Critical Care Commons^™

A “Sweet” Look Into A Rare Disease: Presentation And Management Of Acute Febrile Neutrophilic Dermatosis, Christian L. Menezes Do, Joseph Moran Do, Kaitlyn Musco Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Anti-Synthetase Syndrome Presenting As Rapidly Progressive Interstitial Lung Disease, Nathan Brewster Do, Amogh M. Joshi Do, Alaynna C. Kears Do, Kareem Godil Md, Jessica Boehmler Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Flare Of Rheumatoid Arthritis Associated Interstitial Lung Disease Secondary To Lung Biopsy, Nathan Brewster Do, Breanna S. Goldner Do, Kareem Godil Md, Ethan S. Stern Do, Jessica Boehmler Md

Department of Medicine

No abstract provided.

Implications Of Frailty In Copd Exacerbations, Aimee Almanzar, Armando Cabrera, Felix Hernandez, Hector Y. Vazquez, Asma Jafri, Miriam Zylberglait Lisigurski, Livasky Concepcion, Gustavo Ferrer

Pulmonary Disease

Introduction The extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) patients are similar to symptoms of frailty, a geriatric syndrome. This study was designed to identify the relation between frailty and patient outcomes during a COPD exacerbation. Methods This retrospective study identified 10,235 patients hospitalized for COPD exacerbation, as well as 16 laboratory tests included in a frailty index that have been linked to frailty. Patients were divided into less frail (0-8 positive laboratory values) and more frail (9-16 positive laboratory values) groups. The primary composite endpoints were mechanical ventilation, ICU length of stay, readmission, and discharge status. Results Of …

Anesthetic Management Without The Use Of Neuromuscular Blocking Agents In Myasthenia Gravis Patient Undergoing Coronary Artery Bypass Grafting And Thymectomy, Katarina Kapisoda, Ettore Crimi Md, Omeni Osian

Anesthesiology

We describe a novel and effective anesthetic management of a 67 year old male with myasthenia gravis (MG) who underwent combined coronary artery bypass graft and thymectomy. Induction of general anesthesia with endotracheal intubation was performed with propofol and remifentanyl without use of any neuromuscular blocking agents (NMBA). General anesthesia was then maintained with inhaled isoflurane and continuous intravenous infusion of sufentanyl and dexmedetomidine. In ICU, trachea was extubated within two hours from admission and no complications occurred during the following 24 hours ICU stay. Avoidance of NMBA may improve outcomes by decreasing the risks associated with their use.

Rash Provokes Catastrophic Antiphospholid Syndrome, Alaynna C. Kears Do, Nathan Brewster Do, Breanna S. Goldner Do, Kareem Godil Md, Aaron J. Czysz Md

Department of Medicine

No abstract provided.

Special Considerations In Pediatric Burn Patients Regarding Drug Dosage And Administration, Kelsey Lindsley, Maureen Moynihan, Angela Chu, Kristen Yaeger, Karen L. Kier

Pharmacy and Wellness Review

Pediatric burn patients are a high-risk patient population to treat. These patients have altered physiologic function as a result of the burn injury, in addition to their smaller size and developing bodies. This creates unique challenges during treatment. Accommodations for these patients are made through unique drug dosages and routes of administration. When treating pediatric burn patients, properly assessing and treating pain promptly and effectively is of utmost importance. Nurses who utilize accurate and appropriate pain assessment scales will provide the best treatment of pain. Proper assessment allows the patient to receive the correct analgesic regime, ensuring a faster and …

Review Of The Effects Of Anesthetic Agents Used As Premedication For Patients Undergoing Electroconvulsive Therapy With Diagnoses Of Bipolar Disorder Or Major Depression On Convulsion, Recovery Period, And Hemodynamic Parameters, Volkan Ozen, Mehmet Emin Orhan

Journal of Mind and Medical Sciences

Objective: The aim of this study was to examine the effects of anesthetic agents used as premedication in patients undergoing electroconvulsive therapy (ECT) for diagnoses of bipolar disorder or major depression in terms of convulsion, recovery period, and hemodynamic parameters. Materials and Method: This retrospective study was carried out by screening the anesthesia forms of patients in a psychiatry clinic in Turkey. Results: Researchers reviewed 104 patient files, of which 39 fit the inclusion criteria. 26 patients were given premedication; 13 patients were not given premedication. The study found a significant difference between the group to which dexmedetomidine was given …

A Quality Improvement Project To Determine The Incidence And Prevalence Of Obstructive Sleep Apnea, Best Practice Anesthesia Guidelines, And The Incidence Of Perioperative Cardiac And Respiratory Complications After The Implementation Of The Stop-Bang Questionnaire, Bradly Diamond, Gregory Guerrier, Cody Holliman, Robert Marrero, Tyler Nelson

Doctoral Projects

Patients with obstructive sleep apnea (OSA) are at risk for perioperative respiratory and cardiovascular compromise (Opperer et al., 2016). Unfortunately, almost 90% of patients with moderate-to-severe OSA are not diagnosed and unaware of their disorder; however, they remain at increased perioperative risks (Singh et al., 2015). The STOP-BANG questionnaire was developed to meet the need for a reliable, concise, and efficient screening tool for OSA risk. The facility at which this project was conducted did not utilize a prescreening OSA risk tool. The facility not using a prescreening OSA risk tool is especially important because the State of Mississippi currently …

Increasing Kangaroo Care In A New Small Baby Unit, Dianne Wilderson, Barb Haney, Ashley Mirabile, Beckie Palmer, Jenny Heltzer, Erin Keith-Chancy Bsn,Ccrn, Brooke Smith, Christian Anthony Schneider, Abdebayo Oshodi

Posters

Project Aim: Increase the percent of eligible patients receiving kangaroo care from 19% to 30% by September 2019.

Results:

113 staff completed education

OT consults completed on all SBU patients

20 kangaroo wraps purchased

Kangaroo care rate in NICU increased from 19% (prior to SBU) to 36% (Post SBU opening).

Conclusion: Due to increased multidisciplinary awareness of importance of kangaroo care in the SBU more parents are completing kangaroo care.

"Will Using Telemedicine With Medical Command During Situational Awareness Escalation Add Value To Patient Care?", Kathy Farrell, Bradley Bishop, Lisa Carney, Matthew B. Johnson, Natalie Masters, Lisa Pruitt, Sherry Mccool, Laura Fitzmaurice

Posters

No abstract provided.

Lighting The Way To Ensure Safe Transition Home, Barb Haney, Ashley Mirabile, Dianne Wilderson, Beckie Palmer, Ashley Lewis, Cris Mills, Eugenia K. Pallotto

Posters

All aspects of discharge (education, screenings, appointments, plans and home services" must be completed and appropriately communicated prior to discharge to ensure safe transition to home.

Goal: Standardize all aspects of discharge in a large, busy 84-bed Level IV NICU with >1000 admissions/year and >300 nurses, >60 NNPs, and >25 neonatologists.

• 95% of patients with lengths of stay >3 days have all discharge planning completed prior to discharge/Parent Care Unit overnight stay

Clabsi Prevention Through Prevention Huddles And Clabsi Risk Assessment And Prevention Form In Electronic Medical Record, Tara Benton, Barb Haney, Lacey Bergerhofer, Yolanda Ballam, Kaitlyn Hoch

Posters

Our aim is to increase the awareness of high risks for central line associated bloodstream infection (CLABSI) and decrease the CLABSI rate with the implementation of CLABSI prevention huddles and an electronic medical record (EMR) "CLABSI Risk Assessment and Prevention" form.

End Tidal Carbon Dioxide Monitoring (Capnography) In The Cardiac Intensive Care Unit, Madeline Elaine Huff, Kenneth T. Shelton

School of Medicine Publications

Background: Carbon dioxide levels can be monitored throughout the respiratory cycle via capnography. In this way, capnography allows healthcare professionals to follow several respiratory factors in real-time, including respiratory depression, apnea, and hypercapnia. Postoperative patients are subjected to significant harm while receiving sedating medications without appropriate monitoring and intervention. Earlier detection of alterations to ventilation status will better enable providers to more accurately dose medications during procedures, especially in high-risk patient populations.

Methods: Patient selection included post-operative patients in the intensive care unit that were receiving sedation/analgesia, high dose or high frequency opioids, epidural or intrathecal pain management, patients that …

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operations Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Improving Recognition And Reporting Of Adverse Drug Reactions In The Nicu: A Quality Improvement Project., Betsy Cammack, Alexandra Oschman, Tamorah R. Lewis Md Phd

Manuscripts, Articles, Book Chapters and Other Papers

Adverse drug reactions (ADRs) are under-recognized and under-reported in the Neonatal Intensive Care Unit (NICU) population, with up to 95% of all ADRs not reported. Compared with non-elderly adults, pediatric patients are 3 times more likely to experience an ADR, with varying rates from 0.6% to 16.8%. The Children's Mercy NICU has an ADR rate of 0.29% (2015). This high rate presents an opportunity to increase recognition and reporting, and improve characterization of ADRs in the NICU.

Methods: The primary aim of this quality improvement project was for 70% of patients who received specified medications (indomethacin, dexmedetomidine, fentanyl, lorazepam, dexamethasone, …

The Role Of Diagnostic Bronchoscopy In Refractory Asthma Management, Christopher Mcgrath, Md, Tuhina Raman, Md, Jessica Most, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Posters

Refractory asthma is an uncommon entity, manifesting in less than five percent of asthmatics and characterized by high medication requirements, persistent symptoms, frequent exacerbations, and significant airflow obstruction despite standard medical therapy.[1] Bronchoscopy may be an effective tool for identifying refractory asthma phenotypes.[3] The objective of this case series is to demonstrate the use of bronchoscopy to personalize treatment among a population of refractory asthmatics.

Identification Of Policy Priorities To Address The Burden Of Smokeless Tobacco In Pakistan: A Multimethod Analysis, Kamran Siddiqi, Ziauddin Islam, Zohaib Khan, Faraz Siddiqui, Masuma Mishu, Omara Dogar, Vandana Shah, Javaid Khan, Subhash Pokhrel, Romaina Iqbal

Section of Pulmonary & Critical Care

Introduction: We assessed the magnitude of smokeless tobacco (ST) use in Pakistan and identified policy gaps to help ascertain short-, medium-, and long-term priorities. We then elicited stakeholders' views as to which of these identified priorities are most important.
Methods: In a multimethod study, we: analyzed Global Tobacco Surveillance System data sets to estimate ST consumption and disease burden; conducted a documentary review to identify gaps in policies to control ST in comparison with smoking; elicited stakeholders' views in an interactive workshop to identify a set of policy options available to address ST burden in Pakistan; and ranked policy …

Prasugrel Inappropriate Use In Patients Post-Percutaneous Coronary Intervention (Pci). A Single Center Study, Ahmed Amro, Kanaan Mansoor, Mohammad Amro, Amal Sobeih, Obadah Aqtash, Hisham Hirzallah, Alaa Gabi, Madhulika Urella, Waseem Ahmed, Sandra Shenouda, Dr. Rameez Sayyed, Md

Marshall Journal of Medicine

Prasugrel is a thienopyridine that was approved by the US Food and Drug Administration (FDA) in combination with aspirin for the reduction of thrombotic events as well as stent thrombosis in patients with ACS who undergo PCI. This retrospective study aims to assess the frequency of inappropriate use of prasugrel and to emphasize that prasugrel still needs more attention as inappropriate use may result in significant morbidity.

Intensive Care To Intermediate Care Bridge Program, Natasha Bartlett, Sally Langerak, Lindsey Lucas, Jonathan Archibald, Tayla Robbins, Miranda Thompson, Patrice Tetu, Calla Hastings, Megan Garland, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

To deliver the highest quality of care across the continuum, a large academic tertiary medical center envisioned a project that would provide an internal source of cross trained nurses for their medical intensive care unit (SCU2) and their medical intermediate care unit (R4/IMC/AVU). The hope for this program was to improve communication and collaboration between nurses and enhance the care that they provide to patients and their families.

A highly qualified team of nurses was established to create a performance improvement project. The overall goal of this endeavor was to build a more collaborative relationship between the units and ultimately …

Comparison Of The Sequential Organ Failure Assessment (Sofa) And Quick Sofa Scores In Predicting In-Hospital Mortality Among Adult Critical Care Patients With Suspected Infection, Mohammed A. Said, Wangari Siika, Vitalis Mung’Ayi, Reena Shah

Internal Medicine, East Africa

Introduction: Sepsis is global health priority and the leading cause of death in critical care. The SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis. It uses SOFA and qSOFA scores in place of the SIRS criteria for better ability to predict mortality in patients with suspected infections. The performance of these scores in critical care units outside high-income countries remains largely unknown.

Methods: We compared the performance of SOFA and qSOFA in predicting the in-hospital mortality of an adult critical care unit in Kenya. We conducted a retrospective review of all patients admitted …

Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

A Unique Model For Perinatal Palliative Care In A Level Iv Neonatal Intensive Care Unit, Kelstan L. Ellis Do, Megan Tucker Md

Research Days

No abstract provided.

Improved Coordination Of Care For Picu Patients With Newly Diagnosed Anterior Mediastinal Masses, Laura Mccarthy

Presentations

This presentation describes a quality improvement project to develop a multi-disciplinary standardized approach for prompt surgical intervention to establish a diagnosis of anterior mediastinal mass. The aim was to decrease the time from presentation to surgical diagnostic procedure totreatment.

A Refractory Case Of Severely Uncontrolled Eosinophilic Asthma On Maximal Therapy, William Ueng Mph, Jaimin Patel Do, Nathan Brewster Do, Swetangini Patel P3, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Propofol Infusion Syndrome: A Serious Complication With A Commonly Used Drug In The Icu, Hernando Castillo Ms, Jaimin Patel Do, Nathan Brewster Do, Swetangini Patel P3, Brian Civic Md

Department of Medicine

No abstract provided.

Education As Important Predictor For Successful Employment In Adults With Congenital Heart Disease Worldwide., Maayke Sluman, Maayke Sluman, Silke Apers, Judith Sluiter, Karen Nieuwenhuijsen, Philip Moons, Philip Moons, Koen Luyckx, Koen Luyckx, Adrienne Kovacs, Adrienne Kovacs, Corina Thomet, Werner Budts, Junko Enomoto, Hsiao-Ling Yang, Jamie Jackson, Paul Khairy, Stephen Cook, Raghavan Subramanyan, Luis Alday, Katrine Eriksen, Mikael Dellborg, Mikael Dellborg, Malin Berghammer, Malin Berghammer, Eva Mattsson, Andrew Mackie, Samuel Menahem, Maryanne Caruana, Kathy Gosney, Alexandra Soufi, Susan Fernandes, Kamila White, Edward Callus, Shelby Kutty, Berto Bouma, Barbara Mulder

Psychology Faculty Works

Background: Conflicting results have been reported regarding employment status and work ability in adults with congenital heart disease (CHD). Since this is an impor‐ tant determinant for quality of life, we assessed this in a large international adult CHD cohort. Methods: Data from 4028 adults with CHD (53% women) from 15 different countries were collected by a uniform survey in the cross‐sectional APPROACH International Study. Predictors for employment and work limitations were studied using general linear mixed models. Results: Median age was 32 years (IQR 25‐42) and 94% of patients had at least a high school degree. Overall employment rate …

Who Codes In The Nicu: An Analysis Of Demographics And Factors That Place Neonates At Higher/Lower Risk Of A Serious Code Event And Prognosis Post-Code, Danielle N. Gonzales, Ashley K. Sherman, Jennifer Dremann, Staci Elliott, Amelia Gute, Amber Bellinghausen, Jessica Brunkhorst, Danielle Reed

Posters

This study analyzed resuscitation events in a level IV neonatal intensive care unit from 2012-2017 to determine whether there are identifiable differences between those who have a rapid response event and those with a short or long code and determine factors post-event that may impact survival to discharge.