RESUMEN
WHAT THIS PAPER ADDS: There is no reference in the literature regarding the transfer of patients between hospitals for interventional radiology procedures. This paper outlines an approach to assist with the safe assessment, reassessment and repatriation of patients requiring urgent procedures in a different hospital.
Asunto(s)
Seguridad del Paciente , Transferencia de Pacientes , Radiografía Intervencional , Radiología Intervencionista , Derivación y Consulta , Humanos , Radiología Intervencionista/métodos , Radiografía Intervencional/métodosRESUMEN
A middle-aged patient presented with toxic inhalational injury, and was resuscitated prehospitally and treated in the emergency department for smoke inhalation, carbon monoxide (CO) exposure and cyanide poisoning with the use of antidotes. Due to the CO effects on spectrophotometry, an anaemia initially identified on blood gas analysis was thought to be artefactual, but was later confirmed by laboratory testing to be accurate. In addition, cyanide can confound haemoglobin testing due to its use in the analytical process and non-cyanide analysis is required when there is suspected exposure. Although no consensus exists on a first-line cyanide antidote choice, hydroxocobalamin is the only antidote without a serious side effect profile and/or deleterious cardiovascular effects. We propose prehospital enhanced care teams consider carrying hydroxocobalamin for early administration in toxic inhalational injury.
Asunto(s)
Cianuros/envenenamiento , Lesión por Inhalación de Humo/complicaciones , Administración Intravenosa , Antídotos/administración & dosificación , Análisis de los Gases de la Sangre , Intoxicación por Monóxido de Carbono/complicaciones , Resultado Fatal , Humanos , Hidroxocobalamina/administración & dosificación , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/etiología , Paro Cardíaco Extrahospitalario/terapiaRESUMEN
BACKGROUND: This is a review of our experience in creating transposed femoral vein (TFV) fistulas and some of the lessons we have learnt while performing this challenging procedure over the last 5 years. METHODS: This is retrospective review of patients who underwent TFV fistula formation between January 2013 and December 2017. RESULTS: Fifteen patients underwent FV fistula formation with 4 cases being excluded from analysis. Median follow-up was 1.17 years (interquartile range 0.19-3.59 years). Primary and primary-assisted patency rates were 75% and 100% at 6 months, respectively, and 66.7% and 100% at 1 year. CONCLUSIONS: Our patient group showed good fistula patency at 1 year and did not experience any incidence of ischemic steal syndrome. We believe this to be due to careful preoperative patient assessment and meticulous surgical technique. Our experience suggests that such procedures should be performed by surgeons with vascular expertise wherever possible to reduce the incidence of complications.