The Ochsner journal
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The Ochsner journal · Jan 2014
ReviewFuture management of carotid stenosis: role of urgent carotid interventions in the acutely symptomatic carotid patient and best medical therapy for asymptomatic carotid disease.
Stroke is the fourth leading cause of death in the United States, leading to devastating disability. Most strokes are ischemic, and nearly one-third of these are caused by carotid disease. The primary mechanism of carotid-related stroke is an atheroembolic event from an unstable atherosclerotic plaque rupture. In the 1990s, randomized trials demonstrated the benefit of carotid endarterectomy (CEA) in reducing the risk of stroke in both symptomatic and asymptomatic carotid disease. ⋯ CAS has an increasingly higher risk of stroke with advancing age. Patients treated with CAS have a 1.76-fold increased risk of stroke (95% CI, 1.35-2.31) with each 10-year increase in age. No such age effect is seen in patients treated with CEA. Age is a critical variable in making informed choices regarding treatment of severe carotid artery stenosis.
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The Ochsner journal · Jan 2014
Ultrasound imaging for endotracheal tube repositioning during percutaneous tracheostomy in a cadaver model: a potential teaching modality.
Percutaneous tracheostomy (PCT) is a widely accepted method for the insertion of a tracheostomy tube in a critically ill patient. Because a patient's preexisting endotracheal tube is manipulated during the procedure, premature extubation with potential catastrophic loss of airway control is a risk. As portable ultrasound imaging becomes increasingly useful in the critical care setting, investigations continue to determine the safety of PCT with the technology. ⋯ Ultrasound can be used to identify an endotracheal tube cuff during a PCT, and repositioning the endotracheal tube under ultrasound guidance could decrease the risk of accidental extubation. This approach to PCT may be used in a cadaveric model to teach anatomy and procedural skills to learners and possibly further adopted in real patients to improve the overall safety profile of the PCT procedure.
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Serotonin syndrome is a potentially life-threatening syndrome that is precipitated by the use of serotonergic drugs and overactivation of both the peripheral and central postsynaptic 5HT-1A and, most notably, 5HT-2A receptors. This syndrome consists of a combination of mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity. Serotonin syndrome can occur via the therapeutic use of serotonergic drugs alone, an intentional overdose of serotonergic drugs, or classically, as a result of a complex drug interaction between two serotonergic drugs that work by different mechanisms. A multitude of drug combinations can result in serotonin syndrome. ⋯ Many commonly used medications have proven to be the culprits of serotonin syndrome. Proper education and awareness about serotonin syndrome will improve the accuracy of diagnosis and promote the institution of the appropriate treatment that may prevent significant morbidity and mortality.
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The Ochsner journal · Jan 2013
ReviewHouse Staff Quality Council: One Institution's Experience to Integrate Resident Involvement in Patient Care Improvement Initiatives.
Residents and fellows perform a large portion of the hands-on patient care in tertiary referral centers. As frontline providers, they are well suited to identify quality and patient safety issues. As payment reform shifts hospitals to a fee-for-value-type system with reimbursement contingent on quality outcomes, preventive health, and patient satisfaction, house staff must be intimately involved in identifying and solving care delivery problems related to quality, outcomes, and patient safety. Many challenges exist in integrating house staff into the quality improvement infrastructure; these challenges may ideally be managed by the development of a house staff quality council (HSQC). ⋯ Academic medical centers should consider establishing HSQCs to align institutional quality goals with residency training and medical education.