A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, 2020 Tufts University School of Medicine - Maine Track Program
A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon
Journal of Maine Medical Center
Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.
Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.
Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with ...
Benefits Of Palliative Care In The Intensive Care Unit, 2020 Winona State University
Benefits Of Palliative Care In The Intensive Care Unit, Stephen Swenson, Stephen M. Swenson
Nursing Masters Papers
The use of palliative care is often overlooked until the terminal phase of serious illness when life-prolonging interventions are deemed futile and death is considered imminent.
Alongside the well regarded Clinical Practice Guidelines for Quality Palliative Care (National Coalition for Hospice and Palliative Care, 2018), numerous critical care societies including the American Association of Critical-Care Nurses (Medina & Puntillo, 2006), American College of Critical Care Medicine (Davidson et al., 2008), American College of Chest Physicians (Selecky et al., 2005), American College of Surgeons (2017), and the American Thoracic Society (Lanken et al., 2007) have each published individual policies highlighting the importance Palliative Care medicine in the intensive care unit. The most recent joint policy statement from the Choosing Wisely (2014) task force comprised of the aforementioned critical care societies that addresses palliative care recommends regular engagement in conversations regarding comfort alternatives with families and patients at a high risk of death.
Based on the outcomes of a systematic literature review and review of multiple clinical policy guidelines, the recommendation is to consider a piloted evidence-based practice project that explores the timely assessment of critically ill patients with the use of a palliative care bundled approach to screening patients meeting criteria for palliative care services. Providing timely and consistent palliative care services has been found to provide several benefits including improved symptom management, increased quality of life, increased patient and family satisfaction, decreased Intensive Care Unit and hospital length of stay, a decrease in downstream hospital costs, and readmission rates (Braus et al., 2017; Ciemins, Blum, Nunley, Lasher, & Newman, 2007; Kupensky, Hileman, Emerick, & Chance, 2015; Weissman & Meier, 2011)
Meeting The Critical Need For Ventilators In Treatment Of Covid-19 Patients, 2020 Thomas Jefferson University
Meeting The Critical Need For Ventilators In Treatment Of Covid-19 Patients, Alessandro Naopli, Nicholas Satterthwaite, Lawrence Husick, Dietrich Gravenstein, Jerin Juby, Monica Purcell, Bridget Gekas, Zvi Grunwald, Mae West, Bon Ku, Chip Malloy, Michael Mahla, Mijail Serruya
House Staff Quality Improvement and Patient Safety Conference (2020-)
We have designed and built a microprocessor-controlled valve manifold having a single air input supplied from a standard ventilator, three air outlets (one per patient), and a digital control panel for setting the pressure supplied to each patient as well as the desired respiration rate. The manifold features multiple pressure sensors for system monitoring. Each inspiration limb of the manifold will be fitted with a viral filter. Each expiration limb will have a passive HME in line with a viral filter to prevent patient cross-contamination and spread of virions.
Each patient will receive one epoch of inspiration pressure followed by ...
Isolated Polymorphic Ventricular Tachycardia: An Unusual Presentation Of Acute Myocarditis, 2020 Children's Mercy Hospital
Isolated Polymorphic Ventricular Tachycardia: An Unusual Presentation Of Acute Myocarditis, Natalie S. Shwaish
No abstract provided.
Angiopoietin 1 Protects Against Lps-Induced Acute Lung Injury And Alveolar Remodeling In Neonatal Mice, 2020 Childrens Mercy Hospital
Angiopoietin 1 Protects Against Lps-Induced Acute Lung Injury And Alveolar Remodeling In Neonatal Mice, Umar Salimi
No abstract provided.
Educating Providers: Timely Post-Operative Pain Management In A Level Iv Neonatal Intensive Care Unit (Nicu), 2020 Children's Mercy Hospital
Educating Providers: Timely Post-Operative Pain Management In A Level Iv Neonatal Intensive Care Unit (Nicu), Jamesia Donato
No abstract provided.
Evaluating The Association Between Vasopressin Use And In-Hospital Mortality In Patients With Septic Shock, 2020 Baptist Hospital of Miami
Evaluating The Association Between Vasopressin Use And In-Hospital Mortality In Patients With Septic Shock, Michael Pasqualicchio, Heidi Clarke, Jonathan Kline, Payal Patel
Purpose/Background: The Surviving Sepsis Campaign recommends norepinephrine as the first-line vasopressor in patients with septic shock to maintain a mean arterial pressure (MAP) of at least 65 mmHg. The guideline also makes a weak recommendation (2B) to use vasopressin as an adjuvant therapy to raise MAP to goal or to reduce the norepinephrine rate required to maintain the goal MAP. The recommendation is based on conflicting results of the VASST trial that showed no significant difference in 28-day all-cause mortality between patients managed with norepinephrine alone compared to norepinephrine and vasopressin. However, in subgroup analysis, the VASST trial showed ...
Transition From Fixed-Dosing To Symptom-Triggered Management Of Alcohol Withdrawal Syndrome In The Intensive Care Unit Of A Community Hospital, Marianela Robainas, Heidi Clarke, Claudia Chang, Frances Ordieres Gonzalez, Lorenzo Porras Jr.
Background/Purpose: In the United States, 2 to 7% of heavy alcohol users admitted to the hospital for general medical care will develop severe alcohol withdrawal (AW) requiring treatment. The most dangerous complications of AW are delirium tremens and seizures. Benzodiazepines (BZD) are considered first-line therapy, with varying modality options available to providers. Fixed-dosing has historically been used to manage AW. However, studies suggest that symptom-triggered therapy (STT) can decrease length of stay and BZD duration of therapy. The purpose of this study was to evaluate the current fixed-dose protocol and outline the transition to STT in the intensive care ...
Critical Care Ultrasonography And Its Application For Covid-19, 2020 Air Force Medical University, Beijing
Critical Care Ultrasonography And Its Application For Covid-19, Xi Liu, Md, Yang Hai, Md, Bin Ma, Md, Weelic Chong, Md, Ji-Bin Liu, Md
Department of Radiology Faculty Papers
Ultrasound has developed as an invaluable tool in diagnosis and proper management in the intensive care unit (ICU). Application of critical care ultrasonography is quite distinct from the routine comprehensive diagnostic ultrasound exam, because the urgent setting mandates a goal-directed approach. Performing accurate and efficient critical care ultrasound requires ultrasound providers to first understand the pathophysiology of the disease and related imaging findings, and then follow the protocols to perform a focused ultrasound exam. In the ongoing coronavirus disease 2019 (COVID-19) pandemic, ultrasound plays an essential role in diagnosing and monitoring critically ill COVID-19 patients in the ICU. Our review ...
Chinese Expert Consensus On Critical Care Ultrasound Applications At Covid-19 Pandemic, 2020 Hainan Hospital of PLA General Hospital
Chinese Expert Consensus On Critical Care Ultrasound Applications At Covid-19 Pandemic, Faqin Lv, Md, Jinrui Wang, Md, Xing Yu, Md, Aiping Yang, Md, Ji-Bin Liu, Md, Linxue Qian, Md, Huixiong Xu, Md, Ligang Cui, Md, Mingxing Xie, Md, Xi Liu, Md, Chengzhong Peng, Md, Yi Huang, Md, Haiyan Kou, Md, Shengzheng Wu, Md, Xi Yang, Md, Bin Tu, Md, Huaping Jia, Md, Qingyi Meng, Md, Je Liu, Md, Ruizhong Ye, Md
Department of Radiology Faculty Papers
The spread of new coronavirus (SARS-Cov-2) follows a different pattern than previous respiratory viruses, posing a serious public health risk worldwide. World Health Organization (WHO) named the disease as COVID-19 and declared it a pandemic. COVID-19 is characterized by highly contagious nature, rapid transmission, swift clinical course, profound worldwide impact, and high mortality among critically ill patients. Chest X-ray, computerized tomography (CT), and ultrasound are commonly used imaging modalities. Among them, ultrasound, due to its portability and non-invasiveness, can be easily moved to the bedside for examination at any time. In addition, with use of 4G or 5G networks, remote ...
What Did We Learn About Vads In 2019?, 2020 Indiana University
What Did We Learn About Vads In 2019?, Maya Guglin
The VAD Journal
This is our 6th annual literature review on mechanical circulatory support (MCS) devices.
Our previous reports for 2014, 2015, 2016, 2017, 2018 were published as open access articles and were well received by the readers. In this paper, we summarize the most interesting and important, from our standpoint, publications from 2019. As we have done for the past two years, a section on extracorporeal membrane oxygenation (ECMO) is included and primarily addresses new developments in veno-arterial ECMO use.
Covid-19 In Critically Ill Patients In The Seattle Region - Case Series., 2020 Swedish Health Services
Covid-19 In Critically Ill Patients In The Seattle Region - Case Series., Pavan K Bhatraju, Bijan J Ghassemieh, Michelle Nichols, Richard Kim, Keith R Jerome, Arun K Nalla, Alexander L Greninger, Sudhakar Pipavath, Mark M Wurfel, Laura Evans, Patricia A Kritek, T Eoin West, Andrew Luks, Anthony Gerbino, Chris Dale, Jason D Goldman, D Shane O'Mahony, Carmen Mikacenic
Articles, Abstracts, and Reports
BACKGROUND: Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020.
METHODS: We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up.
RESULTS: We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 ...
Turning Passion Into Purpose: A Journey To Medicine Through Global Health, 2020 HCA Healthcare
Turning Passion Into Purpose: A Journey To Medicine Through Global Health, Laurenie Louissaint Md
No abstract provided.
Vaping-Associated Respiratory Distress Syndrome: Case Classification And Clinical Guidance, 2020 University of Massachusetts Medical School
Vaping-Associated Respiratory Distress Syndrome: Case Classification And Clinical Guidance, Craig M. Lilly, Shahzad Khan, Kathryn Waksmundzki-Silva, Richard S. Irwin
University of Massachusetts Medical School Faculty Publications
Exposure to vaping is associated with a growing list of respiratory syndromes including an acute progressive form with life-threatening hypoxemic respiratory failure and pathologic changes of lung injury termed vaping-associated respiratory distress syndrome.
Data Sources: Center from Disease Control, Departments of Public Health, MEDLINE (via PubMed), and the Cochrane Library.
Study Selection Data Extraction and Data Synthesis: Cases, series, and public health reports of cases that met the Centers for Disease Control and Prevention case definition of vaping-associated respiratory disease were extracted by an author with perfect verification by a second. Cases were classified on the basis of toxin exposure ...
Modern Ventilator Management In Surgical/Trauma Patients, 2020 Marshall University
Modern Ventilator Management In Surgical/Trauma Patients, Errington C. Thompson Md, Facs, Fccm
Marshall Journal of Medicine
Physicians have a lot to consider when they place a patient on the ventilator. This article reviews the literature and provides the physician with a clear guide to managing the ventilator in the ICU. This manuscript is meant to be a practical guide to managing the ventilator at the patient's bedside.
Characteristics And Outcomes Of Patients Directly Discharged To Home From The Intensive Care Unit, 2020 Thomas Jefferson University
Characteristics And Outcomes Of Patients Directly Discharged To Home From The Intensive Care Unit, Ann Zheng, Preeyal M. Patel, Michele Fiorella, Lauren Mcdonnell, Mina Yasuoka, Erika J. Yoo, Md
Introduction: Given the current era of decreasing hospital bed availability, there has been a rise in the practice of direct discharge to home (DDH) from ICUs. We evaluated the demographics, clinical characteristics, outcomes and readmission patterns among DDH patients.
Methods: Retrospective review of patients from 2 MICUs from June 2017 to June 2019 at Thomas Jefferson University hospital, an urban tertiary care center. Primary outcome of interest was 30-day hospital readmission. Patients were dichotomized into two groups based on time between ward transfer order and hospital discharge (<24 or ≥24 hours). Risk adjustment performed with Mortality Probability Model (MPM0 -III). ICU workload at admission and discharge was estimated with nine equivalents of nursing manpower use score (NEMS). Patient characteristics compared using t-test and Fisher exact or χ2 test.
Results: 331 DDH patients were analyzed, with the majority (68.3 ...
Nurse Driven Enteral Nutrition Protocol For Mechanically Ventilated Patients, 2020 University of Kentucky
Nurse Driven Enteral Nutrition Protocol For Mechanically Ventilated Patients, Deena Shewekah
Introduction: Delayed enteral nutrition in critically ill patients increases the risk of complications and poor outcomes. Current evidence-based guidelines recommend initiation of enteral nutrition within 24-48 hours of intensive care unit (ICU) admission. The quality improvement (QI) project aim was to examine whether enteral nutrition was initiated within 24- 48 hours of mechanical ventilation after implementation of QI intervention in order to determine practice change.
Methods: The QI protocol was introduced to the Cardiovascular ICU (CVICU) at UK Chandler Hospital (UKHC) nurses via an education session. A post-education electronic survey identified the nurse’s understanding of the protocol. To identify ...
A Reevaluation Of The Importance Of Timing To Antibiotic Administration In Patients With Sepsis And Septic Shock In The Emergency Department, Melissa Yoon
Sepsis is a life threatening organ dysfunction that is caused by the body’s dysregulated response to an infection. A crucial component of treatment includes intravenous antibiotic administration and is recommended within 1 hour of suspected sepsis. However, research conducted over the past two decades have produced mixed results regarding the relationship between mortality rates and this 1 hour time limit. In light of issues such as increasing antibiotic resistance and limited resources in emergency departments, this study reviewed current literature to critically evaluate the effects of modest delays in antibiotic administration in sepsis and septic shock. The studies suggest ...
Corpus Cavernosum Abscess Secondary To Traumatic Perforation Of Urethral Diverticulum, Thomas C. Gore Do, Anna Schepcoff Do, Domenick Sorresso Md
West Florida Division Virtual Research Day
A corpus cavernosum abscess is a rare condition. Usual etiologies include penile injection of erectile dysfunction medications or illicit drugs, priapism, sexually transmitted infections, and trauma; however, there have been reported cases of idiopathic etiology. The most common causative organisms include Staphylococcus aureus, Streptococci, and Bacteroides . Diagnosis is typically made clinically and through imaging (computed tomography [CT] and ultrasound). The first-line treatment is the use of intravenous (IV) antibiotics and surgical drainage. More conservative treatment, however, includes aspiration in conjunction with IV antibiotics [2-3]. Urethral diverticulum (UD) is the formation of a saccular outpouching of the urethral lumen. Symptoms ...
Point-Of-Care Versus Central Testing Of Hemoglobin During Large Volume Blood Transfusion., 2019 Thomas Jefferson University
Point-Of-Care Versus Central Testing Of Hemoglobin During Large Volume Blood Transfusion., Justin Herman, Brian Park, Bharat K. Awsare, Frances Mae West, Denine Crittendon, Lilah Evans, Mary Harach, Julie Karp, Alexis R. Peedin, Marianna Lanoue, Barbara Goldsmith, Eugene P. Warnick, Michael Baram
Division of Pulmonary and Critical Care Medicine Faculty Papers
BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions.
METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within ...