J Trauma
-
Personal watercraft (PWC) are in widespread and growing use. Injuries involving PWC have been reported, but to date no report has focused on spine injuries as a result of this activity. ⋯ There is a mechanism of injury in PWC use where axial loading may cause thoracolumbar fracture. The public and physicians should be aware of the risks involved in the use of personal watercraft.
-
Continuous monitoring of pH, Pco2, and Po2 using fiberoptic sensor technology has been proposed recently as a clinical monitor of the severity of shock and impaired tissue perfusion. Surrogates of gut tissue perfusion such as gastric tonometry, although cumbersome, have been used to indirectly quantify the degree of gut ischemia. The purpose of this study was to demonstrate the feasibility of monitoring bladder mucosa (BM) and to compare urinary bladder mucosa and proximal jejunum mucosa interstitial pH and Pco2 during hemorrhagic shock and resuscitation. ⋯ Shock-induced changes in the Pco2 of the BM are comparable to tonometric changes in the gut. These data suggest that continuous fiberoptic multisensor probe monitoring of the BM could potentially provide a minimally invasive method for the assessment of impaired tissue perfusion of the splanchnic circulation during shock and resuscitation.
-
Patients with head injuries frequently have abnormal coagulation studies. Monitoring intracranial pressure (ICP) in head injured patients is common practice, but no best practice guidelines exist for coagulation parameters for ICP monitor placement. ⋯ In patients with INR
-
Our purpose was to study the effects of drainage of significant pleural effusions in mechanically ventilated patients in a surgical intensive care unit. ⋯ Drainage of pleural effusions results in increased oxygen delivery and oxygen consumption coinciding with a decrease in pulmonary capillary wedge pressure. The pulmonary arteriovenous shunt decreased, implying an increase in functional residual capacity and improved oxygenation. Further study is needed to determine whether these changes lead to an improved patient outcome (i.e., reduction in length of stay, ventilator days, or mortality).
-
Physician payment by Medicare is based on a Resource-Based Relative Value Scale (RBRVS). The Correct Coding Initiative (CCI) was introduced to counter unbundling by pairing component procedures with more comprehensive procedures. We hypothesized that Medicare's rebundling process ignored relative value concepts. ⋯ A relative value scale depends upon equity in value units. Disregarding RVUs when bundling services and procedures results in severe physician underpayment.