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Acute care surgery

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https://www.readbyqxmd.com/read/28229983/establishment-and-application-of-early-risk-stratification-method-for-acute-abdominal-pain-in-adults
#1
Yu Wang, Hong Zhao, Zhen Zhou, Ci Tian, Hong-Li Xiao, Bao-En Wang
BACKGROUND: Acute abdominal pain is a common symptom of emergency patients. The severity was always evaluated based on physicians' clinical experience. The aim of this study was to establish an early risk stratification method (ERSM) for addressing adults with acute abdominal pain, which would guide physicians to take appropriate and timely measures following the established health-care policies. METHODS: In Cohort 1, the records of 490 patients with acute abdominal pain that developed within the past 72 h were enrolled in this study...
2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28228448/patient-experience-with-discharge-instructions-in-postdischarge-recovery-a-qualitative-study
#2
Molly J Horstman, Whitney L Mills, Levi I Herman, Cecilia Cai, George Shelton, Tareq Qdaisat, David H Berger, Aanand D Naik
OBJECTIVES: We examined the role of discharge instructions in postoperative recovery for patients undergoing colorectal surgery and report themes related to patient perceptions of discharge instructions and postdischarge experience. DESIGN: Semistructured interviews were conducted as part of a formative evaluation of a Project Re-Engineered Discharge intervention adapted for surgical patients. SETTING: Michael E. DeBakey VA Medical Center, a tertiary referral centre in Houston, Texas...
February 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/28225527/neuro-trauma-or-med-surg-intensive-care-unit-does-it-matter-where-multiple-injuries-patients-with-traumatic-brain-injury-are-admitted-secondary-analysis-of-the-american-association-for-the-surgery-of-trauma-multi-institutional-trials-committee-decompressive
#3
Sarah Lombardo, Thomas Scalea, Jason Sperry, Raul Coimbra, Gary Vercruysse, Toby Enniss, Gregory J Jurkovich, Raminder Nirula
INTRODUCTION: Patients with nontraumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without traumatic brain injury (TBI) fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. METHODS: This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28224107/risk-factors-for-mortality-in-postoperative-peritonitis-in-critically-ill-patients
#4
Yoann Launey, Benjamin Duteurtre, Raphaëlle Larmet, Nicolas Nesseler, Audrey Tawa, Yannick Mallédant, Philippe Seguin
AIM: To identify the risk factors for mortality in intensive care patients with postoperative peritonitis (POP). METHODS: This was a retrospective analysis using a prospective database that includes all patients hospitalized in a surgical intensive care unit for POP from September 2006 to August 2011. The data collected included demographics, comorbidities, postoperative severity parameters, bacteriological findings, adequacy of antimicrobial therapy and surgical treatments...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28222811/recurring-septic-shock-in-a-patient-with-blunt-abdominal-and-pelvic-trauma-how-mandatory-is-source-control-surgery-a-case-report
#5
Antonella Frattari, Giustino Parruti, Rocco Erasmo, Luigi Guerra, Ennio Polilli, Rosamaria Zocaro, Giuliano Iervese, Paolo Fazii, Tullio Spina
BACKGROUND: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. CASE PRESENTATION: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock...
February 22, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28222690/ngal-expression-during-cardiopulmonary-bypass-does-not-predict-severity-of-postoperative-acute-kidney-injury
#6
Martin G Friedrich, Ioannis Bougioukas, Johanna Kolle, Christian Bireta, Fawad A Jebran, Marius Placzek, Theodor Tirilomis
BACKGROUND: Renal injury is a serious complication after cardiac surgery and therefore, early detection and much more prediction of postoperative kidney injury is desirable. Neutrophil gelatinase-associated lipocalin (NGAL) is a predictive biomarker of acute kidney injury and may increase after cardiopulmonary bypass (CPB). However, time correlation of NGAL expression and severity of renal injury is still unclear. The aim of our study was to investigate CPB-related urine NGAL (uNGAL) secretion in correlation to postoperative renal function...
February 21, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28217064/a-simple-technique-to-achieve-vascular-access-for-continuous-venous-venous-ultrafiltration-in-a-toddler
#7
Joseph Drew Tobias
Acute renal failure is associated with increased mortality in the Pediatric Intensive Care Unit. When anuric or oliguric renal failure occurs, the associated fluid overload may compromise respiratory function and has been shown to be associated with worse outcomes. Renal replacement therapy using continuous venous-venous hemofiltration (CVVH) allows for fluid, solute, and nitrogenous waste removal. However, large bore vascular access with placement of a double-lumen dialysis catheter is necessary to ensure effective flow rates to allow for CVVH...
January 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28216064/internal-fixation-of-acetabular-fractures-in-an-older-population-using-the-timi-approach-midterm-results-of-a-prospective-study
#8
Rene Aigner, Ralf Hellige, Sabine Knippel, Ludwig Oberkircher, Steffen Ruchholtz, Benjamin Buecking
INTRODUCTION: The incidence of geriatric acetabular fractures continues to increase due to demographic changes. In the elderly, anterior column fractures are common, and standard approaches are associated with a considerable risk for surgery-associated complications. Therefore, a minimally invasive approach was developed in our department. The aim of this study was to examine early and mid-term results regarding the use of this novel two-incision minimally invasive (TIMI) approach in patients aged over 55 years with acetabular fractures...
February 3, 2017: Injury
https://www.readbyqxmd.com/read/28214255/clinical-outcomes-and-90-day-costs-following-hemiarthroplasty-or-total-hip-arthroplasty-for-hip-fracture
#9
Christine I Nichols, Joshua G Vose, Ryan M Nunley
BACKGROUND: In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population. METHODS: Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline...
January 24, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#10
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/28208150/acute-and-subacute-presentations-of-cerebral-edema-following-deep-brain-stimulation-lead-implantation
#11
Albert J Fenoy, Sebastian J Villarreal, Mya C Schiess
BACKGROUND/AIMS: Postoperative cerebral edema around a deep brain stimulation (DBS) electrode is an uncommon reported complication. The goal of this study was to identify instances of postoperative edema based on clinical presentation, and to remark on their management. METHODS: A retrospective chart review was performed on all patients who underwent DBS electrode implantation over a 3-year period. Routine CT imaging on postoperative day (POD) 1 was negative. Patients were identified based on clinical neurological changes, leading to imaging and subsequent diagnosis...
February 17, 2017: Stereotactic and Functional Neurosurgery
https://www.readbyqxmd.com/read/28202833/-emergency-decompressive-craniotomy-in-the-emergency-room-was-effective-in-severe-acute-subdural-hematoma-treatment-two-case-reports
#12
Naoto Shiomi, Tadashi Echigo, Hideki Oka, Masahiro Nozawa, Michiko Okada, Shiho Hiraizumi, Fumitaka Kato, Hirokazu Koseki, Yoichi Hashimoto, Akihiko Hino
The outcome of severe acute subdural hematoma is unfavorable. In particular, patients with levels of consciousness of Glasgow Coma Scale(GCS)3 or 4 tend to be refractory to treatment. Decompressive craniotomy should be promptly performed to remove hematoma. However, if an operating room is not immediately available, emergency burr hole surgery is sometimes performed in the emergency room(primary care room)prior to craniotomy. A previous study has reported that the interval from injury to surgery influences the outcome of severe acute subdural hematoma...
February 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/28199053/the-effect-of-tonsillectomy-on-the-morbidity-from-recurrent-tonsillitis
#13
C M Douglas, K Lang, W M Whitmer, J A Wilson, K Mackenzie
BACKGROUND: Tonsillitis is a common condition with an incidence in UK general practice of 37 per 1000 population a year(1) . Recurrent tonsillitis results in significant morbidity and impacts on individuals' quality of life. This study assesses the morbidity and quality of life of adults with recurrent tonsillitis, and the impact of surgical intervention on their health state. OBJECTIVES: 1.To describe disease specific and global quality of life for adults with recurrent tonsillitis six months after tonsillectomy, using two instruments: the Health Impact of Throat Problems (HITP) and EuroQol-visual analogue scale (EQ-VAS) questionnaire...
February 15, 2017: Clinical Otolaryngology
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#14
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/28195969/acute-mesenteric-ischemia-among-postcardiac-surgery-patients-presenting-with-multiple-organ-failure
#15
Alexis Guillaume, Sébastien Pili-Floury, Sidney Chocron, Eric Delabrousse, Bénédicte De Parseval, Stephane Koch, Emmanuel Samain, Gilles Capellier, Gaël Piton
BACKGROUND: Acute mesenteric ischemia (AMI) is a rare but severe complication after cardiac surgery. However, AMI is likely to be more frequent in the subgroup of patients presenting with multiple organ failure after a cardiac surgery. The primary objective of this study was to identify AMI risk factors among patients requiring intensive care unit (ICU) admission after cardiac surgery. METHODS: Retrospective observational study of all the patients requiring admission to two ICUs in a large university hospital after a cardiac surgery procedure...
March 2017: Shock
https://www.readbyqxmd.com/read/28191325/management-of-esophageal-burns-caused-by-caustic-ingestion-a-case-report
#16
Bita Shahbazzadegan, Mehdi Samadzadeh, Iraj Feizi, Yousef Shafaiee
INTRODUCTION: Domestic and industrial swallowing of caustic substances can cause acute and chronic injuries. In the acute phase of care, focus is on the immediate control of tissue damage and perforation, and in the chronic phase, the focus is on the treatment of pharyngeal narrowing and impaired swallowing. CASE PRESENTATION: The patients of this report were an 18-year-old man and a 20-year-old woman, who had esophageal burns after ingesting chemicals, and for solving their nutritional problems, such as difficulty in swallowing, they had underwent surgery...
November 2016: Iranian Red Crescent Medical Journal
https://www.readbyqxmd.com/read/28190602/prevention-of-acute-kidney-injury-in-intensive-care-units
#17
S Mas-Font, J Ros-Martinez, C Pérez-Calvo, P Villa-Díaz, S Aldunate-Calvo, E Moreno-Clari
Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition...
February 9, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28190429/the-scope-of-neurology-of-critical-illness
#18
E F M Wijdicks
Critical illness increases the probability of a neurologic complication. There are many reasons to consult a neurologist in a critically ill patient and most often it is altered alertness with no intuitive plausible explanation. Other common clinical neurologic problems facing the intensive care specialist and consulting neurologist in everyday decisions are coma following prolonged cardiovascular surgery, newly perceived motor asymmetry, seizures or other abnormal movements, and generalized muscle weakness...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187026/an-algorithmic-approach-to-the-suspected-septic-wrist
#19
Jeffrey R Claiborne, Leslie G Branch, Michael Reynolds, Anthony J Defranzo
An acutely painful, erythematous wrist can be due to a variety of pathologic processes, including crystalline arthropathy, infection, trauma, osteoarthritis, and systemic disease. The broad differential diagnosis of the inflamed wrist and nonspecific clinical findings make accurate diagnosis challenging. There is no published clinical or laboratory criterion that reliably differentiates septic wrist arthritis from a sterile inflammatory arthropathy. For septic joint patients, long-term results are notably poorer in patients with a delay in treatment, therefore establishing evidenced-based guidelines deserves attention...
February 10, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28183542/impact-of-ejection-fraction-on-infectious-renal-and-respiratory-morbidity-for-patients-undergoing-noncardiac-surgery
#20
Michael D Maile, William F Armstrong, Elizabeth S Jewell, Milo C Engoren
OBJECTIVE: We sought to determine if decreased left ventricular systolic function was associated with an increased risk of postoperative infectious, respiratory, or renal complications in patients undergoing noncardiac surgery. DESIGN: Retrospective cohort study. SETTING: Single tertiary-care, university-based medical center. PATIENTS: We studied individuals who participated in the American College of Surgeons National Quality Improvement Program and had a preoperative echocardiogram conducted at our institution...
February 2017: Journal of Clinical Anesthesia
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