The Ochsner journal
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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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The most common cause of recurring lost time from work, low back pain is a huge burden on society. Medical training dictates that we must establish a cause for pain before we can treat it and then base our treatment on a recognized and agreed-upon pathology. But in the overwhelming majority of low back pain cases, the issue is nothing more than a minor mechanical malfunction, the inevitable consequence of normal wear and tear. The severity of the pain does not reflect the benign nature of the underlying problem and its limited extent makes a definitive diagnosis impossible. One important component of the solution is improved spinal triage. Using patterns or syndromes in the initial assessment of low back pain is gaining renewed interest and clinical acceptance. ⋯ A clinical perspective capable of recognizing a defined syndrome at first contact will lead to a better outcome. Most patients with low back pain can be treated successfully with simple, pattern-specific, noninvasive primary management. Patients without a pattern and those who do not respond as anticipated require further investigation and specialized care.
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The Ochsner journal · Jan 2014
Intraoperative and Postoperative Blood Glucose Concentrations in Diabetic Surgical Patients Receiving Lactated Ringer's Versus Normal Saline: A Retrospective Review of Medical Records.
Hyperglycemia is associated with poor postoperative outcomes after carotid endarterectomy. This retrospective study examined the effect of lactated Ringer's and normal saline solutions on intraoperative blood glucose control in diabetic patients undergoing carotid endarterectomy. ⋯ Lactated Ringer's solution does not appear to cause a significant change in the mean blood glucose levels in diabetic patients undergoing carotid endarterectomy compared to patients receiving normal saline. Randomized controlled trials are needed to further determine whether lactated Ringer's solution adversely affects glucose control in diabetic surgical patients.
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The Ochsner journal · Jan 2014
Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment.
Few studies have examined threshold improvements in health-related quality of life (HRQOL) by measuring minimal clinically important differences (MCIDs) in treatment of adult spinal deformity. We hypothesized that patients undergoing operative treatment would be more likely to achieve MCID threshold improvement compared with those receiving nonoperative care, although a subset of nonoperative patients may still reach threshold. ⋯ Patients in both the operative and nonoperative treatment groups demonstrated improvement in at least one HRQOL measure at 1 year. However, surgical treatment was more likely to result in threshold improvement and more likely to lead to simultaneous improvement across multiple measures of ODI, SF-36, and SRS-22. Although a subset of nonoperative patients achieved threshold improvement, nonoperative patients were significantly less likely to improve in multiple HRQOL measures and more likely to sustain MCID deterioration or no change.
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The Ochsner journal · Jan 2014
Urgent cesarean section in a patient with a spinal cord stimulator: implications for surgery and anesthesia.
Spinal cord stimulation used in the treatment of chronic pain is offered to women of child-bearing age. This practice warrants special consideration on the part of the obstetricians and anesthesiologists charged with their care. ⋯ Accepted approaches to managing labor and delivery-such as neuraxial anesthesia and analgesia-need not be denied patients with spinal cord stimulators. Whenever possible, however, the pain specialist should communicate the specific characteristics of the implanted device to the team who will manage the patient in the peripartal period.