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https://www.readbyqxmd.com/read/28820557/papillary-muscle-rupture-in-an-adolescent-with-no-coronary-lesions
#1
Tatjana Lejko Zupanc, Mateja Logar
A 21-year-old man with Wolff-Parkinson-White syndrome presented to the authors' hospital with ventricular fibrillation. Coronary angiography failed to demonstrate coronary stenosis, but temporary mechanical circulatory support resolved the ventricular fibrillation and the patient was extubated eight days later. On the next day, however, he had to be re-intubated with symptoms of congestive heart failure. Echocardiography revealed new severe mitral regurgitation and a mobile mass, while emergency surgery revealed a posteromedial papillary muscle rupture (PMR)...
March 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28820175/noninvasive-mechanical-ventilation-in-early-acute-respiratory-distress-syndrome
#2
Alice Grassi, Giuseppe Foti, John G Laffey, Giacomo Bellani
Non invasive ventilation (NIV) has a well established role in the treatment of acute-on-chronic respiratory failure and cardiogenic pulmonary oedema. Its role in acute hypoxaemic respiratory failure has been increasingly investigated, but its impact on the management and the outcome of the subset of patients affected by acute respiratory distress syndrome (ARDS) is still to be determined. ARDS could be a risk factor for NIV failure and in these patient delayed endotracheal intubation can lead to an increased mortality...
August 17, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28820027/atelectasis-after-airway-extubation-during-veno-arterial-extracorporeal-membrane-oxygenation-support
#3
Hong Wang, Ming Jia, Bin Mao, Xiaotong Hou
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is used in cardiopulmonary failure patients to provide temporary assisted circulation. Usually, prolonged intubation and invasive mechanical ventilation are required in patients with ECMO support. We report on two cases of patients who had no pre-existing injuries of the affected lung, underwent VA ECMO support after open-heart surgery and received airway extubation (AE) or awake ECMO with the recovery of left ventricular ejection fraction. Atelectasis happened after AE and non-invasive positive pressure ventilation attenuated the atelectasis of one patient...
September 2017: Perfusion
https://www.readbyqxmd.com/read/28819204/prognostic-factors-and-outcomes-of-unplanned-extubation
#4
Chien-Ming Chao, Mei-I Sung, Kuo-Chen Cheng, Chih-Cheng Lai, Khee-Siang Chan, Ai-Chin Cheng, Shu-Chen Hsing, Chin-Ming Chen
This study investigated the prognostic factors and outcomes of unplanned extubation (UE) in patients in a medical center's 6 intensive care units (ICUs) and calculated their mortality risk. We retrospectively reviewed the medical records of all adult patients in Chi Mei Medical Center who underwent UE between 2009 and 2015. During the study period, there were 305 episodes of UE in 295 ICU patients (men: 199 [67.5%]; mean age: 65.7 years; age range: 18-94 years). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16...
August 17, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28818509/the-use-of-high-flow-nasal-cannula-in-the-pediatric-emergency-department
#5
REVIEW
Katherine N Slain, Steven L Shein, Alexandre T Rotta
OBJECTIVES: To summarize the current literature describing high-flow nasal cannula (HFNC) use in children, the components and mechanisms of action of a HFNC system, the appropriate clinical applications, and its role in the pediatric emergency department (ED). SOURCES: A computer-based search of PubMed/MEDLINE and Google Scholar for literature on HFNC use in children was performed. DATA SUMMARY: HFNC, a non-invasive respiratory support modality, provides heated and fully humidified gas mixtures to patients via a nasal cannula interface...
August 14, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28818188/healthcare-outcomes-in-undocumented-immigrants-undergoing-two-emergency-dialysis-approaches%C3%A2
#6
S Jawad Sher, Ranjani N Moorthi, Waqas Aftab, Sharon M Moe, Christopher S Weaver, Frank C Messina, Nancy M Martinez-Hoover, Melissa D Anderson, Michael T Eadon
BACKGROUND: Current estimates suggest 6,500 undocumented end-stage renal disease (ESRD) patients in the United States are ineligible for scheduled hemodialysis and require emergent dialysis. In order to remain in compliance with Emergency Medicaid, an academic health center altered its emergency dialysis criteria from those emphasizing interdialytic interval to a set emphasizing numerical thresholds. We report the impact of this administrative change on the biochemical parameters, utilization, and adverse outcomes in an undocumented patient cohort...
August 17, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/28818054/comparison-of-the-trapezius-and-the-adductor-pollicis-muscle-as-predictor-of-good-intubating-conditions-a-randomized-controlled-trial
#7
Stefan Soltesz, Christian Stark, Karl G Noé, Michael Anapolski, Thomas Mencke
BACKGROUND: Adequate muscle relaxation is important for ensuring optimal conditions for intubation. Although acceleromyography of the adductor pollicis muscle is commonly used to assess conditions for intubation, we hypothesized that acceleromyography of the trapezius is more indicative of optimal intubating conditions. The primary outcome was the difference between both measurement sites with regard to prediction of good or acceptable intubating conditions. METHODS: Neuromuscular blockade after injection of rocuronium 0...
August 17, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28817480/revised-national-estimates-of-emergency-department-visits-for-sepsis-in-the-united-states
#8
Henry E Wang, Allison R Jones, John P Donnelly
OBJECTIVES: The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN: Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING: U.S. emergency department visits, 2009-2011. PATIENTS: Adult (age, ≥ 18 yr) emergency department sepsis patients...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28816919/enteral-nutrition-practices-in-critically-ill-children-requiring-noninvasive-positive-pressure-ventilation
#9
Matthew K Leroue, Ryan J Good, Heather E Skillman, Angela S Czaja
OBJECTIVES: Evaluate the practice of providing enteral nutrition in critically ill children requiring noninvasive positive pressure ventilation. DESIGN: Retrospective cohort study. SETTING: PICU within a quaternary care children's hospital. PATIENTS: PICU patients older than 30 days requiring noninvasive positive pressure ventilation for greater than or equal to 24 hours from August 2014 to June 2015. Invasive mechanical ventilation prior to noninvasive positive pressure ventilation and inability to receive enteral nutrition at baseline were additional exclusionary criteria...
August 12, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28816881/the-shikani-optical-stylet-as-an-alternative-to-awake-fiberoptic-intubation-in-patients-at-risk-of-secondary-cervical-spine-injury-a-randomized-controlled-trial
#10
Rabab S S Mahrous, Aly M M Ahmed
BACKGROUND: Conventional intubation of the trachea and consequent prone positioning of anesthetized patients with cervical spine instability may result in secondary neurological injury. Historically, flexible fiberoptics used to be the chief choice for patients presenting with cervical spine instability surgery with difficult airway. Recently, the rigid optical stylets have shown promise in assisting difficult intubations. PURPOSE: The aim of the present study was to compare the efficacy of Shikani optical stylet (SOS) with the flexible fiberscope for awake intubation in patients with cervical spine instability...
August 14, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28816565/dacryocystectomy-as-a-treatment-of-chronic-dacryocystitis-in-the-elderly
#11
Mariana N Meireles, Magda Mh Viveiros, Roberta Lfs Meneghin, Alicia Galindo-Ferreiro, Mariângela Ea Marques, Silvana A Schellini
To evaluate the dacryocystectomy (DCT) outcomes for chronic dacryocystitis in an elderly population over 70 years old. A retrospective chart review was performed for patients over 70 years old who were diagnosed with chronic dacryocystitis and underwent DCT at the Botucatu School of Medicine, UNESP, Brazil, from 2007 to July 2014. Data were collected about patient demographics, age, gender, previous nasal, or ophthalmic diseases, symptoms related to the lacrimal drainage system preoperatively and postoperatively, signs of enlargement of the lacrimal sac (regurgitation of secretion), and histopathologic evaluation...
August 17, 2017: Orbit
https://www.readbyqxmd.com/read/28816011/lessons-learnt-from-incidents-involving-the-airway-and-breathing-reported-from-australasian-emergency-departments
#12
Carmel Crock, Kim Hansen, Toby Fogg, Angela Cahill, Anita Deakin, William B Runciman
OBJECTIVE: To review incident reports relating to problems encountered during the ED management of patients with 'airway or breathing' problems, with the aim of finding and highlighting common themes within these rare events, and making recommendations to further improve patient safety in the areas in which deficiencies have been identified. METHODS: Thematic analysis of 36 incidents reported from Australasian EDs, which were related to problems with airway and breathing...
August 16, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28815143/analyzing-electronic-medical-records-to-predict-risk-of-dit-death-intubation-or-transfer-to-icu-in-pediatric-respiratory-failure-or-related-conditions
#13
Teeradache Viangteeravat, Oguz Akbilgic, Robert Lowell Davis
Large volumes of data are generated in hospital settings, including clinical and physiological data generated during the course of patient care. Our goal, as proof of concept, was to identify early clinical factors or traits useful for predicting the outcome, of death, intubation, or transfer to ICU, for children with pediatric respiratory failure. We implemented both supervised and unsupervised methods to extend our understanding on statistical relationships in clinical and physiological data. As a supervised learning method, we use binary logistic regression to predict the risk of developing DIT outcome...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28814580/ventrain-from-theory-to-practice-bridging-until-re-tracheostomy
#14
Bianca Maria Wahlen, Hassan Al-Thani, Ayman El-Menyar
Imminent upper airway obstruction due to life-threatening tracheal stenosis of any cause is challenging. A 77-year-old woman, with a history of temporal tracheostomy for prolonged mechanical ventilation, presented with life-threatening tracheal stenosis to the emergency department. After failed intubation with a 5.0 mm internal diameter endotracheal tube, the patient was ventilated via a tube exchanger using Ventrain. Ventrain is a manual ventilation device that, in addition to oxygen supply during inspiration, initiates expiration by actively removing gas from the lungs by suction...
August 16, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28814478/effect-of-patient-weight-on-first-pass-success-and-neuromuscular-blocking-agent-dosing-for-rapid-sequence-intubation-in-the-emergency-department
#15
Asad E Patanwala, John C Sakles
OBJECTIVES: The primary objective of this study was to determine the association between patient weight and first pass success (FPS) during rapid sequence intubation (RSI) in the ED. The secondary objective was to evaluate the association between patient weight and neuromuscular blocking agent (NMBA) dosing. METHODS: This was a retrospective cohort study conducted in a tertiary care academic ED. Consecutive adult patients who underwent RSI in the ED between January 2014 and June 2016 were included...
August 16, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28814254/bronchiolitis-care-in-the-hospital
#16
Jennifer Orr Vincent, Huay-Ying Lo, Susan Wu
BACKGROUND: Viral bronchiolitis is a common cause of hospitalization in young children, but despite a variety of therapeutic options, the mainstay of treatment remains supportive care. OBJECTIVE: To examine the most recent evidence for supportive care measures and pharmacologic options in the treatment of bronchiolitis in the hospital setting Methods: MEDLINE search with expert medical librarian for publications on management and therapies for bronchiolitis Results: Evidence does not support the use of bronchodilators, racemic epinephrine, deep suctioning, systemic corticosteroids, or antibiotics in the absence of a concomitant bacterial infection, as these treatments do not change the course of illness or shorten length of stay (LOS)...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#17
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28814057/a-study-on-the-cough-augmentation-using-a-belt-driven-assistive
#18
Sang-Yoep Lee, Kyu-Jin Cho
Coughing is one of the most important mechanisms performed in human body in that it removes mucus. The absence of enough ability to remove mucus leads to accumulation of the mucus on the airway, followed by possible complications such as pneumonia and atelectasis. Patients with diseases or disorders such as spinal cord injury have weakened ability in coughing. So far, there have been various treatments such as intubation surgery, mechanical insufflation-exsufflation or manual assistance provided by paramedic...
July 2017: IEEE ... International Conference on Rehabilitation Robotics: [proceedings]
https://www.readbyqxmd.com/read/28813495/establishing-failure-predictors-for-the-planned-extubation-of-overweight-and-obese-patients
#19
Chien-Ming Chao, Chih-Cheng Lai, Ai-Chin Cheng, Shyh-Ren Chiang, Wei-Lun Liu, Chung-Han Ho, Shu-Chen Hsing, Chin-Ming Chen, Kuo-Chen Cheng
We investigated failure predictors for the planned extubation of overweight (body mass index [BMI] = 25.0-29.9) and obese (BMI ≥ 30) patients. All patients admitted to the adult intensive care unit (ICU) of a tertiary hospital in Taiwan were identified. They had all undergone endotracheal intubation for > 48 h and were candidates for extubation. During the study, 595 patients (overweight = 458 [77%]); obese = 137 [23%]) with planned extubation after weaning were included in the analysis; extubation failed in 34 patients (5...
2017: PloS One
https://www.readbyqxmd.com/read/28812156/accredited-residents-perform-colonoscopy-to-the-same-high-standards-as-consultants
#20
Dedrick Kok Hong Chan, Reuben Kong Min Wong, Khay Guan Yeoh, Ker-Kan Tan
BACKGROUND: Endoscopy remains a critical component of General Surgery and Gastroenterology training. Whilst residents need to gain experience, the quality of endoscopy which patients receive cannot be compromised. We conducted this study to compare quality indicators between consultants and residents with regards to colonoscopy. METHODS: A review of colonoscopies from a prospectively collected database was performed from September 2011 to February 2016. Quality indicators such as caecum intubation rate, adenoma detection rate, adherence to a 6-min withdrawal rule, mean number of polyps detected per colonoscope, and complications were collected and compared between the two groups...
August 15, 2017: Surgical Endoscopy
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