RESUMO
Cardiac tamponade is a rare complication following orthotopic liver transplantation (OLT). The incidence and treatment specific to the immediate postoperative OLT patient have never been reported. Here, we describe a case of OLT complicated by coagulopathy and difficult intraoperative pulmonary artery catheter placement with subsequent postoperative hemopericardium resulting in tamponade. An emergent, ultrasound-guided, lateral-apical pericardiocentesis was successfully performed, suggesting a possible procedural technique for pericardiocentesis in the immediate postoperative period for liver transplant patients.
RESUMO
ABSTRACT: The coronavirus disease 2019 (COVID-19) pandemic has required swift implementation of innovative practices in health care across the globe. We describe a nurse practitioner (NP) and physician assistant (PA)-led initiative to implement telemonitoring (TM) of noncritical patients with COVID-19 by critical care NPs and PAs (C19TM) for early detection of decompensation and early transfer to the intensive care unit (ICU). Every hospitalized patient with suspected or confirmed COVID-19 received an initial telemedicine consult with a critical care NP or PA. Patients were subsequently monitored via electronic health record once every 12-hour shift for the following indicators: oxygen modality and flow, increase in oxygen requirements, sustained tachypnea, and hemodynamic instability. If signs of decompensation were noted, the NP/PA would remotely reassess the patient, provide recommendations to the hospital internal medicine team, and transfer the patient to the ICU. The primary goal was to avoid cardiopulmonary deterioration requiring aerosol-generating procedures outside of the ICU. Over 65 days, 113 patients (86 suspected and 27 confirmed) were enrolled in C19TM. As a result, there were 13 transfers to the ICU, none of which required an aerosol-generating procedure outside of the ICU.