioxide content in the feed stream. Effect of increasing the reject flow rates on the permeability of carbon dioxide was affected by the system pressure and the carbon dioxide content in the feed stream. At low pressures, increase of the reject flow rate resulted in a decrease of carbon dioxide permeability. The opposite behavior was obtained at higher feed pressures. Increase of the reject flow rate reduced the gas residence time within the permeator. Increase of reject flow rate reduced species residence within the permeator and in turn increased resistance to species transport within the permeator. However, higher system pressures and carbon dioxide content in the feed stream resulted in larger levels of membrane plasticization, which increased the permeation rates of all species. The combined efféct of reducing the species residence time within the permeator and the level of membrane plasticization favored the permeation of carbon dioxide versus the other two species. Variations in other permeation properties, which include oxygen and nitrogen permeabilities, stage cut, permeate enrichment in carbon dioxide, and reject depletion in carbon dioxide, were also explained in terms of resistances encountered within the permeator and the membrane.

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Stunning methods for poultry
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Electrical waterbath stunning is the most common method used to stun poultry under commercial conditions. The voltage supplied to a multiple bird waterbath stunner must be adequate to deliver the required minimum current to each bird. High frequency (> 300 Hz) electrical waterbath stunning needs further investigation to determine its efficiency. It should always be followed by a prompt neck cutting procedure where all the major blood vessels in the neck are severed. Irrespective of the waveform or frequency of the currents employed, constant current stunners should be installed under commercial conditions to ensure that the minimum currents are delivered to individual birds in waterbath stunners. Head only electrical stunning of poultry is being investigated in detail and there is scope for commercial development. Important features include (a) a constant current capable of delivering a preset current, (b) a bird restraining conveyor and head presentation devices enabling the stunning tongs to be accurately placed, (c) more effective electrical stunning tongs in terms of delivering necessary currents while using low voltages, and (d) induction of cardiac arrest immediately after stunning to eliminate wing flapping. Stunning/killing of poultry still in their transport containers using gas mixtures would appear to be the best future option as far as bird welfare is concerned. However, birds can also be stunned/killed on a conveyor using gas mixtures, thereby eliminating the stress associated with the shackling of live birds before electrical stunning. Under the conveyor system birds should be presented to the gas mixtures in a single layer. Within gas mixtures a minimum of 90% argon in air would appear to be the first choice. A mixture of 30% carbon dioxide and 60% argon in air is better than using a high concentration of carbon dioxide in air, and is therefore considered to be the second choice. A two stage system that involves firstly stunning broilers with a low concentration of carbon dioxide and then killing them with a high concentration of carbon dioxide can be used by those who wish to use this gas for economic reasons. The two stages should be distinctly separated so that the birds are stunned well before exposure to a high concentration of carbon dioxide in air. In comparison with carbon dioxide alone, a mixture of 30% oxygen and 40% carbon dioxide in air prolongs the induction of anaesthesia and the exposure time required to kill the birds. The addition of oxygen to carbon dioxide may therefore not have any benefit to bird welfare or the processors. Mechanical stunning of poultry using penetrating captive bolts or non-penetrating mushroom headed bolts has been developed. However, stunning with these devices results in very severe wing flapping and further research is necessary to find ways of alleviating this problem.

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1. Crayfishes sense the increase in carbon dioxide and acetic and hydrochloric acids in a gradient.2. Both propinquus and virilis are intoxicated by carbon dioxide; virilis is also intoxicated by acetic acid but to a lesser degree.3. The four species are susceptible to high concentrations of carbon dioxide and when subjected to high concentrations die in the following order, virilis, propinquus, diogenes and immunis.4. Propinquus reacts negatively to the higher concentrations of carbon dioxide in a gradient, but when the total amount of acid present is large, the negative reaction may be interfered with by the direct detrimental effect of the acid.5. Virilis reacts less definitely to the higher concentrations of carbon dioxide in a gradient than does propinquus. This is true whether the total concentration of the acid is large or small.6. Both diogenes and immunis react more or less irregular to carbon dioxide due possibly to the lesser sensitiveness of these two species to this acid.7. Both propinquus and virilis react negatively to the higher concentrations of acetic acid in gradients of this acid; propinquus reacts definitely in the presence of both high and low total concentrations; virilis reacts definitely to low total concentrations, but not so definitely to high total concentrations; diogenes reacts irregular and less intense than the first two species while immunis reacts more definitely but with low intensity.8. All four species react more strongly to hydrochloric acid than acetic acid and more strongly to acetic acid than carbon dioxide.9. The intensity of avoiding reactions of all species to all acids tested as is shown by turnings only are in the following order; propinquus, virilis, immunis and diogenes.10. The intensity of avoiding reactions of all four species varies directly as the total concentrations of the acids, and probably directly as the hydrogen ion concentration.11. Rapid modification of behavior is shown by all four species. This modification may be due to the increased sensitiveness on the part of the animals, the increased sensitiveness being the result of higher ion concentration in the animal's blood.12. The specific reactions of the crayfishes in gradients of carbon dioxide may be correlated with their habitats.

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Carbon dioxide is widely used for a variety of purposes. As it is a normal constituent of air, the public generally regards it as safe. Although low concentrations of carbon dioxide are not harmful to human beings, high concentrations are toxic, and can cause serious harm, including cardiac arrest. Only a limited number of cases of carbon dioxide intoxication have been reported in Korea, and they have all been mild, with no cases of cardiac arrest following acute exposure to high concentrations of carbon dioxide, reported previously. We describe a case of carbon dioxide poisoning following an explosion of a carbon dioxide tank, which led to cardiac arrest in a 66-year-old patient. This cardiac arrest could have been avoided if the patient was fully aware of the hazardous effects and serious consequences of exposure to high concentrations of carbon dioxide.

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