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|000004a0| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 38 |$Unique_|ID{YRB08|
|000004b0| 33 30 30 7d 0d 0a 24 54 | 69 74 6c 65 7b 45 6e 64 |300}..$T|itle{End|
|000004c0| 2d 54 69 64 61 6c 20 43 | 61 72 62 6f 6e 20 44 69 |-Tidal C|arbon Di|
|000004d0| 6f 78 69 64 65 20 43 6f | 6e 63 65 6e 74 72 61 74 |oxide Co|ncentrat|
|000004e0| 69 6f 6e 20 44 75 72 69 | 6e 67 20 43 61 72 64 69 |ion Duri|ng Cardi|
|000004f0| 6f 70 75 6c 6d 6f 6e 61 | 72 79 20 52 65 73 75 73 |opulmona|ry Resus|
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|00000540| 6f 6e 7b 43 68 69 63 61 | 67 6f 20 4d 65 64 20 53 |on{Chica|go Med S|
|00000550| 63 68 6f 6f 6c 2c 20 4e | 6f 72 74 68 20 43 68 69 |chool, N|orth Chi|
|00000560| 63 61 67 6f 2c 20 49 6c | 6c 7d 0d 0a 24 53 75 62 |cago, Il|l}..$Sub|
|00000570| 6a 65 63 74 7b 43 61 72 | 64 69 6f 70 75 6c 6d 6f |ject{Car|diopulmo|
|00000580| 6e 61 72 76 20 72 65 73 | 75 73 63 69 74 61 74 69 |narv res|uscitati|
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|000005a0| 65 20 64 75 72 69 6e 67 | 3b 0d 0a 43 61 72 62 6f |e during|;..Carbo|
|000005b0| 6e 20 64 69 6f 78 69 64 | 65 20 64 75 72 69 6e 67 |n dioxid|e during|
|000005c0| 20 63 61 72 64 69 6f 70 | 75 6c 6d 6f 6e 61 72 79 | cardiop|ulmonary|
|000005d0| 20 72 65 73 75 73 63 69 | 74 61 74 69 6f 6e 7d 0d | resusci|tation}.|
|000005e0| 0a 24 4a 6f 75 72 6e 61 | 6c 7b 4e 20 45 6e 67 6c |.$Journa|l{N Engl|
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|00000600| 7b 33 31 38 7d 0d 0a 24 | 50 61 67 65 7b 36 30 37 |{318}..$|Page{607|
|00000610| 2d 36 31 31 7d 0d 0a 24 | 44 61 74 65 7b 4d 61 72 |-611}..$|Date{Mar|
|00000620| 20 31 30 2c 20 31 39 38 | 38 7d 0d 0a 24 59 42 56 | 10, 198|8}..$YBV|
|00000630| 6f 6c 7b 31 39 38 39 20 | 59 65 61 72 20 42 6f 6f |ol{1989 |Year Boo|
|00000640| 6b 20 6f 66 20 43 72 69 | 74 69 63 61 6c 20 43 61 |k of Cri|tical Ca|
|00000650| 72 65 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 32 2d |re}..$Ch|apter{2-|
|00000660| 31 30 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 44 |10}..$YB|Editor{D|
|00000670| 72 73 2e 20 52 6f 67 65 | 72 73 20 61 6e 64 20 50 |rs. Roge|rs and P|
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|00000690| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|000006a0| 7b 4d 2e 43 2e 20 52 6f | 67 65 72 73 2c 20 4d 2e |{M.C. Ro|gers, M.|
|000006b0| 44 2e 7d 0d 0a 0d 0a 43 | 6f 70 79 72 69 67 68 74 |D.}....C|opyright|
|000006c0| 20 28 63 29 20 59 65 61 | 72 20 42 6f 6f 6b 20 4d | (c) Yea|r Book M|
|000006d0| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|000006e0| 73 2c 20 49 6e 63 2e 2c | 20 31 39 38 39 0d 0a 0d |s, Inc.,| 1989...|
|000006f0| 0a 31 39 38 39 20 59 65 | 61 72 20 42 6f 6f 6b 20 |.1989 Ye|ar Book |
|00000700| 6f 66 20 43 72 69 74 69 | 63 61 6c 20 43 61 72 65 |of Criti|cal Care|
|00000710| 20 4d 65 64 69 63 69 6e | 65 20 28 52 29 0d 0a 0d | Medicin|e (R)...|
|00000720| 0a 43 68 61 70 74 65 72 | 20 32 2d 2d 43 61 72 64 |.Chapter| 2--Card|
|00000730| 69 6f 70 75 6c 6d 6f 6e | 61 72 79 20 52 65 73 75 |iopulmon|ary Resu|
|00000740| 73 63 69 74 61 74 69 6f | 6e 20 28 43 50 52 29 0d |scitatio|n (CPR).|
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|000007a0| 2d 2d 2d 0d 0a 45 6e 64 | 2d 54 69 64 61 6c 20 43 |---..End|-Tidal C|
|000007b0| 61 72 62 6f 6e 20 44 69 | 6f 78 69 64 65 20 43 6f |arbon Di|oxide Co|
|000007c0| 6e 63 65 6e 74 72 61 74 | 69 6f 6e 20 44 75 72 69 |ncentrat|ion Duri|
|000007d0| 6e 67 20 43 61 72 64 69 | 6f 70 75 6c 6d 6f 6e 61 |ng Cardi|opulmona|
|000007e0| 72 79 20 52 65 73 75 73 | 63 69 74 61 74 69 6f 6e |ry Resus|citation|
|000007f0| 0d 0a 0d 0a 52 61 63 6b | 6f 77 20 45 43 2c 20 57 |....Rack|ow EC, W|
|00000800| 65 69 6c 20 4d 48 2c 20 | 46 61 6c 6b 20 4a 4c 0d |eil MH, |Falk JL.|
|00000810| 0a 28 43 68 69 63 61 67 | 6f 20 4d 65 64 20 53 63 |.(Chicag|o Med Sc|
|00000820| 68 6f 6f 6c 2c 20 4e 6f | 72 74 68 20 43 68 69 63 |hool, No|rth Chic|
|00000830| 61 67 6f 2c 20 49 6c 6c | 29 0d 0a 4e 20 45 6e 67 |ago, Ill|)..N Eng|
|00000840| 6c 20 4a 20 4d 65 64 20 | 33 31 38 3a 36 30 37 2d |l J Med |318:607-|
|00000850| 36 31 31 2c 20 4d 61 72 | 20 31 30 2c 20 31 39 38 |611, Mar| 10, 198|
|00000860| 38 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |8..-----|--------|
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|00000880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|000008b0| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|000008c0| 0a 0d 0a 20 20 20 20 20 | 53 74 75 64 69 65 73 20 |...     |Studies |
|000008d0| 6f 66 20 63 61 72 64 69 | 61 63 20 61 72 72 65 73 |of cardi|ac arres|
|000008e0| 74 20 69 6e 20 70 69 67 | 73 20 73 68 6f 77 65 64 |t in pig|s showed|
|000008f0| 20 74 68 61 74 20 63 68 | 61 6e 67 65 73 20 69 6e | that ch|anges in|
|00000900| 20 65 6e 64 2d 74 69 64 | 61 6c 20 63 61 72 62 6f | end-tid|al carbo|
|00000910| 6e 0d 0a 64 69 6f 78 69 | 64 65 20 28 45 54 43 4f |n..dioxi|de (ETCO|
|00000920| 32 29 20 6c 65 76 65 6c | 73 20 77 65 72 65 20 63 |2) level|s were c|
|00000930| 6c 6f 73 65 6c 79 20 72 | 65 6c 61 74 65 64 20 74 |losely r|elated t|
|00000940| 6f 20 63 61 72 64 69 61 | 63 20 6f 75 74 70 75 74 |o cardia|c output|
|00000950| 20 64 75 72 69 6e 67 20 | 62 6f 74 68 0d 0a 63 6c | during |both..cl|
|00000960| 6f 73 65 64 2d 63 68 65 | 73 74 20 70 72 65 63 6f |osed-che|st preco|
|00000970| 72 64 69 61 6c 20 63 6f | 6d 70 72 65 73 73 69 6f |rdial co|mpressio|
|00000980| 6e 20 61 6e 64 20 6f 70 | 65 6e 2d 63 68 65 73 74 |n and op|en-chest|
|00000990| 20 63 61 72 64 69 61 63 | 20 6d 61 73 73 61 67 65 | cardiac| massage|
|000009a0| 2e 20 20 54 6f 20 65 76 | 61 6c 75 61 74 65 0d 0a |.  To ev|aluate..|
|000009b0| 69 74 73 20 75 73 65 66 | 75 6c 6e 65 73 73 20 61 |its usef|ulness a|
|000009c0| 73 20 61 20 6e 6f 6e 69 | 6e 76 61 73 69 76 65 20 |s a noni|nvasive |
|000009d0| 69 6e 64 69 63 61 74 6f | 72 20 6f 66 20 63 69 72 |indicato|r of cir|
|000009e0| 63 75 6c 61 74 6f 72 79 | 20 73 74 61 74 75 73 20 |culatory| status |
|000009f0| 64 75 72 69 6e 67 20 63 | 61 72 64 69 61 63 0d 0a |during c|ardiac..|
|00000a00| 61 72 72 65 73 74 20 61 | 6e 64 20 63 61 72 64 69 |arrest a|nd cardi|
|00000a10| 6f 70 75 6c 6d 6f 6e 61 | 72 79 20 72 65 73 75 73 |opulmona|ry resus|
|00000a20| 63 69 74 61 74 69 6f 6e | 20 28 43 50 52 29 2c 20 |citation| (CPR), |
|00000a30| 45 54 43 4f 32 20 6c 65 | 76 65 6c 73 20 77 65 72 |ETCO2 le|vels wer|
|00000a40| 65 20 6d 65 61 73 75 72 | 65 64 0d 0a 70 72 6f 73 |e measur|ed..pros|
|00000a50| 70 65 63 74 69 76 65 6c | 79 20 64 75 72 69 6e 67 |pectivel|y during|
|00000a60| 20 31 33 20 65 70 69 73 | 6f 64 65 73 20 6f 66 20 | 13 epis|odes of |
|00000a70| 63 61 72 64 69 61 63 20 | 61 72 72 65 73 74 20 69 |cardiac |arrest i|
|00000a80| 6e 20 31 30 20 63 72 69 | 74 69 63 61 6c 6c 79 20 |n 10 cri|tically |
|00000a90| 69 6c 6c 20 70 61 74 69 | 65 6e 74 73 0d 0a 72 65 |ill pati|ents..re|
|00000aa0| 63 65 69 76 69 6e 67 20 | 6d 65 63 68 61 6e 69 63 |ceiving |mechanic|
|00000ab0| 61 6c 20 76 65 6e 74 69 | 6c 61 74 69 6f 6e 2e 20 |al venti|lation. |
|00000ac0| 20 54 68 65 20 43 50 52 | 20 70 72 6f 63 65 64 75 | The CPR| procedu|
|00000ad0| 72 65 73 20 77 65 72 65 | 20 70 65 72 66 6f 72 6d |res were| perform|
|00000ae0| 65 64 20 69 6e 0d 0a 61 | 63 63 6f 72 64 61 6e 63 |ed in..a|ccordanc|
|00000af0| 65 20 77 69 74 68 20 74 | 68 65 20 41 6d 65 72 69 |e with t|he Ameri|
|00000b00| 63 61 6e 20 48 65 61 72 | 74 20 41 73 73 6f 63 69 |can Hear|t Associ|
|00000b10| 61 74 69 6f 6e 20 53 74 | 61 6e 64 61 72 64 73 20 |ation St|andards |
|00000b20| 61 6e 64 20 47 75 69 64 | 65 6c 69 6e 65 73 20 66 |and Guid|elines f|
|00000b30| 6f 72 0d 0a 43 61 72 64 | 69 6f 70 75 6c 6d 6f 6e |or..Card|iopulmon|
|00000b40| 61 72 79 20 52 65 73 75 | 73 63 69 74 61 74 69 6f |ary Resu|scitatio|
|00000b50| 6e 2e 0d 0a 20 20 20 20 | 20 54 68 65 20 45 54 43 |n...    | The ETC|
|00000b60| 4f 32 20 64 65 63 72 65 | 61 73 65 64 20 66 72 6f |O2 decre|ased fro|
|00000b70| 6d 20 61 20 6d 65 61 6e | 20 31 2e 34 25 20 2b 2f |m a mean| 1.4% +/|
|00000b80| 2d 20 30 2e 39 25 20 74 | 6f 20 30 2e 34 25 20 2b |- 0.9% t|o 0.4% +|
|00000b90| 2f 2d 20 30 2e 34 25 20 | 61 66 74 65 72 20 74 68 |/- 0.4% |after th|
|00000ba0| 65 0d 0a 6f 6e 73 65 74 | 20 6f 66 20 63 61 72 64 |e..onset| of card|
|00000bb0| 69 61 63 20 61 72 72 65 | 73 74 2e 20 20 41 66 74 |iac arre|st.  Aft|
|00000bc0| 65 72 20 74 68 65 20 73 | 74 61 72 74 20 6f 66 20 |er the s|tart of |
|00000bd0| 70 72 65 63 6f 72 64 69 | 61 6c 20 63 6f 6d 70 72 |precordi|al compr|
|00000be0| 65 73 73 69 6f 6e 2c 20 | 74 68 65 20 45 54 43 4f |ession, |the ETCO|
|00000bf0| 32 0d 0a 69 6e 63 72 65 | 61 73 65 64 20 74 6f 20 |2..incre|ased to |
|00000c00| 31 2e 30 25 20 2b 2f 2d | 20 30 2e 35 25 2e 20 20 |1.0% +/-| 0.5%.  |
|00000c10| 54 68 65 20 64 65 63 72 | 65 61 73 65 73 20 69 6e |The decr|eases in|
|00000c20| 20 45 54 43 4f 32 20 77 | 65 72 65 20 61 73 73 6f | ETCO2 w|ere asso|
|00000c30| 63 69 61 74 65 64 20 77 | 69 74 68 0d 0a 69 6e 63 |ciated w|ith..inc|
|00000c40| 72 65 61 73 65 73 20 69 | 6e 20 73 79 73 74 65 6d |reases i|n system|
|00000c50| 69 63 20 6f 78 79 67 65 | 6e 20 65 78 74 72 61 63 |ic oxyge|n extrac|
|00000c60| 74 69 6f 6e 2e 20 20 52 | 65 73 74 6f 72 61 74 69 |tion.  R|estorati|
|00000c70| 6f 6e 20 6f 66 20 73 70 | 6f 6e 74 61 6e 65 6f 75 |on of sp|ontaneou|
|00000c80| 73 20 63 69 72 63 75 6c | 61 74 69 6f 6e 0d 0a 6f |s circul|ation..o|
|00000c90| 6e 20 37 20 6f 63 63 61 | 73 69 6f 6e 73 20 77 61 |n 7 occa|sions wa|
|00000ca0| 73 20 68 65 72 61 6c 64 | 65 64 20 62 79 20 61 6e |s herald|ed by an|
|00000cb0| 20 61 6c 6d 6f 73 74 20 | 69 6d 6d 65 64 69 61 74 | almost |immediat|
|00000cc0| 65 20 69 6e 63 72 65 61 | 73 65 20 69 6e 20 45 54 |e increa|se in ET|
|00000cd0| 43 4f 32 2c 20 66 72 6f | 6d 0d 0a 31 2e 33 25 20 |CO2, fro|m..1.3% |
|00000ce0| 2b 2f 2d 20 30 2e 35 25 | 20 74 6f 20 61 6e 20 6f |+/- 0.5%| to an o|
|00000cf0| 76 65 72 73 68 6f 6f 74 | 20 76 61 6c 75 65 20 6f |vershoot| value o|
|00000d00| 66 20 33 2e 37 25 20 2b | 2f 2d 20 32 2e 31 25 20 |f 3.7% +|/- 2.1% |
|00000d10| 77 69 74 68 69 6e 20 33 | 30 20 73 65 63 6f 6e 64 |within 3|0 second|
|00000d20| 73 2e 20 20 57 68 65 72 | 65 61 73 0d 0a 74 68 65 |s.  Wher|eas..the|
|00000d30| 20 45 54 43 4f 32 20 64 | 65 63 6c 69 6e 65 64 20 | ETCO2 d|eclined |
|00000d40| 74 6f 20 61 20 73 74 61 | 62 6c 65 20 76 61 6c 75 |to a sta|ble valu|
|00000d50| 65 20 6f 66 20 32 2e 34 | 25 20 2b 2f 2d 20 31 2e |e of 2.4|% +/- 1.|
|00000d60| 38 25 20 61 74 20 34 20 | 6d 69 6e 75 74 65 73 20 |8% at 4 |minutes |
|00000d70| 61 66 74 65 72 0d 0a 73 | 75 63 63 65 73 73 66 75 |after..s|uccessfu|
|00000d80| 6c 20 43 50 52 2c 20 69 | 74 20 72 65 6d 61 69 6e |l CPR, i|t remain|
|00000d90| 65 64 20 30 2e 37 25 20 | 2b 2f 2d 20 30 2e 34 25 |ed 0.7% |+/- 0.4%|
|00000da0| 20 69 6e 20 70 61 74 69 | 65 6e 74 73 20 69 6e 20 | in pati|ents in |
|00000db0| 77 68 6f 6d 20 43 50 52 | 20 66 61 69 6c 65 64 20 |whom CPR| failed |
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|00001c30| 20 20 54 68 69 73 20 70 | 61 74 74 65 72 6e 20 6f |  This p|attern o|
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|00001d10| 20 4f 6e 65 20 77 6f 6e | 64 65 72 73 20 77 68 65 | One won|ders whe|
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|00001e00| 63 20 62 61 6c 6c 6f 6f | 6e 20 70 75 6d 70 2e 2d |c balloo|n pump.-|
|00001e10| 2d 4d 2e 4d 2e 20 50 61 | 72 6b 65 72 2c 0d 0a 4d |-M.M. Pa|rker,..M|
|00001e20| 2e 44 2e 2c 20 61 6e 64 | 20 4a 2e 45 2e 20 50 61 |.D., and| J.E. Pa|
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|00001e40| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 38 33 30 |nique_ID|{YRB0830|
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|00002000| 65 7b 36 30 35 2d 36 30 | 39 7d 0d 0a 24 44 61 74 |e{605-60|9}..$Dat|
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|00002120| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00002130| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002140| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002150| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002160| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002170| 2d 2d 0d 0a 45 6e 64 6f | 74 6f 78 61 65 6d 69 61 |--..Endo|toxaemia|
|00002180| 3a 20 20 41 6e 20 45 61 | 72 6c 79 20 50 72 65 64 |:  An Ea|rly Pred|
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|000021c0| 44 65 76 65 6e 74 65 72 | 20 53 4a 48 2c 20 42 75 |Deventer| SJH, Bu|
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|00002230| 3a 36 30 35 2d 36 30 39 | 2c 20 4d 61 72 63 68 20 |:605-609|, March |
|00002240| 31 39 2c 20 31 39 38 38 | 0d 0a 2d 2d 2d 2d 2d 2d |19, 1988|..------|
|00002250| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002260| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002270| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002280| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002290| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 41 62 |--------|--....Ab|
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|000025c0| 20 20 54 68 65 20 70 72 | 65 64 69 63 74 61 62 69 |  The pr|edictabi|
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|000036d0| 20 6e 65 63 72 6f 73 69 | 73 20 66 61 63 74 6f 72 | necrosi|s factor|
|000036e0| 20 28 46 69 67 20 34 2d | 32 32 29 2e 20 20 49 62 | (Fig 4-|22).  Ib|
|000036f0| 75 70 72 6f 66 65 6e 20 | 70 72 65 74 72 65 61 74 |uprofen |pretreat|
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|00003740| 20 66 61 63 74 6f 72 2c | 20 62 75 74 20 67 72 65 | factor,| but gre|
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|000037a0| 20 34 2d 32 33 29 2e 0d | 0a 43 6f 6e 63 65 6e 74 | 4-23)..|.Concent|
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|00003820| 20 20 20 20 20 49 6e 20 | 74 68 69 73 20 73 74 75 |     In |this stu|
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|00004160| 2c 20 73 75 63 68 20 61 | 73 20 66 65 76 65 72 2c |, such a|s fever,|
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|000042a0| 68 65 20 68 6f 73 74 20 | 72 65 73 70 6f 6e 73 65 |he host |response|
|000042b0| 20 64 75 72 69 6e 67 20 | 73 65 70 73 69 73 2e 20 | during |sepsis. |
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|00004320| 20 61 6e 74 69 62 6f 64 | 69 65 73 20 32 20 68 6f | antibod|ies 2 ho|
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|00005170| 73 65 2d 74 72 65 61 74 | 65 64 20 70 61 74 69 65 |se-treat|ed patie|
|00005180| 6e 74 73 3b 20 32 20 6f | 66 20 37 39 20 28 32 2e |nts; 2 o|f 79 (2.|
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|000051a0| 65 2d 74 72 65 61 74 65 | 64 20 70 61 74 69 65 6e |e-treate|d patien|
|000051b0| 74 73 0d 0a 64 69 65 64 | 2c 20 77 68 65 72 65 61 |ts..died|, wherea|
|000051c0| 73 20 31 32 20 6f 66 20 | 39 33 20 28 31 32 2e 39 |s 12 of |93 (12.9|
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|000051f0| 20 28 46 69 67 20 35 2d | 31 29 2e 20 20 54 68 65 | (Fig 5-|1).  The|
|00005200| 0d 0a 6d 61 69 6e 20 63 | 61 75 73 65 20 6f 66 20 |..main c|ause of |
|00005210| 64 65 61 74 68 20 77 61 | 73 20 68 65 61 72 74 20 |death wa|s heart |
|00005220| 66 61 69 6c 75 72 65 20 | 28 74 61 62 6c 65 29 2e |failure |(table).|
|00005230| 20 20 52 61 74 65 73 20 | 6f 66 20 72 65 69 6e 66 |  Rates |of reinf|
|00005240| 61 72 63 74 69 6f 6e 20 | 61 6e 64 20 6e 65 65 64 |arction |and need|
|00005250| 0d 0a 66 6f 72 20 61 6e | 67 69 6f 70 6c 61 73 74 |..for an|gioplast|
|00005260| 79 20 6f 72 20 73 75 72 | 67 65 72 79 20 77 65 72 |y or sur|gery wer|
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|00005290| 75 73 20 61 64 76 65 72 | 73 65 20 65 66 66 65 63 |us adver|se effec|
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|000052b0| 72 2c 20 62 75 74 20 68 | 79 70 6f 74 65 6e 73 69 |r, but h|ypotensi|
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|000052e0| 76 69 6e 67 20 73 74 72 | 65 70 74 6f 6b 69 6e 61 |ving str|eptokina|
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|00005300| 74 61 20 69 6e 64 69 63 | 61 74 65 20 74 68 61 74 |ta indic|ate that|
|00005310| 20 73 74 72 65 70 74 6f | 6b 69 6e 61 73 65 20 61 | strepto|kinase a|
|00005320| 64 6d 69 6e 69 73 74 65 | 72 65 64 20 69 6e 20 61 |dministe|red in a|
|00005330| 20 64 6f 73 65 20 6f 66 | 20 31 2e 35 20 6d 69 6c | dose of| 1.5 mil|
|00005340| 6c 69 6f 6e 0d 0a 75 6e | 69 74 73 20 6f 76 65 72 |lion..un|its over|
|00005350| 20 33 30 20 6d 69 6e 75 | 74 65 73 20 77 69 74 68 | 30 minu|tes with|
|00005360| 69 6e 20 34 20 68 6f 75 | 72 73 20 6f 66 20 6f 6e |in 4 hou|rs of on|
|00005370| 73 65 74 20 6f 66 20 70 | 61 69 6e 20 74 6f 20 70 |set of p|ain to p|
|00005380| 61 74 69 65 6e 74 73 20 | 77 69 74 68 20 65 76 6f |atients |with evo|
|00005390| 6c 76 69 6e 67 0d 0a 66 | 69 72 73 74 20 6d 79 6f |lving..f|irst myo|
|000053a0| 63 61 72 64 69 61 6c 20 | 69 6e 66 61 72 63 74 69 |cardial |infarcti|
|000053b0| 6f 6e 20 69 6d 70 72 6f | 76 65 73 20 6c 65 66 74 |on impro|ves left|
|000053c0| 20 76 65 6e 74 72 69 63 | 75 6c 61 72 20 66 75 6e | ventric|ular fun|
|000053d0| 63 74 69 6f 6e 20 61 6e | 64 20 73 68 6f 72 74 2d |ction an|d short-|
|000053e0| 74 65 72 6d 0d 0a 73 75 | 72 76 69 76 61 6c 2e 0d |term..su|rvival..|
|000053f0| 0a 0d 0a 50 6f 73 74 2d | 43 6f 6d 6d 65 6e 74 0d |...Post-|Comment.|
|00005400| 0a 0d 0a 20 20 20 20 20 | 49 6e 76 65 73 74 69 67 |...     |Investig|
|00005410| 61 74 69 6f 6e 73 20 6f | 66 20 74 68 72 6f 6d 62 |ations o|f thromb|
|00005420| 6f 6c 79 74 69 63 20 74 | 68 65 72 61 70 79 20 69 |olytic t|herapy i|
|00005430| 6e 20 61 63 75 74 65 20 | 6d 79 6f 63 61 72 64 69 |n acute |myocardi|
|00005440| 61 6c 20 69 6e 66 61 72 | 63 74 69 6f 6e 20 68 61 |al infar|ction ha|
|00005450| 76 65 0d 0a 70 72 6f 6c | 69 66 65 72 61 74 65 64 |ve..prol|iferated|
|00005460| 20 73 6f 20 72 61 70 69 | 64 6c 79 20 74 68 61 74 | so rapi|dly that|
|00005470| 20 74 68 69 73 20 4e 65 | 77 20 5a 65 61 6c 61 6e | this Ne|w Zealan|
|00005480| 64 20 73 74 75 64 79 2c | 20 70 75 62 6c 69 73 68 |d study,| publish|
|00005490| 65 64 20 69 6e 20 6c 61 | 74 65 20 31 39 38 37 2c |ed in la|te 1987,|
|000054a0| 0d 0a 61 6c 72 65 61 64 | 79 20 73 65 65 6d 73 20 |..alread|y seems |
|000054b0| 6c 69 6b 65 20 61 6e 63 | 69 65 6e 74 20 68 69 73 |like anc|ient his|
|000054c0| 74 6f 72 79 2e 20 20 54 | 68 65 72 65 20 6e 6f 77 |tory.  T|here now|
|000054d0| 20 61 72 65 20 61 74 20 | 6c 65 61 73 74 20 61 20 | are at |least a |
|000054e0| 64 6f 7a 65 6e 20 70 75 | 62 6c 69 73 68 65 64 0d |dozen pu|blished.|
|000054f0| 0a 73 74 75 64 69 65 73 | 20 64 65 6d 6f 6e 73 74 |.studies| demonst|
|00005500| 72 61 74 69 6e 67 20 74 | 68 61 74 20 73 74 72 65 |rating t|hat stre|
|00005510| 70 74 6f 6b 69 6e 61 73 | 65 20 6c 79 73 65 73 20 |ptokinas|e lyses |
|00005520| 69 6e 74 72 61 63 6f 72 | 6f 6e 61 72 79 20 74 68 |intracor|onary th|
|00005530| 72 6f 6d 62 69 2c 20 72 | 65 70 65 72 66 75 73 65 |rombi, r|eperfuse|
|00005540| 73 0d 0a 6a 65 6f 70 61 | 72 64 69 7a 65 64 20 6d |s..jeopa|rdized m|
|00005550| 79 6f 63 61 72 64 69 75 | 6d 2c 20 61 6e 64 20 72 |yocardiu|m, and r|
|00005560| 65 73 75 6c 74 73 2c 20 | 6f 6e 20 61 76 65 72 61 |esults, |on avera|
|00005570| 67 65 2c 20 69 6e 20 69 | 6d 70 72 6f 76 65 64 20 |ge, in i|mproved |
|00005580| 6c 65 66 74 20 76 65 6e | 74 72 69 63 75 6c 61 72 |left ven|tricular|
|00005590| 0d 0a 66 75 6e 63 74 69 | 6f 6e 2e 20 20 46 75 72 |..functi|on.  Fur|
|000055a0| 74 68 65 72 2c 20 74 68 | 65 72 65 20 69 73 20 63 |ther, th|ere is c|
|000055b0| 6f 6e 76 69 6e 63 69 6e | 67 20 65 76 69 64 65 6e |onvincin|g eviden|
|000055c0| 63 65 20 66 72 6f 6d 20 | 74 68 65 20 47 49 53 53 |ce from |the GISS|
|000055d0| 49 20 73 74 75 64 79 20 | 74 68 61 74 0d 0a 73 74 |I study |that..st|
|000055e0| 72 65 70 74 6f 6b 69 6e | 61 73 65 20 69 6d 70 72 |reptokin|ase impr|
|000055f0| 6f 76 65 73 20 62 6f 74 | 68 20 73 68 6f 72 74 2d |oves bot|h short-|
|00005600| 74 65 72 6d 20 61 6e 64 | 20 6c 6f 6e 67 2d 74 65 |term and| long-te|
|00005610| 72 6d 20 73 75 72 76 69 | 76 61 6c 20 28 4c 61 6e |rm survi|val (Lan|
|00005620| 63 65 74 20 32 3a 38 37 | 31 2d 38 37 34 2c 0d 0a |cet 2:87|1-874,..|
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|00005640| 68 65 20 6d 61 6a 6f 72 | 20 75 6e 72 65 73 6f 6c |he major| unresol|
|00005650| 76 65 64 20 71 75 65 73 | 74 69 6f 6e 73 20 6f 66 |ved ques|tions of|
|00005660| 20 70 72 69 6d 61 72 79 | 20 69 6d 70 6f 72 74 61 | primary| importa|
|00005670| 6e 63 65 20 69 6e 20 74 | 68 65 0d 0a 74 68 72 6f |nce in t|he..thro|
|00005680| 6d 62 6f 6c 79 74 69 63 | 20 6d 61 6e 61 67 65 6d |mbolytic| managem|
|00005690| 65 6e 74 20 6f 66 20 61 | 63 75 74 65 20 6d 79 6f |ent of a|cute myo|
|000056a0| 63 61 72 64 69 61 6c 20 | 69 6e 66 61 72 63 74 69 |cardial |infarcti|
|000056b0| 6f 6e 20 69 6e 20 31 39 | 38 39 20 61 72 65 20 74 |on in 19|89 are t|
|000056c0| 68 65 0d 0a 66 6f 6c 6c | 6f 77 69 6e 67 3a 20 20 |he..foll|owing:  |
|000056d0| 28 31 29 20 57 68 61 74 | 20 61 72 65 20 74 68 65 |(1) What| are the|
|000056e0| 20 72 65 6c 61 74 69 76 | 65 20 65 66 66 69 63 61 | relativ|e effica|
|000056f0| 63 79 20 61 6e 64 20 73 | 61 66 65 74 79 20 6f 66 |cy and s|afety of|
|00005700| 20 73 74 72 65 70 74 6f | 6b 69 6e 61 73 65 2c 0d | strepto|kinase,.|
|00005710| 0a 72 65 63 6f 6d 62 69 | 6e 61 6e 74 20 74 69 73 |.recombi|nant tis|
|00005720| 73 75 65 20 70 6c 61 73 | 6d 69 6e 6f 67 65 6e 20 |sue plas|minogen |
|00005730| 61 63 74 69 76 61 74 6f | 72 2c 20 61 6e 64 20 74 |activato|r, and t|
|00005740| 68 65 20 6e 65 77 65 72 | 20 74 68 72 6f 6d 62 6f |he newer| thrombo|
|00005750| 6c 79 74 69 63 20 61 67 | 65 6e 74 73 0d 0a 41 50 |lytic ag|ents..AP|
|00005760| 53 41 43 20 61 6e 64 20 | 70 72 6f 2d 75 72 6f 6b |SAC and |pro-urok|
|00005770| 69 6e 61 73 65 3f 20 20 | 28 32 29 20 57 68 69 63 |inase?  |(2) Whic|
|00005780| 68 20 70 68 61 72 6d 61 | 63 6f 6c 6f 67 69 63 20 |h pharma|cologic |
|00005790| 61 64 6a 75 6e 63 74 73 | 2c 20 69 2e 65 2e 2c 20 |adjuncts|, i.e., |
|000057a0| 61 73 70 69 72 69 6e 2c | 0d 0a 68 65 70 61 72 69 |aspirin,|..hepari|
|000057b0| 6e 2c 20 61 6e 64 20 62 | 65 74 61 2d 62 6c 6f 63 |n, and b|eta-bloc|
|000057c0| 6b 65 72 73 2c 20 73 68 | 6f 75 6c 64 20 62 65 20 |kers, sh|ould be |
|000057d0| 75 73 65 64 20 69 6e 20 | 61 64 64 69 74 69 6f 6e |used in |addition|
|000057e0| 20 74 6f 20 74 68 65 20 | 74 68 72 6f 6d 62 6f 6c | to the |thrombol|
|000057f0| 79 74 69 63 0d 0a 61 67 | 65 6e 74 2c 20 61 6e 64 |ytic..ag|ent, and|
|00005800| 20 66 6f 72 20 68 6f 77 | 20 6c 6f 6e 67 3f 20 20 | for how| long?  |
|00005810| 28 33 29 20 57 68 65 6e | 20 73 68 6f 75 6c 64 20 |(3) When| should |
|00005820| 63 6f 72 6f 6e 61 72 79 | 20 61 72 74 65 72 69 6f |coronary| arterio|
|00005830| 67 72 61 70 68 79 20 61 | 6e 64 0d 0a 70 65 72 63 |graphy a|nd..perc|
|00005840| 75 74 61 6e 65 6f 75 73 | 20 74 72 61 6e 73 6c 75 |utaneous| translu|
|00005850| 6d 69 6e 61 6c 20 63 6f | 72 6f 6e 61 72 79 20 61 |minal co|ronary a|
|00005860| 6e 67 69 6f 70 6c 61 73 | 74 79 20 62 65 20 70 65 |ngioplas|ty be pe|
|00005870| 72 66 6f 72 6d 65 64 2c | 20 61 6e 64 20 66 6f 72 |rformed,| and for|
|00005880| 20 77 68 61 74 0d 0a 69 | 6e 64 69 63 61 74 69 6f | what..i|ndicatio|
|00005890| 6e 73 3f 2d 2d 52 2e 45 | 2e 20 43 75 6e 6e 69 6f |ns?--R.E|. Cunnio|
|000058a0| 6e 2c 20 4d 2e 44 2e 2c | 20 61 6e 64 20 4a 2e 45 |n, M.D.,| and J.E|
|000058b0| 2e 20 50 61 72 72 69 6c | 6c 6f 2c 20 4d 2e 44 2e |. Parril|lo, M.D.|
|000058c0| 0d 0a 24 55 6e 69 71 75 | 65 5f 49 44 7b 59 52 42 |..$Uniqu|e_ID{YRB|
|000058d0| 30 38 33 30 35 7d 0d 0a | 24 54 69 74 6c 65 7b 4d |08305}..|$Title{M|
|000058e0| 79 6f 63 61 72 64 69 61 | 6c 20 49 6e 66 61 72 63 |yocardia|l Infarc|
|000058f0| 74 20 45 78 74 65 6e 73 | 69 6f 6e 3a 20 20 4f 63 |t Extens|ion:  Oc|
|00005900| 63 75 72 72 65 6e 63 65 | 2c 20 4f 75 74 63 6f 6d |currence|, Outcom|
|00005910| 65 2c 20 61 6e 64 20 52 | 69 73 6b 20 46 61 63 74 |e, and R|isk Fact|
|00005920| 6f 72 73 20 69 6e 20 74 | 68 65 20 4d 75 6c 74 69 |ors in t|he Multi|
|00005930| 63 65 6e 74 65 72 20 49 | 6e 76 65 73 74 69 67 61 |center I|nvestiga|
|00005940| 74 69 6f 6e 20 6f 66 20 | 4c 69 6d 69 74 61 74 69 |tion of |Limitati|
|00005950| 6f 6e 20 6f 66 20 49 6e | 66 61 72 63 74 20 53 69 |on of In|farct Si|
|00005960| 7a 65 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 0d 0a 4d |ze}..$Au|thor{..M|
|00005970| 75 6c 6c 65 72 2c 20 4a | 45 0d 0a 52 75 64 65 2c |uller, J|E..Rude,|
|00005980| 20 52 45 0d 0a 42 72 61 | 75 6e 77 61 6c 64 2c 20 | RE..Bra|unwald, |
|00005990| 45 0d 0a 48 61 72 74 77 | 65 6c 6c 2c 20 54 44 0d |E..Hartw|ell, TD.|
|000059a0| 0a 52 6f 62 65 72 74 73 | 2c 20 52 0d 0a 53 6f 62 |.Roberts|, R..Sob|
|000059b0| 65 6c 2c 20 42 45 0d 0a | 52 69 74 74 65 72 2c 20 |el, BE..|Ritter, |
|000059c0| 43 0d 0a 50 61 72 6b 65 | 72 2c 20 43 42 0d 0a 4a |C..Parke|r, CB..J|
|000059d0| 61 66 66 65 2c 20 41 53 | 0d 0a 53 74 6f 6e 65 2c |affe, AS|..Stone,|
|000059e0| 20 50 48 0d 0a 52 61 61 | 62 65 2c 20 44 53 20 4a | PH..Raa|be, DS J|
|000059f0| 72 0d 0a 57 69 6c 6c 65 | 72 73 6f 6e 2c 20 4a 54 |r..Wille|rson, JT|
|00005a00| 0d 0a 52 6f 62 65 72 74 | 73 6f 6e 2c 20 54 0d 0a |..Robert|son, T..|
|00005a10| 4d 49 4c 49 53 20 53 74 | 75 64 79 20 47 72 6f 75 |MILIS St|udy Grou|
|00005a20| 70 7d 0d 0a 24 41 66 66 | 69 6c 69 61 74 69 6f 6e |p}..$Aff|iliation|
|00005a30| 7b 48 61 72 76 61 72 64 | 20 4d 65 64 20 53 63 68 |{Harvard| Med Sch|
|00005a40| 6f 6f 6c 2c 20 42 6f 73 | 74 6f 6e 7d 0d 0a 24 53 |ool, Bos|ton}..$S|
|00005a50| 75 62 6a 65 63 74 7b 4d | 79 6f 63 61 72 64 69 61 |ubject{M|yocardia|
|00005a60| 6c 20 69 6e 66 61 72 63 | 74 69 6f 6e 2c 20 73 69 |l infarc|tion, si|
|00005a70| 7a 65 20 6c 69 6d 69 74 | 61 74 69 6f 6e 20 6f 66 |ze limit|ation of|
|00005a80| 3b 0d 0a 4d 79 6f 63 61 | 72 64 69 61 6c 20 69 6e |;..Myoca|rdial in|
|00005a90| 66 61 72 63 74 69 6f 6e | 2c 20 65 78 74 65 6e 73 |farction|, extens|
|00005aa0| 69 6f 6e 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 41 |ion}..$J|ournal{A|
|00005ab0| 6e 6e 20 49 6e 74 65 72 | 6e 20 4d 65 64 7d 0d 0a |nn Inter|n Med}..|
|00005ac0| 24 56 6f 6c 75 6d 65 7b | 31 30 38 7d 0d 0a 24 50 |$Volume{|108}..$P|
|00005ad0| 61 67 65 7b 31 2d 36 7d | 0d 0a 24 44 61 74 65 7b |age{1-6}|..$Date{|
|00005ae0| 4a 61 6e 75 61 72 79 20 | 31 39 38 38 7d 0d 0a 24 |January |1988}..$|
|00005af0| 59 42 56 6f 6c 7b 31 39 | 38 39 20 59 65 61 72 20 |YBVol{19|89 Year |
|00005b00| 42 6f 6f 6b 20 6f 66 20 | 43 72 69 74 69 63 61 6c |Book of |Critical|
|00005b10| 20 43 61 72 65 7d 0d 0a | 24 43 68 61 70 74 65 72 | Care}..|$Chapter|
|00005b20| 7b 35 2d 33 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |{5-3}..$|YBEditor|
|00005b30| 7b 44 72 73 2e 20 52 6f | 67 65 72 73 20 61 6e 64 |{Drs. Ro|gers and|
|00005b40| 20 50 61 72 72 69 6c 6c | 6f 7d 0d 0a 24 54 61 62 | Parrill|o}..$Tab|
|00005b50| 6c 65 7b 54 61 62 6c 65 | 20 4f 6d 69 74 74 65 64 |le{Table| Omitted|
|00005b60| 7d 0d 0a 24 43 6f 6d 6d | 65 6e 74 61 74 6f 72 7b |}..$Comm|entator{|
|00005b70| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|00005b80| 63 29 20 59 65 61 72 20 | 42 6f 6f 6b 20 4d 65 64 |c) Year |Book Med|
|00005b90| 69 63 61 6c 20 50 75 62 | 6c 69 73 68 65 72 73 2c |ical Pub|lishers,|
|00005ba0| 20 49 6e 63 2e 2c 20 31 | 39 38 39 0d 0a 0d 0a 31 | Inc., 1|989....1|
|00005bb0| 39 38 39 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |989 Year| Book of|
|00005bc0| 20 43 72 69 74 69 63 61 | 6c 20 43 61 72 65 20 4d | Critica|l Care M|
|00005bd0| 65 64 69 63 69 6e 65 20 | 28 52 29 0d 0a 0d 0a 43 |edicine |(R)....C|
|00005be0| 68 61 70 74 65 72 20 35 | 2d 2d 43 61 72 64 69 6f |hapter 5|--Cardio|
|00005bf0| 76 61 73 63 75 6c 61 72 | 0d 0a 0d 0a 2d 2d 2d 2d |vascular|....----|
|00005c00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005c10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005c20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005c30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005c40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 4d 79 |--------|----..My|
|00005c50| 6f 63 61 72 64 69 61 6c | 20 49 6e 66 61 72 63 74 |ocardial| Infarct|
|00005c60| 20 45 78 74 65 6e 73 69 | 6f 6e 3a 20 20 4f 63 63 | Extensi|on:  Occ|
|00005c70| 75 72 72 65 6e 63 65 2c | 20 4f 75 74 63 6f 6d 65 |urrence,| Outcome|
|00005c80| 2c 20 61 6e 64 20 52 69 | 73 6b 20 46 61 63 74 6f |, and Ri|sk Facto|
|00005c90| 72 73 20 69 6e 20 74 68 | 65 0d 0a 4d 75 6c 74 69 |rs in th|e..Multi|
|00005ca0| 63 65 6e 74 65 72 20 49 | 6e 76 65 73 74 69 67 61 |center I|nvestiga|
|00005cb0| 74 69 6f 6e 20 6f 66 20 | 4c 69 6d 69 74 61 74 69 |tion of |Limitati|
|00005cc0| 6f 6e 20 6f 66 20 49 6e | 66 61 72 63 74 20 53 69 |on of In|farct Si|
|00005cd0| 7a 65 0d 0a 0d 0a 4d 75 | 6c 6c 65 72 20 4a 45 2c |ze....Mu|ller JE,|
|00005ce0| 20 52 75 64 65 20 52 45 | 2c 20 42 72 61 75 6e 77 | Rude RE|, Braunw|
|00005cf0| 61 6c 64 20 45 2c 20 48 | 61 72 74 77 65 6c 6c 20 |ald E, H|artwell |
|00005d00| 54 44 2c 20 52 6f 62 65 | 72 74 73 20 52 2c 20 53 |TD, Robe|rts R, S|
|00005d10| 6f 72 62 65 6c 20 42 45 | 2c 20 52 69 74 74 65 72 |orbel BE|, Ritter|
|00005d20| 20 43 2c 0d 0a 50 61 72 | 6b 65 72 20 43 42 2c 20 | C,..Par|ker CB, |
|00005d30| 4a 61 66 66 65 20 41 53 | 2c 20 53 74 6f 6e 65 20 |Jaffe AS|, Stone |
|00005d40| 50 48 2c 20 52 61 61 62 | 65 20 44 53 20 4a 72 2c |PH, Raab|e DS Jr,|
|00005d50| 20 57 69 6c 6c 65 72 73 | 6f 6e 20 4a 54 2c 20 52 | Willers|on JT, R|
|00005d60| 6f 62 65 72 74 73 6f 6e | 20 54 2c 20 4d 49 4c 49 |obertson| T, MILI|
|00005d70| 53 0d 0a 53 74 75 64 79 | 20 47 72 6f 75 70 0d 0a |S..Study| Group..|
|00005d80| 28 48 61 72 76 61 72 64 | 20 4d 65 64 20 53 63 68 |(Harvard| Med Sch|
|00005d90| 6f 6f 6c 2c 20 42 6f 73 | 74 6f 6e 29 0d 0a 41 6e |ool, Bos|ton)..An|
|00005da0| 6e 20 49 6e 74 65 72 6e | 20 4d 65 64 20 31 30 38 |n Intern| Med 108|
|00005db0| 3a 31 2d 36 2c 20 4a 61 | 6e 75 61 72 79 20 31 39 |:1-6, Ja|nuary 19|
|00005dc0| 38 38 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |88..----|--------|
|00005dd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005de0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005df0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e10| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|00005e20| 0d 0a 0d 0a 20 20 20 20 | 20 50 61 74 69 65 6e 74 |....    | Patient|
|00005e30| 73 20 77 68 6f 73 65 20 | 69 6e 69 74 69 61 6c 20 |s whose |initial |
|00005e40| 6d 79 6f 63 61 72 64 69 | 61 6c 20 69 6e 66 61 72 |myocardi|al infar|
|00005e50| 63 74 69 6f 6e 20 69 73 | 20 65 78 74 65 6e 64 65 |ction is| extende|
|00005e60| 64 20 73 6f 6f 6e 20 61 | 66 74 65 72 0d 0a 68 6f |d soon a|fter..ho|
|00005e70| 73 70 69 74 61 6c 69 7a | 61 74 69 6f 6e 20 61 72 |spitaliz|ation ar|
|00005e80| 65 20 6d 6f 72 65 20 6c | 69 6b 65 6c 79 20 74 6f |e more l|ikely to|
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|00005fa0| 20 69 6e 66 61 72 63 74 | 20 65 78 74 65 6e 73 69 | infarct| extensi|
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|00005ff0| 20 63 72 65 61 74 69 6e | 65 20 6b 69 6e 61 73 65 | creatin|e kinase|
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|00006050| 63 72 65 61 74 69 6e 65 | 20 6b 69 6e 61 73 65 20 |creatine| kinase |
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|00006220| 20 20 20 20 20 45 78 74 | 65 6e 73 69 6f 6e 20 77 |     Ext|ension w|
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|000062c0| 63 6f 6e 73 69 64 65 72 | 65 64 20 6d 61 6a 6f 72 |consider|ed major|
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|000063b0| 20 68 6f 73 70 69 74 61 | 6c 69 7a 61 74 69 6f 6e | hospita|lization|
|000063c0| 2e 20 20 41 66 74 65 72 | 20 64 69 73 63 68 61 72 |.  After| dischar|
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|000063e0| 69 74 61 6c 2c 20 74 68 | 6f 73 65 20 77 68 6f 20 |ital, th|ose who |
|000063f0| 73 75 72 76 69 76 65 64 | 0d 0a 65 61 72 6c 79 20 |survived|..early |
+--------+-------------------------+-------------------------+--------+--------+