Articles: operative.
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Critical care medicine · May 2018
Comparative Study Observational StudyReporting of Sepsis Cases for Performance Measurement Versus for Reimbursement in New York State.
Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database. ⋯ Approximately four of five discharges with a diagnosis code of severe sepsis or septic shock in the Statewide Planning and Research Cooperative System data were reported in the New York State Department of Health Sepsis Clinical Database. Incomplete reporting appears to be driven more by underrecognition than attempts to game the system, with minimal bias to risk-adjusted hospital performance measurement.
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Should Percussion Pacing Have a Role in Perioperative Advanced Cardiac Life Support?: A Case Report.
Percussion pacing involves using one's fist to repeatedly strike a patient's left sternal border in a rhythmic manner. The resulting increase in ventricular pressure can trigger myocardial depolarization and subsequent contraction. We describe the successful treatment of acute preoperative symptomatic sinus bradycardia with percussion pacing in a 63-year-old patient scheduled for placement of a gastric feeding tube after trauma involving spinal cord injury. Although no longer included in current advanced cardiovascular life support guidelines, percussion pacing may be a suitable alternative to chest compressions in multitrauma cases where the force of compressions could cause further complications.
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Randomized Controlled Trial
Effects of Ambient Temperature and Forced-air Warming on Intraoperative Core Temperature: A Factorial Randomized Trial.
The effect of ambient temperature, with and without active warming, on intraoperative core temperature remains poorly characterized. The authors determined the effect of ambient temperature on core temperature changes with and without forced-air warming. ⋯ Ambient intraoperative temperature has a negligible effect on core temperature when patients are warmed with forced air. The effect is larger when patients are passively insulated, but the magnitude remains small. Ambient temperature can thus be set to comfortable levels for staff in patients who are actively warmed.
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Anesthesia and analgesia · May 2018
Randomized Controlled Trial Multicenter StudyRandomized Clinical Trial of Preoperative High-Dose Methylprednisolone on Postoperative Pain at Rest After Laparoscopic Appendectomy.
Methylprednisolone administered intravenously preoperatively has been shown to reduce pain, nausea, and fatigue after elective surgery. We aimed to show that 125 mg of methylprednisolone given intravenously 30 minutes before laparoscopic surgery for suspected appendicitis would reduce pain at rest during the first 3 postoperative days. ⋯ A 125-mg dose of methylprednisolone given intravenously 30 minutes before laparoscopic surgery for appendicitis seemed no better than placebo at providing a clinical meaningful reduction in postoperative pain at rest.
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Anesthesia and analgesia · May 2018
Randomized Controlled Trial Multicenter Study Comparative StudyVideolaryngoscopy for Physician-Based, Prehospital Emergency Intubation: A Prospective, Randomized, Multicenter Comparison of Different Blade Types Using A.P. Advance, C-MAC System, and KingVision.
Videolaryngoscopy is a valuable technique for endotracheal intubation. When used in the perioperative period, different videolaryngoscopes vary both in terms of technical use and intubation success rates. However, in the prehospital environment, the relative performance of different videolaryngoscopic systems is less well studied. ⋯ During prehospital emergency endotracheal intubation performed by emergency physicians, success rates of 3 commercially available videolaryngoscopes A.P. Advance, C-MAC PM, and KingVision varied markedly. We also found that although any of the videolaryngoscopes provided an adequate view, actual intubation was more difficult with the channeled blade KingVision.