Critical Care Commons^™

Complex Reconstruction After Extreme Fournier’S Gangrene; A Case Report, Serban Dumitrache, Leonida A. Goman, Raluca Dutu, Raluca Capatina, Carmen Giuglea, Dan M. Enescu

Journal of Mind and Medical Sciences

In this article we present a severe case of Fournier's gangrene (FG) that affected a 64-year-old male patient, with no other known comorbidities. FG is a type of necrotizing fasciitis of the perineal and genital regions, that affects mostly males in the 5th-7th decades, with mortality rates that reach 70%. The infection usually advances through the superficial fascial layers of the perineum and abdomen and affects the skin. In our case the infection also affected the spermatic fasciae and advanced in the abdominal and pelvic cavities, abdominal muscles, and surrounding soft tissues. Subsequent debridement left the patient with large soft …

When Myocardial Infarction Is Choosing Young Victims, Cristina Nedelcu, Mihaela Ionescu, Paris Ionescu, Vitalie Morosanu, Gabriel Smarandache, Dumitru Cristinel Badiu, Florentina Gherghiceanu, Vlad Denis Constantin, Emanuele Maria Merlo, Daniel Niţă

Journal of Mind and Medical Sciences

We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a “burnout …

Diagnosis And Management Of Pericardial Effusion, Maria Manea, Ovidiu Gabriel Bratu, Nicolae Bacalbasa, Camelia Cristina Diaconu

Journal of Mind and Medical Sciences

Pericardial effusion is a common pathology in clinical practice. The etiology of pericardial effusion is diverse, from infectious diseases, malignancies, autoimmune diseases, chronic renal failure, to drug-related or after an invasive cardiac intervention. Clinical presentation of pericardial effusion is variable, depending on the volume of the fluid and the rate of accumulation. Clinical manifestations are dramatic if the pericardial fluid accumulates rapidly. Classical symptoms in pericardial effusion include pleuritic chest pain associated with dyspnea. In case of cardiac tamponade, orthopnea, jugular venous distension, pulsus paradoxus, hypotension, and shock appear. Transthoracic echocardiography is the gold standard investigation for the diagnosis of …

Post-Extubation Stridor Complicating Covid-19-Associated Acute Respiratory Distress Syndrome: A Case Series., Joseph Moran Do, Sara Godil Md, Breanna S. Goldner Do, Kareem Godil Md, Jonaid Aslam Md

Department of Medicine

Post-extubation stridor is a known complication of mechanical ventilation that affects a substantial number of all critical care patients and leads to increased morbidity and mortality. Common risk factors for the development of post-extubation stridor include female gender, older age, and prolonged length of mechanical ventilation. There may be an increased incidence of post-extubation stridor in patients who require mechanical ventilation to manage the respiratory complications of COVID-19. In this case series, we analyzed nine patients from across our institution who were intubated to manage acute respiratory distress syndrome (ARDS) secondary to COVID-19 and subsequently developed post-extubation stridor. The patients …

Moral Distress To Moral Courage, A Pathway To Success For Resident Nurses, Melinda Furrer

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No abstract provided.

Effects Of Sedation Vacations And Sedation Level Quality Improvement Project, Gisele Bazan, Bo Ewing, Cynthia Grissman, April Marpa, August Montgomery, Tana Overman

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No abstract provided.

Post-Pyloric Feeding Tube Placement, Patrick Arenivar, Michelle Bradberry, Nikki L. Galaviz, Stephan R Smith, Lauren Johnston, Christi Robnett, Jamie Roney

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No abstract provided.

Powder 'Bites The Dust': Elimination Of Body Powder From Patient Care, And Introducing Healthier Alternatives, Janet Thorson-Mador

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No abstract provided.

Brushing Away Pathogens: An Oral Care Initiative To Tackle Nv-Hap, Sarah Mcafee, Lari Johnson

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No abstract provided.

The Use Of Enhanced Recovery After Surgery (Eras) To Decrease Length Of Stay And Increase Patient Satisfaction: An Integrative Research Review, Kelsey Mcmurry

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No abstract provided.

Improving Access & Quality Of Care For Rural Inpatients Requiring Hemodialysis, Louise Dyjur, Teresa Mcconnell, Patty Harmon

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No abstract provided.

Patient Fall Reduction Quality Improvement Project, Stephanie Dunkle, Lauren English, Alexa Baughman, Casey Hernandez, Sarah Langley, Mindy Starch, Jamie Roney

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No abstract provided.

Target Zero: Implementing And Sustaining A Successful Clabsi Prevention Program, Erica Mccartney, Giselle Deibler, Patty Palmer

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No abstract provided.

Risk Factors For And Prediction Of Post-Intubation Hypotension In Critically Ill Adults: A Multicenter Prospective Cohort Study, Nathan J. Smischney, Rahul Kashyap, Ashish K. Khanna, Ernesto Brauer, Lee E. Morrow, Mohamed O. Seisa, Darrell R. Schroeder, Daniel A. Diedrich, Ashley Montgomery, Pablo Moreno Franco, Uchenna R. Ofoma, David A. Kaufman, Ayan Sen, Cynthia Callahan, Chakradhar Venkata, Gozde Demiralp, Rudy Tedja, Sarah Lee, Mariya Geube, Santhi I. Kumar, Peter E. Morris, Vikas Bansal, Salim Surani, On Behalf Of Sccm Discovery (Critical Care Research Network Of Critical Care Medicine) Hemair Investigators Consortium

Internal Medicine Faculty Publications

OBJECTIVE: Hypotension following endotracheal intubation in the ICU is associated with poor outcomes. There is no formal prediction tool to help estimate the onset of this hemodynamic compromise. Our objective was to derive and validate a prediction model for immediate hypotension following endotracheal intubation.

METHODS: A multicenter, prospective, cohort study enrolling 934 adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 was conducted to derive and validate a prediction model for immediate hypotension following endotracheal intubation. We defined hypotension as: 1) mean arterial pressure < 65 mmHg; 2) systolic blood pressure < 80 mmHg and/or decrease in systolic blood pressure of 40% from baseline; 3) or the initiation or increase in any vasopressor in the 30 minutes following endotracheal intubation.

RESULTS: Post-intubation hypotension developed in 344 (36.8%) patients. …

Not All Free Air In The Nicu Is Necrotizing Enterocolitis., Paul Holtrop, Paras Khandar, Nathan Novotny

Articles

When a tiny preterm baby in our neonatal intensive care unit (NICU) has an intestinal perforation, it is always necrotizing enterocolitis (NEC), right? Not so fast, my friend. Many of these preterm infants who perforate have free air from spontaneous intestinal perforation (SIP) and not NEC. As it turns out, not all free air in the NICU is NEC. How can you tell the difference and does it matter?

It can be challenging to tell the difference, but SIP tends to occur earlier in life, often within the first week, whereas NEC usually occurs slightly later. One analysis of a …

The Presence And Prognosis Of Acute Kidney Injury And Renal Abnormalities In Hospitalized Sars-Cov-2 Patients, Mara Waaraniemi

Theses and Graduate Projects

SARS-CoV-2, a novel coronavirus reached pandemic status by the World Health Organization in the spring of 2020. As a novel virus, analysis of the early literature on the clinical manifestations of SARS-CoV-2 is imperative to help guide clinical practice and inform future research. Early studies about the clinical manifestation of the virus showed a proportion of hospitalized patients developing renal abnormalities and AKI. This paper analyzed literature through searching the PubMed database to assess whether renal abnormalities and AKI were present in hospitalized SARS-CoV-2 patients, how the renal abnormalities manifested themselves in patients, and the associated treatment and prognosis of …

Novel Use Of Fresh Frozen Plasma In Treating Hereditary Angioedema: A Success Story From Pakistan, Amber Sabeen Ahmed, Sidra Fayyaz

Section of Internal Medicine

Hereditary angioedema (HAE) due to a C1-esterase inhibitor(C1-INH) deficiency is a rare and potentially life-threatening disorder. It is characterized by an episodic and self-limiting increase in vascular permeability. The condition manifests itself as recurrent attacks of swelling in any part of the body. The angioedema can cause the involvement of the respiratory tract, skin, and gastrointestinal tract. Laryngeal involvement can make the condition life-threatening. It does not respond well to conventional angioedema therapy of steroids, adrenaline, and antihistamines. The targeted therapy for HAE consists of plasma-derived or recombinant C1-INH, ecallantide, and icatibant or bradykinin receptor antagonist. In the absence of …

Does Administration Of Antipsychotic Medications Reduce The Incidence And Duration Of Delirium In Critically Ill Adult Patients?, Ellen Brateng

Theses and Graduate Projects

Background: Acute delirium is a common complication among critically ill patients. Besides the manifestation of distressing symptoms, delirium can result in negative patient outcomes. Several studies show that antipsychotics such as haloperidol are one of the most commonly used interventions for delirium despite large variability and lower quality of evidence available to advocate for their use.

Methods: A literature review was conducted to investigate current evidence on the use of antipsychotic agents for preventing and treating delirium in the intensive care unit.

Discussion: There is conflicting data concerning the prophylaxis and treatment of delirium in critically ill patients. For prophylaxis …

Development, Expansion And Role Of Myeloid-Derived Suppressor Cells In Post-Sepsis Immune Suppression, Tuqa Alkhateeb

Electronic Theses and Dissertations

Myeloid-derived suppressor cells (MDSCs) numbers increase significantly in sepsis and are associated with high mortality rates. These myeloid cell precursors promote immunosuppression, especially in the late (post sepsis) stage. However, the mechanisms that underlie MDSC expansion and programming are not completely understood. To investigate these mechanisms, we used a cecal-ligation and puncture (CLP) mouse model of polymicrobial sepsis that progresses from an early/acute proinflammatory phase to a late/chronic immunosuppressive phase. Previous studies in our laboratory showed that microRNA (miR)-21 and miR-181b elevate levels of the transcription factor nuclear factor 1 (NFI-A) that promotes MDSC expansion. We report here that miR-21 …

Hyperkalemia Secondary To Prophylactic Heparin Use In A Trauma Patient: Case Report, Marco Custodio, Errington C. Thompson

Marshall Journal of Medicine

This case report describes a complex trauma patient who develops hyperkalemia secondary to heparin. Heparin is a commonly used drug in trauma patients. Physicians need to be aware of this potentially harmful adverse reaction in these high-risk patients.

Coverage Of The 2019 Eastern Equine Encephalitis Virus Outbreak On News Media, Corey H. Basch, Joseph Fera, Christie Jaime, Nasia Quininoes

Publications and Research

Background: The media plays as an important role in delivering information about emergent issues, such as the Eastern equine encephalitis virus (EEEV) outbreak of 2019. As such, there has been an increase in news coverage of vector-borne disease coverage due to a rise in emerging or re-emerging arboviruses.

Methods: The purpose of this study was to describe the content of news clips related to the recent (2019) EEEV outbreak in the United States.

Results: Only 3 of the important topics identified were mentioned in a majority of the 110 videos analyzed. These topics were, mosquito mentioned as transmitter, prevention by …

A Counterpoint Paper: Comments On The Electrocardiographic Part Of The 2018 Fourth Universal Definition Of Myocardial Infarction Endorsed By The International Society Of Electrocardiology And The International Society For Holter And Noninvasive Electrocardiology, Yochai Birnbaum, Miguel Fiol, Kjell Nikus, Javier Garcia Niebla, Ljuba Bacharova, Sergio Dubner, Wojciech Zareba, Peter W Macfarlane, Antonio Luiz Ribeiro, Iwona Cygankiewicz, Antoni Bayes De Luna

Faculty, Staff and Students Publications

The Fourth Universal Definition of Myocardial Infarction (FUDMI) focuses on the distinction between nonischemic myocardial injury and myocardial infarction (MI), along with the role of cardiovascular magnetic resonance, in order to define the etiology of myocardial injury. As a consequence, there is less emphasis on updating the parts of the definition concerning the electrocardiographic (ECG) changes related to MI. Evidence of myocardial ischemia is a prerequisite for the diagnosis of MI, and the ECG is the main available tool for (a) detecting acute ischemia, (b) triage, and (c) risk stratification upon presentation. This review focuses on multiple aspects of ECG …

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, Stephen Swenson, Stephen M. Swenson

Nursing Masters Papers

Abstract

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 …

Idiopathic Pulmonary Hemosiderosis - A Rare Cause Of Chronic Anemia, Ayesha Butt, Rashida Ahmed, Muhammad Dawood Amir Sheikh, Omar Khan, Nousheen Iqbal, Arshalooz Rahman, Javaid Khan

Medical College Documents

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease marked by alveolar bleeding and accumulation of hemosiderin in the lungs. Here we present three cases of IPH. The first case is of a 26-year-old male with anemia, hemoptysis and dyspnea. Bronchoscopy confirmed diffuse alveolar hemorrhage (DAH). A diagnosis of IPH was made after ruling out other causes of DAH and observing good response to steroids. The patient's condition improved with prednisolone and azathioprine. The second case is of 26-year-old female with severe anemia. Imaging suggested IPH and lung biopsy confirmed it. She died shortly afterwards. The third case is of a …

The First Reported Case Of Hyperreninemic Hypoaldosteronism Due To Mucopolysaccharidosis Disorder., Antony Gayed, Valerie A Schott, Laura Meltzer

Ambulatory and Primary Care Articles

Mucopolysaccharidoses (MPS) are rare genetic lysosomal storage disorders caused by a deficiency of enzymes that catalyze the breakdown of glycosaminoglycans. MPS-III, also known as Sanfilippo syndrome, is caused by a deficiency of one of four enzymes that catalyze heparan sulfate proteoglycan degradation. MPS-IIIA results from a deficiency of heparan sulfatase. The natural history of MPS-IIIA is marked by progressive neurodegeneration. A nine-year-old boy with developmental delay presented with progressive three-month functional decline culminating in emergency department presentation for lethargy and immobility. Laboratory workup revealed hepatic and renal failure, coagulopathy, pancytopenia, hypernatremia, and uremia requiring emergent dialysis. He developed hyperkalemia during …

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

Health Equity and Quality Improvement (HEQI) Summit

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, Natalie S. Shwaish

Research Days

No abstract provided.

Angiopoietin 1 Protects Against Lps-Induced Acute Lung Injury And Alveolar Remodeling In Neonatal Mice, Umar Salimi

Research Days

No abstract provided.

Educating Providers: Timely Post-Operative Pain Management In A Level Iv Neonatal Intensive Care Unit (Nicu), Jamesia Donato

Research Days

No abstract provided.