Nitrous Oxide Administration In General Anesthesia Patients, Kaley Smith, Karen Colorafi, Kenn Daratha, Braden Hemingway

Central Division Nurse Clinical Inquiry Conference

Abstract:

Background:

Nitrous oxide is an inexpensive and fast-acting gas used in a variety of inpatient and outpatient perioperative settings to hasten the onset of and emergence from general anesthesia. Problematically, nitrous oxide has been identified as a risk factor for postoperative nausea and vomiting (PONV), one of the most common adverse events after anesthesia. Unresolved PONV is linked to increased pain, wound dehiscence, aspiration, and longer stays in the recovery area and/or hospital. An Apfel Simplified Risk Score can be calculated to predict PONV based on four patient characteristics: female sex, non-smoker, history of PONV or motion sickness, and …

Rates Of Postoperative Pneumonia In Healthy Adults Receiving Neostigmine Versus Sugammadex: A Multi-Center Evidence-Based Practice Project, Kirstie Gorthy, Braden Hemingway, Karen Colorafi, Kenn Daratha

Central Division Nurse Clinical Inquiry Conference

Abstract:

Background

Residual neuromuscular blockade increases morbidity and mortality following surgery with general anesthesia and paralysis. Optimal antagonism of pharmacologic muscle relaxation is critical to avoiding residual weakness and subsequent pneumonia. The clinical question that guided the investigation of the evidence was, ‘Among healthy adults requiring neuromuscular blockade during general anesthesia for elective, noncardiac surgery, does the use of sugammadex compared to neostigmine for reversal of neuromuscular blockade influence the rate of postoperative pneumonia within seven days?’

Purpose

The primary purpose of this evidence-based practice project was to describe the rates of pneumonia among healthy adults antagonized with neostigmine or …

Outcomes Of Patients With Intermediate Risk Pulmonary Embolism Treated With A Multidisciplinary Pulmonary Embolism Response Team. The Emergent Role Of Percutaneous Catheter Thrombectomy And The Importance Of Cardiac Surgery Engagement, Juan N Pulido, Robert Fletcher, Michelle A. Poitevin, Kristina Pratt, Paul P Huang, George P Pappas, Eric J Lehr

Articles, Abstracts, and Reports

Background: Management of Intermediate Risk Pulmonary Embolism (IRPE) remains controversial due to the dynamic nature of the disease and the lack of correlative outcomes with large clot burden. We describe the outcomes of patients presenting with IRPE managed by a multidisciplinary Pulmonary Embolism Response Team (PERT).

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score were used as risk stratification tools. Patients …

Clinical Practice Panel: Stand By Me: Using An Enhanced Recovery After Surgery (Eras)Checklist To Guide Early Mobility Of Postoperative Craniotomy Patients On A Progressive Care Unit, Alyssa Mooney, Jerome Codilla, Joanna Arraiza, Sohl Chapman, Nkiru Chukwudi, Ronald Rosales

2023 South Division Nursing Research Conference

No abstract provided.

Iv Dexamethasone To Assist With Post Operative Pain And Nausea, Tasha Coumbs

Articles, Abstracts, and Reports

No abstract provided.

Stand By Me: Using An Enhanced Recovery After Surgery (Eras) Checklist To Guide Early Mobility Of Postoperative Craniotomy Patients On A Progressive Care Unit, Jerome Codilla, Alyssa Mooney, Joanna Arraiza, Sohl Chapman, Nkiru Chukwudi, Ronald Rosales

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Podium Presentation: Opioid Use Among Total Knee Arthroplasty Patients, Kelsie Welle, Karen Colorafi, Kenn Daratha

2022 Providence Nurse Research Conference

No abstract provided.

Will Apfel Score Awareness Among Caregivers Improve Postoperative Nausea And Vomiting (Ponv) Incidence And Management In Day Surgery?, Leni Alejo, Cherry De Guia, Cassandra Luck-Bird, Cynthia Rodriguez, Lilibeth Paloso, Gillian Ramirez, Deborah Graham

2022 Providence Nurse Research Conference

Background: Evidence supports Apfel Simplified Risk Score (SRS) as being effective in predicting postoperative nausea and vomiting (PONV) in patients following general anesthesia. Raising awareness of a person’s risk for PONV allows for prescription of antiemetics based on the Apfel SRS. Clinical Practice Guidelines (CPGs) for the management of PONV highlight first identifying patients’ risk to better manage anesthesia side effects. A team of nurses working in a tertiary hospital in Texas led a project using the Apfel SRS to improve PONV management.

Purpose: To raise awareness of patients' PONV risk perioperatively to improve patient outcomes of PONV events, prophylactic …

Identifying Skin Integrity Issues In The Post Anesthesia Care Unit: A Qualitative Improvement Project, Lori Patten

2022 Providence Nurse Research Conference

No abstract provided.

Evaluation Of A Beta-Lactam Antibiotic Allergy Assessment Tool For Patients Receiving Surgical Prophylaxis, Katelynn Tran, Alyssa B Christensen, Tobias Pusch, Jennifer Marfori

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022

No abstract provided.

Preoperative Phytonadione Supplementation For Mitral Valve Intervention Hemostasis, Katherine M. Nguyen, Joshua Francis, Celine Munoz, Torin P. Fitton

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022

No abstract provided.

The Impact Of Preoperative Breast Characteristics On Immediate Breast Reconstruction Complications: A Multivariate Analysis Of Tissue Expander And Autologous Reconstruction, Jeffrey N. Li, Sumeer S. Teotia, Nicholas T. Haddock

View All Washington/Montana GME

Presented at the 2022 Virtual Northwest Medical Research Symposium

National Early Warning Score (News): Medical Surgical Unit Pilot, Electronic Hospital-Wide Roll-Out, And Unit Educational Case Studies, Leslie Farrington, Rn, Bsn, Ccrn, Mackenzie Brown, Rn, Bsn, Molly Cody, Rn, Bsn, Megan Greco, Rn, Bsn, Cecille Lamorena Bsn, Rn, Ccrn-K, Crystal Martinez, Rn, Bsn, Jacoba Walsh, Rn, Bsn, Elizabeth Winokur, Phd, Rn, Cen

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Smoke Evacuation In The Operating Room, Kristina Macalalag Salacup, Rn, Bsn, Cnor

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Pediatric Surgery Nurses Lead And Coordinate Covid-19 Recovery Efforts, Shelly Johnson, Alice E. Dupler

2021 Providence Nurse Research Conference

Background: In early 2020, the appearance of the novel COVID-19 virus became a global concern, infecting hundreds of thousands of people. To reduce the spread of the virus, the United States government instituted social distancing and required hospitals to take steps to create extra beds for patient with COVID. One method to increase hospital capacity was the cancellation of scheduled, elective surgeries. In one large pediatric hospital in the Pacific Northwest, there was no formal process in place for cancelling elective procedures or for prioritizing when or how to reschedule the case. Because nurses were being called on to provide …

Evaluation Of Surgical Antibiotic Prophylaxis Compliance At A Large, Tertiary Medical Center, Meagan Greckel, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Surgical site infections (SSIs) are a significant cause of morbidity, prolonged hospitalization, and mortality. •Studies estimate SSIs contribute to nearly one million additional inpatient days per year and SSI mortality rate has been estimated to be 3%. •Additionally, SSIs in the US alone have an annual cost of approximately $3.5 billion. •A prior quality improvement project performed at a large, tertiary medical center in 2018-2019 identified that consistent adherence to the system surgical antibiotic prophylaxis (SAP) guideline and institutional antibiogram for antibiotic selection was an area for improvement. •This was particularly evident in hysterectomy and colorectal surgeries; therefore, …

Temporal Trends And Predictors Of Surgical Ablation For Atrial Fibrillation In A Large Western Us Healthcare System, Scott Brancato, Mansen Wang, Kateri Spinelli, Alison Leiataua, James Brevig, Zachary M Deboard, Torin P. Fitton, Maheer Gandhavadi, Jonathan P. Piccini, Neil Worrall, Tyler J Gluckman

Articles, Abstracts, and Reports

No abstract provided.

Heparin-Induced Thrombocytopenia Presenting As Splenic Hemorrhage Following Cardiac Surgery: A Case Report., Joseph Ferry, Samuel J Youssef, Pierce Wu, Livia Hegerova

Articles, Abstracts, and Reports

BACKGROUND: Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5-10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5-10%.

CASE PRESENTATION: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department on day nine following coronary artery bypass graft surgery with acute weakness, dizziness, and malaise. Her …

Salvage Of Failed Femoral Neck Fracture Fixation With Conversion Total Hip Arthroplasty Using The Direct Anterior Approach., Andrew G Yun, Marilena Qutami, Kory B Dylan Pasko

Articles, Abstracts, and Reports

Purpose: Failed femoral neck fracture (FNF) fixation with

Materials and Methods: Medical records for 42 patients with a prior history of FNF fixation who underwent conversion THA with hardware removal between 2009 and 2019 were retrospectively reviewed. Surgery was performed by a single surgeon at a single institution. All patients underwent hardware removal followed by direct anterior approach (DAA) THA using two separate incisions. Clinical outcomes, radiographic findings, and perioperative morbidity and mortality are reported.

Results: Clinically, there were no postoperative dislocations, periprosthetic fractures, or infections at follow-up. After a mean follow-up of 4 years, the mean hip disability and …

Conversion From Knee Arthrodesis Back To Arthroplasty: A Particular Challenge In Combination With Fungal Periprosthetic Joint Infection., Sven Frieler, Emre Yilmaz, Ryan Goodmanson, Yannik Hanusrichter, Thomas A Schildhauer, Hinnerk Baecker

Articles, Abstracts, and Reports

A 58-year-old female treated at an outside facility with knee arthrodesis due to persistent periprosthetic joint infection fulfilled all prerequisites for a conversion back to arthroplasty, as part of a 2-stage revision. Owing to the detection of Candida parapsilosis, the treatment concept was converted to a three-stage procedure. A scheduled spacer exchange with additional amphotericin B-loaded polymethylmethacrylate was conducted as an intermediate revision before reimplantation. Conversion in the setting of fungal periprosthetic joint infection presents a challenge, and successful treatment hinges on the use of proper antifungal and antimicrobial protocols, advanced surgical techniques, and a multidisciplinary team approach. At …

Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes., Eric O Klineberg, Peter G Passias, Gregory W Poorman, Cyrus M Jalai, Abiola Atanda, Nancy Worley, Samantha Horn, Daniel M Sciubba, D Kojo Hamilton, Douglas C Burton, Munish Chandra Gupta, Justin S Smith, Alexandra Soroceanu, Robert A Hart, Brian Neuman, Christopher P Ames, Frank J Schwab, Virginie Lafage

Articles, Abstracts, and Reports

STUDY DESIGN: Retrospective review of prospective database.

OBJECTIVE: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes.

METHODS: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 >weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], …

Functional Outcome Of Traumatic Spinopelvic Instabilities Treated With Lumbopelvic Fixation., Emre Yilmaz, Martin F Hoffmann, Alexander Von Glinski, Christiane Kruppa, Uwe Hamsen, Cameron K Schmidt, Ahmet Oernek, Matthias Koenigshausen, Marcel Dudda, Thomas A Schildhauer

Articles, Abstracts, and Reports

The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age …

Nonrecurrent Early Post-Transplantation Focal Segmental Glomerulosclerosis., Momina M Ahmed, Massini A Merzkani, Matthew R D'Costa, Muhannad A Leghrouz, Mary E Fidler, Haraldur Bjarnason, Patrick G Dean, Fernando C Fervenza, Sanjit Reddy, Hatem Amer

Articles, Abstracts, and Reports

No abstract provided.

Improving Quality Of Patient Care By Reducing The Prevalence Of Surgical Site Infections, Gina Dashiell, Luanna Hansen

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No abstract provided.

Cdc Wound Classification: Accuracy Equals Determination Of Surgical Site Infection (Ssi), Theodore J. Walker

View All

No abstract provided.

Aromatherapy For First Line Treatment Of Postoperative Nausea And Vomiting In Pacu, Michelle Leiby, Katie Trottier

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No abstract provided.

Building A Culture Committed To Fall Prevention, Mary Uppinghouse, Queena Kim, Marissa Evans

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No abstract provided.

Process Improvement For Simethicone Use During Endoscopic Procedures, Airene D. Albutra, Mary Estelle De Vera, Sarah J. Wyrick

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No abstract provided.

Perioperative Anticoagulation Management In Spine Surgery: Initial Findings From The Ao Spine Anticoagulation Global Survey., Philip Louie, Garrett Harada, James Harrop, Thomas Mroz, Khalid Al-Saleh, Giovanni Barbanti Brodano, Jens R Chapman, Michael Fehlings, Serena Hu, Yoshiharu Kawaguchi, Michael Mayer, Venugopal Menon, Jong-Beom Park, Sheeraz Qureshi, Shanmuganathan Rajasekaran, Marcelo Valacco, Luiz Vialle, Jeffrey C Wang, Karsten Wiechert, K Daniel Riew, Dino Samartzis

Articles, Abstracts, and Reports

STUDY DESIGN: Cross-sectional, international survey.

OBJECTIVES: This study addressed the global perspectives concerning perioperative use of pharmacologic thromboprophylaxis during spine surgery along with its risks and benefits.

METHODS: A questionnaire was designed and implemented by expert members in the AO Spine community. The survey was distributed to AO Spine's spine surgeon members (N = 3805). Data included surgeon demographic information, type and region of practice, anticoagulation principles, different patient scenarios, and comorbidities.

RESULTS: A total of 316 (8.3% response rate) spine surgeons completed the survey, representing 64 different countries. Completed surveys were primarily from Europe (31.7%), South/Latin America (19.9%), and …

Management Of Failed Uka To Tka: Conventional Versus Robotic-Assisted Conversion Technique., Andrew G Yun, Marilena Qutami, Mary Chang-Hwa Chen, Kory B Dylan Pasko

Articles, Abstracts, and Reports

BACKGROUND: Failure of unicompartmental knee arthroplasty (UKA) is a distressing and technically challenging complication. Conventional conversion techniques (CCT) with rods and jigs have produced varying results. A robotic-assisted conversion technique (RCT) is an unexplored, though possibly advantageous, alternative. We compare our reconstructive outcomes between conventional and robotic methods in the management of failed UKA.

METHODS: Thirty-four patients with a failed UKA were retrospectively reviewed. Patients underwent conversion total knee arthroplasty (TKA) with either a CCT or RCT. Seventeen patients were included in each group. All procedures were done by a single surgeon at a single institution, with a mean time …