The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery.

Background: Postoperative pain is an important problem for patients undergoing shoulder surgery. Our study investigated analgesic efficacy, duration of analgesia, postoperative analgesic use and patient satisfaction with the use of preemptive intravenous dexketoprofen for interscalene block in addition to general anesthesia in arthroscopic shoulder surgery. Methods: 60 patients, scheduled for arthroscopic shoulder surgery were randomized (30 patients each) into either: - control group (Group1) or dexketoprofen group (Group 2). Patients were followed for 48 hours to compare both groups for; post-operative pain scores, effectiveness of postoperative analgesia, duration of analgesia, and analgesia consumption. Duration of postoperative sensory block of the shoulder joint was defined as time to onset of pain at the incision site. Duration of postoperative motor block of the shoulder joint was defined as time to onset of first shoulder movement. Results: While no significant difference was determined for motor block time, sensory block time was significantly longer in the dexketoprofen group (p < 0.05).VAS scores were significantly lower at all times in the dexketoprofen group (p < 0.05).Total PCA fentanyl consumption was 274.16 ± 314.89 (µg) in the dexketoprofen group, and 490.00 ± 408.98 (µg) in the control group, the difference was statistically significant (p < 0.05). No significant difference was observed between the groups' demographic and hemodynamic data. Conclusion: Pre-emptive IV dexketoprofen may be a good option for arthroscopic shoulder surgery and provides effective analgesia.

Compartment Syndrome of the Flexor Compartment of the Arm Secondary to Pectoralis Major Tendon Rupture.

Case. Compartment syndrome following muscle rupture is a rare entity with few mentions in the literature. We present a case of pectoralis major rupture in a 38-year-old male that evolved into compartment syndrome of the anterior compartment of the arm. Rupture of the pectoralis is uncommon and most often occurs during weight lifting. Compartment syndrome secondary to this injury is extremely uncommon, with only one reported case in the pectoralis major itself and several cases of biceps compartment syndrome. Due to the potentially devastating consequences of a missed compartment syndrome, it is imperative that physicians maintain a high level of suspicion in patients with these unusual injuries presenting with severe swelling and pain.

Implementation of sepsis management guideline in a community-based teaching hospital - can education be potentially beneficial for septic patients?

OBJECTIVE: To assess clinical outcomes associated with the implementation of the sepsis management guideline in a community-based hospital. In addition, evaluate the utility and effectiveness of a Sepsis Education Program. RESEARCH DESIGN AND METHODS: This is an observational cohort study of patients presenting to the Emergency Department at a community-based teaching centre meeting severe sepsis or septic shock criteria. A quality improvement programme consisting of a comprehensive Sepsis Education Program based on recommendations from the Surviving Sepsis Campaign was implemented and evaluated. Patients were identify by the admission diagnosis and were evaluated over two time periods (7/2003-6/2004 and 7/2005-6/2006) and to show clinical outcomes before and after implementation of the sepsis guideline/quality improvement programme. RESULTS: A total of 96 patients with severe sepsis (34 control group and 62 SSC group) were included. Both groups had similar intensive care unit (ICU)-length of stay (3 vs. 3 days, p = 0.647). Patients who required mechanical ventilation (MV) had similar MV time (4 vs. 3.5 days p = 0.349). A greater percentage of survival was found in the SSC group [45% vs. 73% (p = 0.006)]. Patient received similar care with regards to appropriate early antibiotics (85% vs. 90%, p 0.459). The main difference between the two group was the early fluid resuscitation (2 l vs. 3 l, p = 0.006) over the first 3 h and a difference remained significant at 6 h (4.2 l vs. 6.3 l, p = 0.013). CONCLUSIONS: In a community based teaching hospital, implementing the surviving sepsis campaign guideline through an education programme was feasible and resulted in early therapy with aggressive fluid administration and appropriate antibiotics. The Sepsis Education Program resulted in early therapeutic interventions and contributed to the survival benefits.

Acute respiratory distress syndrome complicating Plasmodium vivax malaria.

Malaria is one of the most common infectious diseases in the world, and severe respiratory complications have been described mainly in association with Plasmodium falciparum. We describe a case of acute respiratory distress syndrome complicating infection with P. vivax in the setting of relatively low parasitemia in a 47-yr-old woman after a brief trip to Papua New Guinea. A review of the literature shows that pulmonary complications of P. vivax are rare but occur more frequently than generally acknowledged. Pathogenic mechanisms of these complications are discussed.

Management of venous thromboembolic disease in the chronically critically ill patient.

Although PE is the most common preventable cause of death among U.S. hospital patients, proper treatment of thromboembolism and adequate prophylaxis in high-risk patients have been shown to be effective in saving lives. Because clinical symptoms and signs of thromboembolic disease are often nonspecific, early diagnosis and treatment rely on the capacity of physicians to adequately identify a patient at risk, choose the appropriate diagnostic modalities in a cost-effective fashion, and promptly initiate treatment. The diagnosis of VTE is particularly challenging in patients who are in the post acute period of a complex medical or surgical illness. Avenues that need to be further explored include various diagnostic tests such as spiral CT, MR imaging, and transesophageal echocardiography, which are less invasive than the present gold standard of pulmonary angiography. Also needed are better clinical data regarding the optimal choice of preventive therapy (e.g., unfragmented heparin or LMWH or mechanical devices) and clinical outcome of such therapy in patients with prolonged illness.