RESUMO
Stress ulcer prophylaxis (SUP) is often inappropriately utilized, particularly in critically ill patients. The objective of this study is to find an effective way of reducing inappropriate SUP use in an academic medical intensive care unit (ICU). Medical ICU patients receiving SUP were identified over a 1-month period, and their charts were reviewed to determine whether American Society of Health-System Pharmacists guidelines were followed. Inappropriate usage was calculated as inappropriate patient-days and converted to incidence per 100 patient-days. Two interventions were implemented: (1) Pharmacists reviewed indications for SUP on each patient during daily team rounds and daily medication reconciliation and (2) residents rotating on ICU services were educated on a bimonthly basis. Postintervention data were obtained in a similar fashion. Prior to intervention, the incidence of inappropriate SUP usage was calculated to be 26.75 per 100 patient-days (n = 1099 total patient-days). Total cost attributable to the inappropriate use was $2433. Post intervention, we were able to decrease the inappropriate incidence of SUP usage to 7.14 per 100 patient-days (n = 1149 total patient-days). In addition, total cost of inappropriate use was reduced to $239.80. Our study highlights an effective multidisciplinary approach to reduce the inappropriate use of SUP in an academic medical ICU. We were able to reduce the incidence of inappropriate use of SUP by 73.31% ( P < .001). Furthermore, we were able to decrease the costs by approximately $2200/month.
Assuntos
Antagonistas dos Receptores H2 da Histamina/administração & dosagem , Unidades de Terapia Intensiva , Serviço de Farmácia Hospitalar/organização & administração , Inibidores da Bomba de Prótons/administração & dosagem , Úlcera Gástrica/prevenção & controle , Centros Médicos Acadêmicos , Antagonistas dos Receptores H2 da Histamina/efeitos adversos , Antagonistas dos Receptores H2 da Histamina/economia , Humanos , Prescrição Inadequada/economia , Prescrição Inadequada/prevenção & controle , Inibidores da Bomba de Prótons/efeitos adversos , Inibidores da Bomba de Prótons/economia , Estudos Retrospectivos , Fatores de Risco , Úlcera Gástrica/economiaAssuntos
Hipersensibilidade a Drogas/etiologia , Ceratolíticos/imunologia , Medicamentos sem Prescrição/efeitos adversos , Ácido Salicílico/imunologia , Verrugas/tratamento farmacológico , Administração Cutânea , Adulto , Hipersensibilidade a Drogas/diagnóstico por imagem , Hipersensibilidade a Drogas/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Mãos/diagnóstico por imagem , Humanos , Ceratolíticos/administração & dosagem , Medicamentos sem Prescrição/administração & dosagem , Ácido Salicílico/administração & dosagem , Tomografia Computadorizada por Raios XAssuntos
Antivirais/efeitos adversos , Antivirais/uso terapêutico , Benzimidazóis/efeitos adversos , Benzimidazóis/uso terapêutico , Diabetes Mellitus/induzido quimicamente , Fluorenos/efeitos adversos , Fluorenos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Hepatite C/tratamento farmacológico , Sofosbuvir/efeitos adversos , Sofosbuvir/uso terapêutico , Idoso , Coinfecção , Humanos , Masculino , Resultado do TratamentoRESUMO
This case report describes a successful procedure involving pulmonary vein isolation (PVI) and left atrial appendage (LAA) closure with a watchman device in a 78-year-old male with atrial fibrillation and an interrupted inferior vena cava. Due to the vascular anomaly, a transhepatic approach was used, which proved successful.
Assuntos
Infecções por Adenoviridae/complicações , Infecções por Adenoviridae/diagnóstico , Hospedeiro Imunocomprometido , Pneumonia Viral/diagnóstico por imagem , Adenoviridae , Adulto , Evolução Fatal , Feminino , Humanos , Pneumonia Viral/complicações , Radiografia Torácica , Síndrome do Desconforto RespiratórioRESUMO
Angiosarcoma is a cancer that is derived from endothelial cells that line blood vessels and lymphatic channels. Cutaneous angiosarcoma can appear anywhere on the skin and the clinical presentation is highly variable. Most cases appear on the scalp and face de novo. Our case describes a 91-year-old female with cutaneous scalp angiosarcoma. Our case serves to remind physicians that an abnormal skin finding in older adults should raise their index of suspicion for angiosarcoma and an early biopsy should be performed.
RESUMO
Loperamide is an over-the-counter, peripherally acting, µ-opioid receptor agonist used for the treatment of diarrhea. In recent times users have found that at higher doses, loperamide crosses the blood-brain barrier and reaches central µ-receptors in the brain, leading to central opiate effects including euphoria and respiratory depression. We report a case of a 37-year-old female who attempted suicide with over 200 loperamide tablets. During her overdose, her QTc was significantly prolonged at >600 ms. Our case aims to add to the growing body of literature describing life-threatening ventricular arrhythmias associated with loperamide toxicity and further suggests that a metabolite of loperamide, desmethylloperamide, may play a role in the pathogenesis.