Critical Care Commons^™

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

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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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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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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 …