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https://www.readbyqxmd.com/read/28230563/implementation-of-an-early-mobility-pathway-in-neurointensive-care-unit-patients-with-external-ventricular-devices
#1
Megan Moyer, Bethany Young, Joseph Borst, William Pino, Marisa Hart, Jesse LoBreglio, Derek Zaleski, Isaira Leonor, David Kung, Michelle Smith, Eric Zager, M Sean Grady, Monisha Kumar
BACKGROUND: Patients with an external ventricular drain (EVD) may not be readily mobilized because of concerns of catheter dislodgment and/or inappropriate cerebrospinal fluid drainage. Delayed mobilization may result in longer hospital stays and an increased risk for complications related to immobility. We aimed to determine the safety, feasibility, and outcome of an EVD mobilization protocol in patients with subarachnoid hemorrhage (SAH). METHODS: A multidisciplinary group developed a formal algorithm for the mobilization of patients with SAH with EVDs...
February 23, 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28226988/analysis-and-experimental-simulation-of-blood-pressure-signal-distortions-observed-on-intensive-care-patients-monitored-by-a-catheter-in-radial-artery
#2
Lisa Guigue, Carole Lavault, Francis Grimbert, Yves Lavault, Norbert Noury, Francois R Boucher, Lisa Guigue, Carole Lavault, Francis Grimbert, Yves Lavault, Norbert Noury, Francois R Boucher, Francois R Boucher, Carole Lavault, Lisa Guigue, Yves Lavault, Francis Grimbert, Norbert Noury
The follow-up of patients with hemodynamic instability in intensive care units most often requires blood pressure measurement using a fluid-filled catheter in the radial artery and a fluid-filled tubing connected to a pressure transducer. However, in this usual setup major distortions frequently occur that may alter the pressure signal. Underdamping and overdamping have been well described whereas other types of distortions, including attenuations and varied envelopes of pulse pressure, have been less studied...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28219329/ultrafiltration-rate-is-an-important-determinant-of-microcirculatory-alterations-during-chronic-renal-replacement-therapy
#3
Gerke Veenstra, Andrius Pranskunas, Inga Skarupskiene, Vidas Pilvinis, Marc H Hemmelder, Can Ince, E Christiaan Boerma
BACKGROUND: Hemodialysis (HD) with ultrafiltration (UF) in chronic renal replacement therapy is associated with hemodynamic instability, morbidity and mortality. Sublingual Sidestream Dark Field (SDF) imaging during HD revealed reductions in microcirculatory blood flow (MFI). This study aims to determine underlying mechanisms. METHODS: The study was performed in the Medical Centre Leeuwarden and the Lithuanian University of Health Sciences. Patients underwent 4-h HD session with linear UF...
February 20, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28214966/anomalous-coronary-arteries-and-myocardial-bridges-risk-stratification-in-children-using-novel-cardiac-catheterization-techniques
#4
Hitesh Agrawal, Silvana Molossi, Mahboob Alam, S Kristen Sexson-Tejtel, Carlos M Mery, E Dean McKenzie, Charles D Fraser, Athar M Qureshi
The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children's Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions...
February 18, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28209449/maxillofacial-and-concomitant-serious-injuries-an-eight-year-single-center-experience
#5
Fausto Fama, Marco Cicciu, Alessandro Sindoni, Enrico Nastro-Siniscalchi, Roberto Falzea, Gabriele Cervino, Francesca Polito, Francesco De Ponte, Maria Gioffre-Florio
PURPOSE: Maxillofacial injuries are frequently associated with multiple trauma and can determine functional and aesthetic bad outcomes. The severity of maxillofacial injuries may be considerable and can divert clinicians' attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department (ED) of the University Hospital of Messina (North-East Sicily, Italy) for maxillofacial traumas...
January 20, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#6
Aaron Weinberg, Victor F Tapson, Danny Ramzy
Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28208199/systemic-thrombolytic-therapy-for-acute-pulmonary-embolism-who-is-a-candidate
#7
Stavros V Konstantinides, Stefano Barco
Pulmonary embolism (PE) is a major cause of both acute and long-term morbidity for a large number of patients worldwide, and massive PE is frequently fatal. Right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of PE. Patients with clinically overt RV failure, that is, with cardiogenic shock or persistent hypotension at presentation (acute high-risk PE), are clearly in need of immediate reperfusion treatment with systemic thrombolysis or, alternatively, surgical or catheter-directed techniques...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28208194/risk-stratification-for-proven-acute-pulmonary-embolism-what-information-is-needed
#8
Deisy Barrios, Roger D Yusen, David Jiménez
Classification of risk drives treatment decisions for patients with acute symptomatic pulmonary embolism (PE). High-risk patients with acute symptomatic PE have hemodynamic instability (i.e., shock or hypotension present), and treatment guidelines suggest systemically administered thrombolytic therapy in this setting. Normotensive PE patients at low risk for early complications (low-risk PE) might benefit from treatment at home or early discharge, while normotensive patients with preserved systemic arterial pressure deemed as having a high risk for PE-related adverse clinical events (intermediate-high-risk PE) might benefit from close observation and consideration of escalation of therapy...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28197295/spontaneous-coronary-artery-dissection-the-phantom-menace
#9
Nikolaos Spinthakis, Nada Abdulkareem, Mohamed Farag, Diana A Gorog
We present a case of a 66-year-old lady with chest pain, without dynamic 12-lead electrocardiographic (ECG) changes and normal serial troponin. Coronary angiography revealed a linear filing defect in the first obtuse marginal branch of the circumflex artery indicating coronary artery dissection, with superadded thrombus. She was managed medically with dual antiplatelet therapy and has responded well. Spontaneous coronary artery dissection (SCAD) is a rare cause of cardiac chest pain, which can be missed without coronary angiography...
December 2016: Cardiology Research
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#10
Pradeep Kumar, M K Renuka, M S Kalaiselvan, A S Arunkumar
CONTEXT: Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU). AIMS: We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU. SETTINGS AND DESIGN: This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28193544/current-approach-to-liver-traumas
#11
Levent Kaptanoglu, Necmi Kurt, Hasan Ediz Sikar
INTRODUCTION: Liver injuries remain major obstacle for successful treatment, due to size and location of the liver. Requirement for surgery should be determined by clinical factors, most notably hemodynamical state. In this present study we tried to declare our approach to liver traumas. We also tried to emphasize the importance of conservative treatment, since surgeries for liver traumas carry high mortality rates. PRESENTATION OF CASE: Patients admitted to the Department of Emergency Surgery at Kartal Research and Education Hospital, due to liver trauma were retrospectively analyzed between 2003 and 2013...
February 11, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28193193/observation-management-of-pulmonary-embolism-and-agreement-with-claims-based-and-clinical-risk-stratification-criteria-in-united-states-patients-a-retrospective-analysis
#12
Elaine Nguyen, Craig I Coleman, W Frank Peacock, Philip S Wells, Erin R Weeda, Veronica Ashton, Concetta Crivera, Peter Wildgoose, Jeff R Schein, Thomas J Bunz, Gregory J Fermann
BACKGROUND: Guidelines suggest observation stays are appropriate for pulmonary embolism (PE) patients at low-risk for early mortality. We sought to assess agreement between United States (US) observation management of PE and claims-based and clinical risk stratification criteria. METHODS: Using US Premier data from 11/2012 to 3/2015, we identified adult observation stay patients with a primary diagnosis of PE, ≥1 PE diagnostic test claim and evidence of PE treatment...
February 13, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28190526/focused-assessment-with-sonography-for-trauma-fast-versus-multidetector-computed-tomography-in-hemodynamically-stable-emergency-patients
#13
R Fornell Pérez
This critically appraised topic (CAT) study aims to evaluate the quality and extent of the scientific evidence that supports the use of focused assessment with sonography for trauma (FAST) versus multidetector computed tomography (MDCT) in hemodynamically stable trauma patients in the emergency room. An efficient search of the literature yielded several recent articles with a high level of evidence. The CAT study concludes that FAST is an acceptable initial imaging test in hemodynamically stable patients, although its performance is limited in certain circumstances...
February 10, 2017: Radiología
https://www.readbyqxmd.com/read/28190445/management-of-neurologic-complications-of-coagulopathies
#14
J D Vanderwerf, M A Kumar
Coagulopathy is common in intensive care units (ICUs). Many physiologic derangements lead to dysfunctional hemostasis; these may be either congenital or acquired. The most devastating outcome of coagulopathy in the critically ill is major bleeding, defined by transfusion requirement, hemodynamic instability, or intracranial hemorrhage. ICU coagulopathy often poses complex management dilemmas, as bleeding risk must be tempered with thrombotic potential. Coagulopathy associated with intracranial hemorrhage bears directly on prognosis and outcome...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28184357/delayed-splenic-rupture-normal-appearing-spleen-on-the-initial-multidetector-computed-tomography-mdct-can-sometimes-be-misleading
#15
Alireza Hamidian Jahromi, Matias Migliaro, Melisa Romano, Guillermo Sangster
INTRODUCTION: Delayed splenic rupture (DSR) is an unusual outcome following blunt abdominal trauma. Although DSR is defined as bleeding more than 48 hours after blunt trauma in a previously hemodynamically stable patient, a review of the reported cases in the literature shows that in almost all of the cases the initial CT imaging revealed some form of damage to the spleen. CASE PRESENTATION: Here we describe an extremely rare condition in a case that presented with a DSR following blunt trauma and had a normal appearing spleen in the initial post trauma MDCT scan...
November 2016: Trauma Monthly
https://www.readbyqxmd.com/read/28183560/anesthesia-and-brugada-syndrome-a-12-year-case-series
#16
Mélanie Duque, Luís Santos, Sandy Ribeiro, Dora Catré
STUDY OBJECTIVE: The aim of this 12-year case series was to review the drugs used during anesthetic management of patients with diagnosis of or risk criteria for Brugada syndrome (BrS), and to document any possible association between these drugs and arrhythmogenic activity or unexplained hemodynamic instability. DESIGN: A retrospective clinical observational study. SETTING: Tertiary hospital. PATIENTS: Thirty-one patients met our inclusion criteria: 20 belonging to group D (diagnosed BrS) and 11 to group R (risk of BrS)...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28181450/management-of-iatrogenic-aortal-dissection-as-a-complication-of-coronary-intervention-wait-and-watch
#17
Rajesh Dandale, Alexander Krapivsky, Feraydoon Niroomand
Iatrogenic aortic dissection (AD) is quite a rare complication during percutaneous coronary intervention (PCI). The exact mechanism of iatrogenic AD during PCI is unknown. A standard of care in the management of iatrogenic AD is still lacking. We describe a case of an 83-year-old man, with an aortocoronary bypass graft, who underwent complex PCI with rotational atherectomy catheterization with a radial approach for a chronic right coronary artery stenosis, complicated by AD. According to our experience, retrograde dissection into the aorta during PCI can be sealed with a coronary stent that covers the coronary ostium and should be treated conservatively in most circumstances, unless complication like extension of dissection into other vessels or pericardial effusion or hemodynamic instability occurs...
February 9, 2017: Future Cardiology
https://www.readbyqxmd.com/read/28181385/hemodynamic-profile-and-behavioral-characteristics-during-induction-of-anesthesia-in-pediatric-patients-with-attention-deficit-hyperactivity-disorder
#18
Richard S Cartabuke, Joseph D Tobias, Julie Rice, Dmitry Tumin
AIM: There is no consensus regarding the administration of stimulant drugs preoperatively, particularly in pediatric patients diagnosed with ADHD. The primary objective of the current study was to assess differences in blood pressure and heart rate before and after induction of anesthesia between patients on chronic amphetamine or methylphenidate therapy who receive their normal dose preoperatively compared to patients in whom the prescribed medication was withheld. Secondary objectives were to assess the anxiety level during the induction of anesthesia and the effect of premedication with midazolam...
February 8, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28181055/endotracheal-bioimpedance-cardiography-improves-immediate-postoperative-outcome-a-case-control-study-in-off-pump-coronary-surgery
#19
Thomas Leclercq, Marc Lilot, Thomas Schulz, Alexandre Meyer, Fadi Farhat, Jean-Luc Fellahi
The feasibility and clinical utility of the endotracheal cardiac output monitor (ECOM) to optimize intraoperative hemodynamics and improve short-term outcome in off-pump coronary artery bypass grafting (OPCAB) is unknown. We aimed to compare ECOM with a standard of care in that specific surgical setting. Twenty consecutive adult ECOM-monitored patients undergoing OPCAB were prospectively included (ECOM group) and retrospectively compared to 42 patients scheduled for similar surgery without ECOM monitoring (Control group)...
February 8, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28180099/the-importance-of-complete-pericardiectomy-and-the-role-of-the-apical-suction-device-in-chronic-constrictive-pericarditis
#20
Sang Yoon Kim, Kwon Joong Na, Kyung-Hwan Kim
BACKGROUND: The aim of this study was to analyze the preoperative attributes and clinical impacts of complete pericardiectomy in chronic constrictive pericarditis. METHODS: A total of 26 patients were treated from January 2001 to December 2013. The pericardium was resected as widely as possible. When excessive bleeding or hemodynamic instability occurred intraoperatively, a cardiopulmonary bypass (CPB; n=3, 11.5%) or an apical suction device (n=8, 30.8%) was used...
February 2017: Korean Journal of Thoracic and Cardiovascular Surgery
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