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1.
Hosp Pract (1995) ; 47(4): 177-180, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31594430

RESUMEN

Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data.Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California.Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group.Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0-1.2%, 5.3-44.8%, 0-0.3% and 0.6-16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL.Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.


Asunto(s)
Glucemia , Hospitales Rurales/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Monitoreo Fisiológico/normas , Sistemas de Atención de Punto/normas , Hospitales Rurales/normas , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Unidades de Cuidados Intensivos/normas , Estándares de Referencia , Índice de Severidad de la Enfermedad
2.
J Emerg Trauma Shock ; 12(2): 98-100, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31198275

RESUMEN

Objective: The objective of the study is to determine if marijuana, methamphetamine, or cocaine is associated with worse outcomes following trauma. Methods: A retrospective cross-sectional study was conducted on 731 trauma patients. Data collected from Natividad Medical Center's trauma registry were used to analyze reports of adult patients from July 1, 2014, to July 1, 2017. Analyzed endpoints were mortality, rates of major trauma, mean Injury Severity Score (ISS), and length of stay (LOS). Results: Odds ratios for mortality contained null value in each group. Odds ratios for suffering major trauma for marijuana and amphetamines were 1.2 and 2.6, respectively. P values for ISS were >0.05 for each group. P values for LOS were >0.05 for marijuana and cocaine and 0.01 for amphetamines. Conclusions: A positive screen for marijuana, amphetamine, or cocaine is not associated with increased mortality for victims of trauma. Amphetamines are associated with higher rates of major trauma and longer LOS. Marijuana is associated with higher rates of major trauma. Cocaine is not associated with the likelihood of suffering major trauma or length of stay.

3.
J Emerg Trauma Shock ; 12(1): 61-63, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31057287

RESUMEN

Trauma patients experience relative adrenal insufficiency or critical illness-related corticosteroid insufficiency (CIRCI) in majority of 60% of patients. It has been shown that both septic shock and trauma cause dysfunction of the hypothalamic-pituitary axis and, in some cases, structural damage to the adrenal glands themselves through hemorrhage or infarction. Empiric steroids are used commonly in patients with septic shock for patients who are refractory to fluids and vasopressors. Here, we present a unique case of a 40-year-old male with multisystem trauma who developed adrenal crisis treated by empiric stress-dose steroids. His history later revealed a history of hypopituitarism. Although data do not support the use of empiric steroids for trauma patients, this case illustrates an example where considering steroid use and keeping adrenal insufficiency and CIRCI in the differential can influence outcome.

5.
Bull Emerg Trauma ; 6(4): 325-328, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30402521

RESUMEN

Objective: To determine if there was any decrease in measures of injury severity or outcome with obese patients (body mass index greater than or equal to 30 kg/m2) as compared to non-obese patients (body mass index less than 30 kg/m2). Methods: We conducted a retrospective review of the trauma database maintained by Natividad Medical Center's Level 2-Trauma program. From July 1st, 2014 to July 1st, 2017 there were 371 cases of penetrating trauma in adults between the ages of 18-80 years old. Overall 311 patients had BMI data recorded. We divided these 311 patients into two groups: penetrating injury due to firearm (n= 198) and penetrating injury due to stabbing or piercing (n=113). We compared non-obese patients against obese patients for age, gender, Injury Severity Score (ISS), length of stay (LOS), Intensive Care Unit LOS, units of blood given, direct transfer from ED to operating room, and mortality. Results: A total of 311 patients were included in the study, 198 (63.6%) patients suffered from gunshot wounds and 113 (36.4) from stab or piercing wounds. The mean age was 33.6 ± 12.8 and there were 283 (91%) men among the victims. Overall 87 (28%) required emergent surgery and a 19 (6.1%) mortality rate was recorded. In the gunshot wound group there was no significant difference between non-obese and obese patients for age (p=0.400), gender (p=0.900), ISS (p=0.544), LOS (p=0.273), Intensive Care Unit LOS (p=0.729), units of blood given (p=0.300), or mortality (p=0.855). We found that in the stab or piercing group there was no significant difference between non-obese and obese patients for age (p=0.900), gender (p=0.900), ISS (p=0.580), LOS (p=0.839), Intensive Care Unit LOS (p=0.305), units of blood given (p=0.431), or mortality (p=0.321). Conclusion: Our findings indicate that in our patient population, there was no significant difference in markers of injury severity, morbidity, or mortality in adult non-obese patients as comparted with obese patients.  Furthermore, there was no significant difference between the two groups in operative rates, suggesting that obesity may not confer a protective effect in penetrating trauma.

6.
Bull Emerg Trauma ; 6(3): 217-220, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30090816

RESUMEN

Objective: To determine if there exists an upper limit for amount of blood transfused in trauma patients before it reaches a point of futility. Methods: A prospective cohort study was conducted on 131 patients who received massive blood transfusion (MBT), defined as 10 U or higher of PRBCs received in the initial 24 hours. Data collected from a Level II trauma center registry were used to analyze reports of adult patients from July 2014 to 2017. Cohorts were divided by amount of blood received - 0 to 9 U, 10-19 U, 20 to 29 U, 30-39 U, 40 U or higher - odds ratio for mortality and p-values for mean Injury Severity Score and overall hospital length of stay were calculated for each group. Results: Odds ratios for massive blood transfusion groups from 10 units to 39 units each contained the null value, while our 40 units and above group did not (OR 12.52, 95% CI 1.3-117.7). Conclusion: Although this study is limited by its sample size, these results suggests that 40 units of PRBCs may be a threshold at which survival rates begin to decrease significantly.

7.
Surg J (N Y) ; 4(2): e102-e104, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29922722

RESUMEN

Hemorrhagic cholecystitis is an uncommon form of acute cholecystitis which can be rapidly fatal. It may be hard to detect as it frequently presents with symptoms found in other, more common diagnoses. We report the case of a 63 year old man recently started on anticoagulation for deep vein thrombosis who was found to have hemorrhagic cholecystitis.

9.
J Burn Care Res ; 37(5): e493-6, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26284628

RESUMEN

Silver has had an important role in preventing burn-related infections for decades. Relatively few side effects is one factor that has led to its wide spread use. Here, the authors present the first case of argyria, acute leukopenia, and possibly acute kidney injury associated with the use of a silver-containing soft silicone foam dressing. A 56-year-old female was transferred to the burn center with an exfoliating skin condition involving 70% TBSA diagnosed as toxic epidermal necrolysis associated with trimethoprim/sulfamethoxazole. On presentation she appeared to have clinical sepsis and was started on vancomycin and piperacillin/tazobactam. Clinical sepsis resolved within several days. Initial wound care consisted of daily topical double antibiotic and 3% bismuth tribromophenate petroleum gauze. After several days, the wounds were covered with a silver-containing soft silicone foam dressing. After 7 days, the leukocyte count declined from 18,000 to 600/cm. Silver toxicity was suspected and the dressings removed. Initial serum silver level was 190 and 249 µg/L 1 week later. The leukocyte level normalized within 7 days. Over the following days and weeks, the patient's skin began to show blue-gray coloration consistent with argyria. The patient subsequently developed acute kidney injury requiring hemodialysis and multiple organ failure. Although controversy exists about the causal relationship between silver-containing dressings and leukopenia, the authors believe that this case represents a case of acute leukopenia and argyria from the use of a silver-containing soft silicone foam dressing. It may have been a contributing factor to the development of acute kidney injury as well.


Asunto(s)
Argiria/etiología , Vendajes/efectos adversos , Leucopenia/etiología , Siliconas/efectos adversos , Antiinfecciosos , Quemaduras/terapia , Femenino , Humanos , Persona de Mediana Edad
11.
Transl Lung Cancer Res ; 2(1): E25-8, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25806213

RESUMEN

Empyema necessitans is a rare complication of untreated pleural space infections. Untreated empyema that spontaneously burrows through the parietal pleura can present with a subcutaneous abscess. In the following case report, we present a 55 year old male who presented with an intermittent left chest mass later to be diagnosed as empyema necessitans. The patient suffered from a hemothorax treated by tube thoracostomy three years prior. The patient had been seen several times and no mass could be appreciated. The patient was diagnosed with empyema necessitans on computed tomography and treated with a left thoracotomy. Empyema necessitans can develop if pleural infections are left untreated. We present an unusual presentation of this rare complication. Empyema necessitans should be kept in the differential diagnosis of patients with left chest masses or abscesses.

12.
J Emerg Trauma Shock ; 5(4): 363-6, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23248512

RESUMEN

Scapulothoracic dissociation (STD) is a devastating consequence of high-energy trauma sustained by the shoulder girdle that can easily result in rapid mortality. Since described by Oreck et al. in 1984, STD has been reported in a handful of journals and individual case series, though is still considered a rare occurrence in the context of shoulder injuries. In this report, we examine the case of a 25-year-old female involved in a high-speed rollover auto accident. Unique to this case was the discovery of a completely transected axillary artery and vein with intracorporeal bleeding and complete avulsion of the ipsilateral brachial plexus requiring immediate ligation of the vessels followed by interval above-elbow-amputation and later glenohumeral disarticulation.

13.
West J Emerg Med ; 13(1): 100-2, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22461935

RESUMEN

Volvulus is an unusual condition in Western countries, generally isolated to elderly patients with multiple comorbidities. This report describes an unusual case of a very large gangrenous sigmoid volvulus in a young, otherwise healthy 25-year-old female. A review of the diagnosis and management is subsequently described. Without a consideration of the atypical demographics for sigmoid volvulus, the case illustrates the potential morbidity due to a delayed diagnosis. Early identification and management are crucial in treating sigmoid volvulus before the appearance of gangrene and necrosis, thereby avoiding further complications and associated mortality.

14.
Laryngoscope ; 122(5): 1031-4, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22294288

RESUMEN

OBJECTIVES/HYPOTHESIS: Since originally described in 1985 by Ciaglia, percutaneous dilational tracheostomy (PDT) has grown in popularity, and today is widely used for critically ill patients requiring long-term mechanical ventilation. Since the inception of PDT, obesity has been considered a relative contraindication to its use. The purpose of this study is to evaluate the risks of PDT in obese patients. STUDY DESIGN: Retrospective review. METHODS: A retrospective review was performed of prospectively collected data from 426 patients who underwent PDT at a single teaching institution from July 2003 to October 2009. The groups were separated into those who had a body mass index (BMI) of <30 or ≥30 kg/m(2) . The following variables were collected: blood loss at the time of procedure, difficulty in tracheotomy dilation and/or tracheostomy placement, presence of tracheal ring breaks, any bleeding episodes requiring treatment by surgery or blood transfusion, pre- and postprocedure pneumonia, and stoma infection requiring antibiotics. All tracheostomies were placed using the Ciaglia Blue Rhino Introducer Kit (Cook Medical Inc., Bloomington, IN). Statistical analysis was performed with nonparametric statistics using χ(2) testing with P < .05 as significant. RESULTS: No statistically significant difference was found between the obese and nonobese groups for any of the variables studied. Similar results were found when BMI of 40 was used for grouping. CONCLUSIONS: PDT can be performed safely in obese patients. There were no statistically significant differences in measured variables found between the two study groups. This study supports the use of intensive care unit bedside PDT in the obese population.


Asunto(s)
Broncoscopía/métodos , Enfermedad Crítica/terapia , Dilatación/métodos , Obesidad/terapia , Traqueostomía/métodos , Índice de Masa Corporal , Femenino , Humanos , Masculino , Respiración Artificial , Estudios Retrospectivos , Resultado del Tratamiento
15.
J Surg Res ; 173(2): 362-4, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21227457

RESUMEN

BACKGROUND: At our institution, we began using sodium acetate for resuscitation of trauma patients in 2005. Sodium acetate is used as an alternative to normal saline to help prevent hyperchloremic metabolic acidosis as well as to help buffer metabolic acidosis. DISCUSSION: Here we present a case of a 29-year-old trauma patient who began to have severe lactic acidosis after the infusion of sodium acetate. This is the first reported case of lactic acidosis caused by sodium acetate infusion. Up to this point, we have not experienced any adverse events and patients have tolerated sodium acetate well. CONCLUSION: This unique case report presents the first case of lactic acidosis from sodium acetate infusion. The lactic acidosis seen in this patient reminds us of the complex regulation of pyruvate dehydrogenase and the potential for down regulation of the enzyme shunting substrates to formation of lactate.


Asunto(s)
Acidosis Láctica/inducido químicamente , Resucitación/efectos adversos , Acetato de Sodio/efectos adversos , Adulto , Humanos , Masculino
16.
Surg Infect (Larchmt) ; 12(4): 317-20, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21859335

RESUMEN

BACKGROUND: Over the past decade, there has been an increase in both community-acquired and health-care-associated Clostridium difficile colitis secondary to broad-spectrum antibiotic exposure. Toxic megacolon is a rare complication of pseudomembranous colitis that often necessitates emergency colectomy. METHODS: Review of the pertinent English-language literature. RESULTS: We present a case of community-acquired C. difficile colitis that made its initial presentation as fulminant toxic megacolon. Six months after a total colectomy, the patient has no complaints. CONCLUSION: Prompt total colectomy may improve survival in patients with toxic megacolon. The incidence of C. difficile-related toxic megacolon and post-operative outcomes of total colectomy should be investigated in a larger observational study.


Asunto(s)
Clostridium difficile/aislamiento & purificación , Infecciones Comunitarias Adquiridas/cirugía , Enterocolitis Seudomembranosa/cirugía , Megacolon Tóxico/cirugía , Colectomía , Infecciones Comunitarias Adquiridas/complicaciones , Enterocolitis Seudomembranosa/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
17.
Scand J Trauma Resusc Emerg Med ; 19: 24, 2011 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-21486493

RESUMEN

INTRODUCTION: Sodium acetate has been shown to cause hemodynamic instability when used as a hemodialysis buffer. The pattern of hemodynamic response to injury will be evaluated between those who received sodium acetate and those who did not.The primary purpose of the study is to analyze the effect of sodium acetate on hemodynamic parameters. Secondarily we looked at the effects on prevention and treatment of hyperchloremic metabolic acidosis. METHODS: The study arm was comprised of patients who had received sodium acetate infusions in place of normal saline between March 2005 and December 2009. A control arm was created based on matching three pre-treatment variables: injury severity score (ISS), pH (+/- 0.03) and base deficit (+/- 3). A retrospective chart review was performed for patients in both arms. Blood pressure, arterial blood gas data and chemistry values were recorded for the time points of -6, -1, 0, 1, 6, 12, 24, 48, and 72 hours from start of sodium acetate infusion. Patients were excluded based on the following criteria: patients who were given sodium bicarbonate within 48 hours of starting sodium acetate, those given sodium acetate as a bolus, non-trauma patients, burn patients, patients who expired within 24 hours of arrival to the ICU, patients diagnosed with rhabdomyolysis and patients whose medical record could not be obtained. RESULTS: A total of 78 patients were included in the study, 39 in the study arm and 39 in the control arm. There were no statistically significant drops in blood pressure within either group. The median pH between the two groups at the start of infusion was equal. Both groups trended towards normal pH with the study arm improving faster than the control arm. The median serum bicarbonate at start of sodium acetate infusion was 19 mmol/L and 20 mmol/L at time zero for the study and control arms respectively with both trending upward during the study period. Chloride trended up initially in both groups but the study arm began to correct sooner at 24 hours compared to 48 hours for the control arm. CONCLUSION: We analyzed the use of sodium acetate as an alternative to normal saline or lactated ringers during resuscitation of critically ill trauma patients at a single center. Our data shows that the hemodynamic profile remained favorable, without evidence of instability at any point during the study period. Normalization of hyperchloremia and metabolic acidosis occurred faster in the patients who received sodium acetate.


Asunto(s)
Equilibrio Ácido-Base/efectos de los fármacos , Acidosis/tratamiento farmacológico , Enfermedad Crítica , Acetato de Sodio/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Estudios Retrospectivos , Acetato de Sodio/farmacología , Adulto Joven
18.
Breast Dis ; 31(1): 49-52, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20519804

RESUMEN

Giant fibroadenomas are a rare form of fibroadenoma that present as rapidly enlarging breast masses. They are typically greater than 5 cm or 500 grams in size and most frequently are seen in premenopausal Afro-Caribbean or East Asian females. This unique case report presents a 22-year-old female who presented with an enlarging breast mass measuring 23 × 28 cm. After core needle biopsy, the mass was diagnosed as a giant fibroadenoma and treated surgically with mastectomy. After a 5 year follow up she has not reported any signs of recurrence of the mass.


Asunto(s)
Neoplasias de la Mama/patología , Fibroadenoma/patología , Adulto , Neoplasias de la Mama/cirugía , Femenino , Fibroadenoma/cirugía , Humanos , Mastectomía , Adulto Joven
19.
Surg Laparosc Endosc Percutan Tech ; 18(2): 209-12, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18427345

RESUMEN

This case represents the first laparoscopic removal of a gallbladder containing a polypoid cystadenoma, which had prolapsed into the common bile duct. During the operation it was necessary to reduce the prolapsed polyp out of the cystic duct back into the gallbladder. The gallbladder was removed and the specimen was identified as cystadenoma on pathologic review. Only 7 gallbladder cystadenomas have been previously reported in literature. Although this is the second reported gallbladder cystadenoma to cause intrinsic obstruction of the common bile duct, it is the first to be treated with a minimally invasive laparoscopic cholecystectomy.


Asunto(s)
Colecistectomía Laparoscópica , Enfermedades del Conducto Colédoco/etiología , Cistoadenoma/complicaciones , Cistoadenoma/cirugía , Neoplasias de la Vesícula Biliar/complicaciones , Neoplasias de la Vesícula Biliar/cirugía , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Conducto Colédoco/patología , Cistoadenoma/patología , Dilatación Patológica , Femenino , Neoplasias de la Vesícula Biliar/patología , Humanos
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