RESUMO
ABSTRACT: By early 2020, the novel SARS-CoV-2 virus (COVID-19) was spreading rapidly worldwide, and its effects proved devastating. In many critically ill patients afflicted with COVID-19, treatment often involves prolonged periods of proning that, along with other interventions, can lead to improved oxygenation. However, sustaining this position predisposed patients to increased complications. We present a case of an older patient with respiratory failure secondary to COVID-19 who developed rapidly forming facial and knee wounds and a brachial plexus injury from proning. The pressure injuries were unresponsive to standard wound care treatments and resulted in full-thickness wounds. During outpatient posthospital follow-up, a facial eschar was debrided, and weakness of the left shoulder and arm secondary to a brachial plexus injury was identified. This case highlights various complications associated with prolonged proning and the importance of close attention to follow-up by both inpatient and outpatient providers.
RESUMO
1. Developing and implementing an intensive interdisciplinary medical home within a large academic medical center was feasible. 2. Deploying a complex care management program that shared staff and resources with an intensive primary care program was not successful. 3. Barriers included traversing legal barriers to text messaging patients, making hospital consults feasible financially, managing challenging patients, team wellness, provider back up, managing homebound patients, and discharging patients. 4. Although expensive, this model may have hidden benefits including improved patient satisfaction, quality of care, and providing a solid care system for a health system's most challenging and vulnerable population.
Assuntos
Cuidados Críticos , Assistência Centrada no Paciente , Centros Médicos Acadêmicos , Humanos , Satisfação do Paciente , Encaminhamento e ConsultaRESUMO
En la Argentina no existen datos epidemiológicos sobre displasia fibromuscular. La realización de un registro nacional puede aportar información que conduzca a una actualización de los consensos y recomendaciones para un correcto diagnóstico, evaluación y tratamiento. El Registro Argentino de Displasia Fibromuscular (SAHARA-DF) inició su actividad de recopilación de datos en octubre de 2015. Al año 2019 se confirmaron 49 pacientes (44 mujeres, 38 hipertensos, edad 45,3 ± 17,2 años, 12 con presentación neurológica). Veintidós pacientes tuvieron lesiones vasculares en más de un sitio, a pesar del sesgo diagnóstico por falta de estudios complementarios en casi la mitad de los casos. El sitio afectado más frecuente fue el renovascular, seguido por el carotídeo y el ilíaco, y las lesiones multifocales fueron más frecuentes que las unifocales (35 versus 14, respectivamente). Se constató la presencia de aneurismas asociados en 13 casos y disección arterial en 4 casos. De las 22 angioplastias renales realizadas, 14 fueron con colocación de stent (endoprótesis). En este estudio preliminar de una población argentina se evidencia el carácter sistémico de la enfermedad y se plantea un llamado a actuar en cuanto a la necesidad de debatir el algoritmo diagnóstico y el método de tratamiento. (AU)
In Argentina there are no epidemiological data regarding fibromuscular dysplasia. Building a National Registry may provide information leading to updated consensus and recommendations for a correct diagnosis, assessment and treatment. Data gathering for the Argentine Registry of Fibromuscular Dysplasia (SAHARA-DF) was initiated in October 2015. By 2019, 49 patients were confirmed (44 women, 38 hypertensives, age 45.3 ± 17.2 years, 12 with a neurological presentation). Twenty-two patients had multi-site vascular lesions, in spite of a diagnosis bias due to lack of supporting studies in almost half of the cases. The renovascular site was the most affected, followed by the carotid and iliac sites, and multifocal lesions were more frequent than unifocal (35 versus 14, respectively). Associated aneurysms were found in 13 cases, and arterial dissection in 4. Twenty-two renal angioplasties were performed, 14 with stent placement. In this preliminary study of an Argentinian population, the systemic nature of the disease is evidenced, and a call for action arises regarding the need for discussing the diagnostic algorithm and treatment method. (AU)
