Trending Articles
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We describe successful pain control in a patient suffering from severe pain, using an opioid combination of transdermal fentanyl and oral oxycodone. A woman in her 40s with a giant-cell tumor of the sacrum suffered from refractory 4-5/5 pain on the Wong-Baker faces pain rating scale in her sacrum, feet and legs. Despite administration of fentanyl (2,520 microg day(-1)), she could not sleep in the supine position due to pain and dysesthesia. ⋯ Hence, we reduced the oral oxycodone dose and began a combination of transdermal fentanyl and oral oxycodone in addition to increasing doses of pregabalin. With the combination of transdermal fentanyl (25 microg x hr(-1)) and oral oxycodone (60 mg x day(-1)) her pain decreased to 1-3/5 on the faces pain rating scale. Our experience suggests that an opioid combination may provide favorable pain control in patients with severe pain, while minimizing the side effects of each drug.
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J Health Hum Serv Adm · Jan 2004
Mergers and the new workplace: the effects of a merger of two emergency departments on nursing staff.
Even small mergers have big consequences. This case study demonstrates the complex nature of organizational change found even in small organizational subunits and provides important insight for managers and leaders who have completed or are considering such mergers. The study examined the amalgamation of two emergency departments. ⋯ However, the nurses experienced stress due to the pace of work and the physical layout of the newly renovated department. The findings also suggest that personal-level problems that the nurses experienced were consistent with the consequences of survivor's syndrome, the psychological contract, and communication issues. It was recommended that the organization undertake initiative to alleviate these stresses.
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We describe a case in which fibrinogen concentrate was useful to improve anticoagulation after aortic graft replacement. A 44-year-old man with left ventricular assist system (LVAS) underwent thoracic abdominal aortic aneurysm (TAAA) graft replacement. LVAS requires anticoagulant therapy for thromboprophylaxis. ⋯ Three hours after administration of fibrinogen concentrate, TAAA graft replacement operation was finished. Ten days after the surgery, he was discharged from the ICU. Fibrinogen concentrate might be useful in difficult hemostasis reducing consumption of blood preparations.
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Epiglottic cysts often cause difficulty in airway management. A 71-year-old man had extraction for an epiglottic cyst of 4 cm in diameter. Anesthesia was induced with small divided doses of propofol. ⋯ The operation was finished in 55-min and the patient was extubated 15 min after the end of the operation. His postoperative course was uneventful and he was discharged from the hospital three days after the operation. The authors conclude that the combined use of the laryngoscope and Trachlight is helpful for endotracheal intubation in patients with large epiglottic cysts.
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Aviat Space Envir Md · May 1997
Hyperthermia-induced cardiac arrest in monkeys: limited efficacy of standard CPR.
Successful resuscitation from heatstroke cardiopulmonary arrest has been only partially explored and the data covering the post resuscitation pathophysiology leading to secondary arrest is, in most cases, insufficient. ⋯ We conclude that experimentally-induced heatstroke can be transiently reversed by standard resuscitative procedures, but is followed by a delayed, irreversible, secondary shock state, which could not be prevented by the treatment we employed. We were, however, able to document in detail the pathophysiologic processes involved in the resuscitation, and the irreversible shock one sees after "successful" CPR.