The internal educational program (IEP) of Vanderbilt University's Division of Trauma, Emergency Surgery and Surgical Critical Care aims to provide educational opportunities on topics related to trauma care from pre-hospital care to post-discharge requirements. The IEP will explore various areas of interest throughout the year and outline the full continuum of care provided to trauma patients. The IEP involves the trauma team, which consists of physicians, nurses, and other specialists from various departments. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
This document reviews mortality from maxillofacial trauma. It discusses several potential causes of life-threatening complications or death following maxillofacial injuries, including airway obstruction, massive bleeding, or undiagnosed cervical spine injuries. It also examines specific situations that may adversely affect the airway, such as soft tissue swelling, displaced fractures causing airway blockage, or trauma to the larynx or trachea. The management of airway is crucial in maxillofacial trauma patients, as a compromised airway can lead to death.
This document contains summaries of multiple studies that have found associations between red blood cell transfusions and negative health outcomes in critically ill and surgical patients. Specifically:
- 42 of 45 observational studies found that the risks of red blood cell transfusions outweighed the benefits for adult intensive care unit, trauma and surgical patients. Transfusions were associated with increased mortality, infections, multi-organ dysfunction and acute respiratory distress syndrome.
- Pooled analyses found odds ratios of 1.7 for mortality, 1.8 for infections, and 2.5 for acute respiratory distress syndrome in patients who received red blood cell transfusions.
- Transfusions appeared to have dose-dependent relationships with negative outcomes, with each additional unit
Association Between Warfarin with common sulfonylureas and HypoglycemiaBhargav Kiran
This study analyzed medical claims data from 465,918 Medicare beneficiaries aged 65 and older with type 2 diabetes who were prescribed glipizide or glimepiride between 2006-2011. The study found that among quarters where these sulfonylureas were used, hospital admissions or emergency department visits for hypoglycemia were more common in quarters where warfarin was also used compared to quarters without warfarin use. Concurrent use of warfarin and the sulfonylureas was also associated with increased risk of fall-related fractures and altered consciousness or mental status. The risk of hypoglycemia from concurrent use was higher in patients starting warfarin and those aged 65-74. The study suggests the possibility of
This document discusses vascular access complications from central venous catheterization and arterial catheterization in emergency medicine settings. It summarizes that approximately 8% of emergency department patients require invasive vascular access procedures. Central lines are commonly used for resuscitation, medications, dialysis, and monitoring but can cause infections, thrombosis, embolism, and injury. Infectious complications like central line-associated bloodstream infections occur in 0.5-1.2% of central line patients and increase costs and hospital stays. Proper technique and guidelines have reduced infection rates. Thrombotic complications also occur and increase risks of infection, embolism, and complications.
The document discusses consent forms and the Glasgow Coma Scale. It states that consent forms are used in medical procedures to document that the patient understands the risks and benefits and gives permission. The Glasgow Coma Scale is a neurological scale used to assess consciousness after head injuries by evaluating verbal, eye, and motor responses on a scale of 3 to 15, with lower scores indicating more severe brain injury. It is commonly used in emergency services but has limitations if other factors are altering consciousness.
1) The speaker discusses the evidence and guidelines for treating sepsis put forth by the Surviving Sepsis Campaign (SSC), noting that while some elements like antibiotics are strongly evidenced, other physiological targets like CVP are weakly evidenced and may not be suitable for all patients.
2) Compliance with SSC bundles is low even in committed institutions, suggesting the guidelines are difficult to follow or clinicians disagree with some aspects.
3) Attempts to protocolize care need to allow clinical judgment based on the individual patient's full clinical picture rather than strict adherence to bundles.
This guideline provides evidence-based recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage (ICH). ICH can cause rapid neurological deterioration in the first few hours after onset, so early aggressive care is important. The guideline covers prehospital and emergency department management, hemostasis, blood pressure control, surgical treatment, predicting outcomes, rehabilitation, and preventing recurrence. The goal is to establish a framework for goal-directed treatment to improve outcomes for patients with ICH.
This study summarizes the experience of an Australian helicopter emergency medical service conducting prehospital blood transfusions over 5 years. It found that 147 patients received prehospital blood transfusions, most being male (69%) with blunt trauma. The median heart rate (115 bpm) and blood pressure (80 mmHg) indicated patients were often hemodynamically unstable. A total of 382 units of blood were transfused with no early transfusion reactions noted. The study concludes that prehospital blood transfusion using a physician-led helicopter service is feasible and safe.
This document reviews mortality from maxillofacial trauma. It discusses several potential causes of life-threatening complications or death following maxillofacial injuries, including airway obstruction, massive bleeding, or undiagnosed cervical spine injuries. It also examines specific situations that may adversely affect the airway, such as soft tissue swelling, displaced fractures causing airway blockage, or trauma to the larynx or trachea. The management of airway is crucial in maxillofacial trauma patients, as a compromised airway can lead to death.
This document contains summaries of multiple studies that have found associations between red blood cell transfusions and negative health outcomes in critically ill and surgical patients. Specifically:
- 42 of 45 observational studies found that the risks of red blood cell transfusions outweighed the benefits for adult intensive care unit, trauma and surgical patients. Transfusions were associated with increased mortality, infections, multi-organ dysfunction and acute respiratory distress syndrome.
- Pooled analyses found odds ratios of 1.7 for mortality, 1.8 for infections, and 2.5 for acute respiratory distress syndrome in patients who received red blood cell transfusions.
- Transfusions appeared to have dose-dependent relationships with negative outcomes, with each additional unit
Association Between Warfarin with common sulfonylureas and HypoglycemiaBhargav Kiran
This study analyzed medical claims data from 465,918 Medicare beneficiaries aged 65 and older with type 2 diabetes who were prescribed glipizide or glimepiride between 2006-2011. The study found that among quarters where these sulfonylureas were used, hospital admissions or emergency department visits for hypoglycemia were more common in quarters where warfarin was also used compared to quarters without warfarin use. Concurrent use of warfarin and the sulfonylureas was also associated with increased risk of fall-related fractures and altered consciousness or mental status. The risk of hypoglycemia from concurrent use was higher in patients starting warfarin and those aged 65-74. The study suggests the possibility of
This document discusses vascular access complications from central venous catheterization and arterial catheterization in emergency medicine settings. It summarizes that approximately 8% of emergency department patients require invasive vascular access procedures. Central lines are commonly used for resuscitation, medications, dialysis, and monitoring but can cause infections, thrombosis, embolism, and injury. Infectious complications like central line-associated bloodstream infections occur in 0.5-1.2% of central line patients and increase costs and hospital stays. Proper technique and guidelines have reduced infection rates. Thrombotic complications also occur and increase risks of infection, embolism, and complications.
The document discusses consent forms and the Glasgow Coma Scale. It states that consent forms are used in medical procedures to document that the patient understands the risks and benefits and gives permission. The Glasgow Coma Scale is a neurological scale used to assess consciousness after head injuries by evaluating verbal, eye, and motor responses on a scale of 3 to 15, with lower scores indicating more severe brain injury. It is commonly used in emergency services but has limitations if other factors are altering consciousness.
1) The speaker discusses the evidence and guidelines for treating sepsis put forth by the Surviving Sepsis Campaign (SSC), noting that while some elements like antibiotics are strongly evidenced, other physiological targets like CVP are weakly evidenced and may not be suitable for all patients.
2) Compliance with SSC bundles is low even in committed institutions, suggesting the guidelines are difficult to follow or clinicians disagree with some aspects.
3) Attempts to protocolize care need to allow clinical judgment based on the individual patient's full clinical picture rather than strict adherence to bundles.
This guideline provides evidence-based recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage (ICH). ICH can cause rapid neurological deterioration in the first few hours after onset, so early aggressive care is important. The guideline covers prehospital and emergency department management, hemostasis, blood pressure control, surgical treatment, predicting outcomes, rehabilitation, and preventing recurrence. The goal is to establish a framework for goal-directed treatment to improve outcomes for patients with ICH.
This study summarizes the experience of an Australian helicopter emergency medical service conducting prehospital blood transfusions over 5 years. It found that 147 patients received prehospital blood transfusions, most being male (69%) with blunt trauma. The median heart rate (115 bpm) and blood pressure (80 mmHg) indicated patients were often hemodynamically unstable. A total of 382 units of blood were transfused with no early transfusion reactions noted. The study concludes that prehospital blood transfusion using a physician-led helicopter service is feasible and safe.
This document summarizes the limitations of the current Dallas criteria for diagnosing myocarditis based on histopathological examination of endomyocardial biopsies. There is considerable sampling error and variability between expert pathologists in interpreting biopsies. Additionally, virus can be present in cardiac tissue without meeting Dallas criteria. Alternative criteria including clinical presentation, viral detection, and immune markers may better identify patients with viral or post-viral myocarditis who could benefit from immune modulation therapy. The diagnosis of myocarditis and causes of new-onset heart failure need to be redefined using a multi-disciplinary approach.
The Prevalence of Hcv Infection among Renal Failure Patients Before Starting ...CrimsonpublishersMedical
HCV infection is common and associated with significant morbidity and mortality among heamodialysis (HD) patients [1]. Heamodialysis is a trusted intermediate procedure for management of chronic kidney disease (CKD) patients. As such CKD is an immunedeficient state, hence blood borne viral infection particularly HCV pose great risk to patients treated by heamodialysis [2]. A high prevalence of HCV infection in heamodialysis patients has been reported in heamodialysis units since the introduction of heamodialysis therapy. Risk factors such as the number of blood transfusions or duration on heamodialysis. The prevalence of HCV infection in patients undergoing dialysis is greater than that in the general population, suggesting that patients on dialysis may be at higher risk of acquiring HCV infection.
Prevention of stroke in patients with tiaSachin Shende
This document provides guidelines from the American Heart Association/American Stroke Association for the prevention of future stroke in patients who have experienced an ischemic stroke or transient ischemic attack (TIA). Some key points:
- Over 690,000 adults in the US experience an ischemic stroke each year, and an additional 240,000 will experience a TIA. The risk of future stroke after an initial event is approximately 3-4% annually.
- The aim of the guidelines is to provide evidence-based recommendations to clinicians for controlling risk factors and preventing recurrent brain ischemia in these high-risk patients.
- Important revisions from the previous guidelines include new sections on sleep apnea and aortic arch atherosclerosis, expanded sections
Acs0005 Patient Safety In Surgical Care A Systems Approachmedbookonline
This document discusses patient safety in surgical care from a systems approach. It begins by defining key terms related to patient safety such as adverse events, errors, and preventable events. Several studies are cited that estimate the incidence of adverse events in surgery, finding rates between 3-4% resulting in half being preventable. Common preventable complications included infections, bleeding, and technical errors. Creating a just culture that views errors as systems failures rather than individual faults is important for improving safety.
BLOOD TRANSFUSIONS ARE ASSOCIATED WITH MORTALITY IN PEDIATRIC PATIENTS WITH S...Texas Children's Hospital
Restrictive thresholds for red blood cell (RBC) transfusion have not been shown to be inferior to liberal transfusion thresholds after cardiac surgery in pediatric or adult patients.1,2
RBC transfusions are associated with readmission due to heart failure (HF) in adults after aortic valve replacements, and with increased risk of right ventricle-pulmonary artery conduit failure in pediatric patients.3,4
Data are limited about RBC transfusions in pediatric patients with HF.
This document summarizes research on risk assessment of patients presenting to the emergency department (ED) with acute heart failure (AHF). Nearly 700,000 ED visits each year are due to AHF, with over 80% resulting in hospital admission. Existing risk prediction tools for AHF have not impacted admission rates. The authors hypothesize that evaluating both physiological risk factors and barriers to self-care, along with strategies to overcome barriers and shared decision making between providers and patients, could allow more patients to be safely discharged from the ED or observation units rather than admitted. This approach may help reduce hospital admissions, readmissions, and costs while improving long-term management of heart failure.
This document discusses controversies surrounding genetic testing for hypertrophic cardiomyopathy (HCM). It summarizes that:
1) Genetic testing is recommended for any patient diagnosed with HCM to help identify mutations in family members at risk.
2) The yield of genetic testing varies depending on clinical phenotype, with some phenotypes having an 80% yield while others are below 5%.
3) Genetic results should not be the sole factor in deciding whether to implant an implantable cardioverter defibrillator, as some positive results are uncertain and family history must also be considered.
This document provides a summary of the 31st ISACON MP 2017 conference held in Bhopal, Madhya Pradesh from September 30th to October 2nd, 2017. It was well attended by approximately 300 delegates from India and abroad. Pre-conference workshops were held on the 30th covering difficult airways, ultrasound in anesthesia, and chronic pain management. The scientific sessions on the 1st included guest lectures on the history of ISA MP chapter and goal directed fluid therapy. The Dr. S.K. Mehta oration was delivered on low flow anesthesia. Inaugural ceremonies included the welcoming of government officials and the felicitation of senior members. Paper presentations were made for the Dr. T.N.
Ethical Considerations around Urgent Hip Hemiarthroplasty during COVID-19: A ...asclepiuspdfs
Ethical discussion surrounding management of hip fractures in the elderly has always been challenging, but the recent coronavirus disease-19 (COVID-19) pandemic has superimposed additional difficulties that have to be addressed by clinicians. We present a case report of elderly gentleman with a history of moderate to advanced dementia, who was diagnosed with an intertrochanteric femoral fracture after a fall, and was incidentally found to be COVID-19 positive. After a lengthy discussion with next of kin, he had operative management of his hip fracture, followed by a brief convalescence, and eventual discharge to his nursing facility where he passed away.
A retrospective chart review was conducted of 91 patients admitted with sepsis between 2013-2014 to examine outcomes of central venous catheters (CVCs) and arterial catheters (ACs). 52 CVCs were placed in 36 patients and 48 ACs in 37 patients, with 32 receiving both. Of those with CVCs, 7 complications occurred in 10 patients (19% rate). Of those with ACs, 3 complications in 4 patients (8.1% rate). Logistic regression found no significant difference in mortality between those who received lines and those who did not, including among patients with higher illness scores. The study concludes that CVC and AC placement confers no significant improvement in survival for sepsis patients and can lead to unnecessary complications
Elevated Tissue Doppler E/E' on Index Admission Can Help Identify Patients at...crimsonpublishersOJCHD
Readmissions for congestive Heart Failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E'), during the index admission for CHF could independently predict 30 day readmission.
One year mortality rate after hip fracture in the western region of saudi ara...Prof. Hesham N. Mustafa
Background:
The mortality rate of elderly patients who sustain a hip fracture is high compared to the general population. Identifying risk factors can help predict patients at risk of hip fracture to reduce the mortality rate. No studies have shown the mortality rate of patients with hip fractures in the western region of Saudi Arabia. Therefore, this study aimed to identify the risk factors associated with the mortality of patients with hip fractures admitted to the King Abdulaziz Hospital and compare the results with other studies.
Methods:
The mortality rate (within 1 yr or less) in 177 patients over the age of 60 yr who were admitted to the university hospital between July, 2007, and September, 2012, with hip fractures was retrospectively studied. The patients were assessed with regard to gender, age, type of hip fracture, and type of surgical intervention.
Results:
The overall mortality rate 1 yr after hip fracture was 12.43%, and the mean age was 77.77 yr old. The risk factors most associated with mortality were as follows: advanced age (71 to 80 and 81 to 90 yr old), male, peritrochanteric (extracapsular) fracture, and operative fixation with dynamic hip screw.
Conclusions:
The mortality rate of patients with hip fractures within 1 yr has a high-risk potential, especially for male patients over 71 yr of age with peritrochanteric (extracapsular) fractures. Surgical treatment with dynamic hip screw also was shown to be a risk factor between the different treatment options.
Level of Evidence:
Level IV.
Advancingdialysis.org cardiac arrhythmia in thrice weekly hemodialysisAdvancingDialysis.org
This study used continuous cardiac monitoring to examine arrhythmias in hemodialysis patients over 6 months. It found that:
- Nearly all patients (97%) experienced arrhythmias, with clinically significant arrhythmias occurring in 2/3 of patients. Bradycardia was the most common arrhythmia.
- Arrhythmia rates were highest during the first dialysis session of the week and the long interdialytic gap between sessions. Bradycardic events peaked late in the long gap.
- Atrial fibrillation spiked during dialysis and gradually decreased after, climbing again in the last 36 hours of the long gap.
- Dialysis prescriptions like higher dialysate
Comparison of Infection Episodes in CKD Patients with or without Hemodialysis...ijtsrd
This study compared infection episodes in chronic kidney disease (CKD) patients with and without hemodialysis. A cross-sectional study of 56 CKD patients found that those undergoing hemodialysis had higher rates of chills, increased white blood cell count, and elevated erythrocyte sedimentation rate compared to non-hemodialysis patients. The study concluded that CKD patients on long-term hemodialysis were more prone to developing infections than those not on hemodialysis, likely due to factors such as catheter insertion for hemodialysis. Better infection prevention strategies are needed for CKD patients undergoing hemodialysis.
Advancing dialysis: Recasting kidney failure as cardiovascular diseaseAdvancingDialysis.org
This document discusses issues related to end-stage renal disease (ESRD) and dialysis treatment in the United States. It notes that ESRD represents 7% of the Medicare budget while only treating 1% of the US population. Total Medicare spending on dialysis has risen steadily to over $35 billion per year. The dialysis patient population has also increased over time and now exceeds 500,000 patients, though the annual growth rate has fallen below 2%. Despite increased spending, health outcomes like mortality and hospitalization rates have stabilized in recent years. The document suggests that the main challenge for dialysis is in managing chronic conditions like hypertension, left ventricular hypertrophy, and heart failure, which are major drivers of morbidity and mortality
Presented November, 3 2017.
Peter McCullough, MD, MPH, FACC, FACP, FCCP, FAHA, FNKF
Baylor University Medical Center
EMERGING PRESCRIPTION PROTOCOL FOR MORE FREQUENT HEMODIALYSIS
Ultrafiltration controlled prescription guide that improves treatment tolerability, reduces dialysis-induced cardiomyopathy, addresses chronic fluid overload while meeting clinical targets.
Discussion lead:
Allan Collins, MD, FACP
University of Minnesota School of Medicine
Chief Medical Officer, NxStage Medical, Inc.
CURBSIDE CONSULTATION: HOME DIALYSIS PATIENT CONSIDERATIONS
Biochemical, health-related quality of life, and economic factors when transitioning patients home.
Discussion lead:
Paul Komenda, MD, MHA, FRCPC
Seven Oaks General Hospital
REAL LIFE EXPERIENCE: PHYSICIAN AND PATIENT LEARNINGS
Dr. Kraus will discuss the prescribed regimen while Mr. Davis shares his clinical and lifestyle experiences as a more frequent hemodialysis patient.
Discussion leads:
Michael Kraus, MD, FACP
Indiana University School of Medicine
Evernard Davis III
Current Dialysis Patient, Retired Energy Consultant:
Reversal of warfarin associated coagulopathy prothrombin complex concentratesTÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Should atrial fibrillation patients with only 1 nongender related cha2 ds2-v...Bhargav Kiran
1) The study investigated outcomes in AF patients with 0 or 1 non-gender related (NGR) stroke risk factor (CHA2DS2-VASc score of 0-1 in males and 1-2 in females) who were treated or not treated with oral anticoagulation (OAC).
2) Among 2208 AF patients with 0-1 NGR risk factors, those not treated with OAC and with 1 risk factor had higher rates of stroke/embolism (2.09% per year) compared to those with 0 risk factors (adjusted hazard ratio 2.82).
3) Treating patients with 1 NGR risk factor with OAC was associated with a positive net
This document provides an overview of the internal educational program (IEP) of the Vanderbilt University Division of Trauma, Emergency Surgery and Surgical Critical Care. The goal of the IEP is to explore topics related to trauma care from pre-hospital care to injury prevention. The program will outline the full continuum of care provided to trauma patients. It then introduces the trauma team members and multidisciplinary liaisons that will be involved in the educational sessions. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
This document discusses patient safety in healthcare. It defines patient safety as the absence of preventable harm during healthcare. It notes that most patient harm is due to systemic flaws rather than individual negligence. It then discusses various types of patient safety concerns like medical errors, adverse events, infections, and falls. International patient safety goals are also presented, such as properly identifying patients, improving communication, and reducing healthcare-associated infections. The document emphasizes that improving safety requires efforts across many areas to protect patients from harm.
This document summarizes the limitations of the current Dallas criteria for diagnosing myocarditis based on histopathological examination of endomyocardial biopsies. There is considerable sampling error and variability between expert pathologists in interpreting biopsies. Additionally, virus can be present in cardiac tissue without meeting Dallas criteria. Alternative criteria including clinical presentation, viral detection, and immune markers may better identify patients with viral or post-viral myocarditis who could benefit from immune modulation therapy. The diagnosis of myocarditis and causes of new-onset heart failure need to be redefined using a multi-disciplinary approach.
The Prevalence of Hcv Infection among Renal Failure Patients Before Starting ...CrimsonpublishersMedical
HCV infection is common and associated with significant morbidity and mortality among heamodialysis (HD) patients [1]. Heamodialysis is a trusted intermediate procedure for management of chronic kidney disease (CKD) patients. As such CKD is an immunedeficient state, hence blood borne viral infection particularly HCV pose great risk to patients treated by heamodialysis [2]. A high prevalence of HCV infection in heamodialysis patients has been reported in heamodialysis units since the introduction of heamodialysis therapy. Risk factors such as the number of blood transfusions or duration on heamodialysis. The prevalence of HCV infection in patients undergoing dialysis is greater than that in the general population, suggesting that patients on dialysis may be at higher risk of acquiring HCV infection.
Prevention of stroke in patients with tiaSachin Shende
This document provides guidelines from the American Heart Association/American Stroke Association for the prevention of future stroke in patients who have experienced an ischemic stroke or transient ischemic attack (TIA). Some key points:
- Over 690,000 adults in the US experience an ischemic stroke each year, and an additional 240,000 will experience a TIA. The risk of future stroke after an initial event is approximately 3-4% annually.
- The aim of the guidelines is to provide evidence-based recommendations to clinicians for controlling risk factors and preventing recurrent brain ischemia in these high-risk patients.
- Important revisions from the previous guidelines include new sections on sleep apnea and aortic arch atherosclerosis, expanded sections
Acs0005 Patient Safety In Surgical Care A Systems Approachmedbookonline
This document discusses patient safety in surgical care from a systems approach. It begins by defining key terms related to patient safety such as adverse events, errors, and preventable events. Several studies are cited that estimate the incidence of adverse events in surgery, finding rates between 3-4% resulting in half being preventable. Common preventable complications included infections, bleeding, and technical errors. Creating a just culture that views errors as systems failures rather than individual faults is important for improving safety.
BLOOD TRANSFUSIONS ARE ASSOCIATED WITH MORTALITY IN PEDIATRIC PATIENTS WITH S...Texas Children's Hospital
Restrictive thresholds for red blood cell (RBC) transfusion have not been shown to be inferior to liberal transfusion thresholds after cardiac surgery in pediatric or adult patients.1,2
RBC transfusions are associated with readmission due to heart failure (HF) in adults after aortic valve replacements, and with increased risk of right ventricle-pulmonary artery conduit failure in pediatric patients.3,4
Data are limited about RBC transfusions in pediatric patients with HF.
This document summarizes research on risk assessment of patients presenting to the emergency department (ED) with acute heart failure (AHF). Nearly 700,000 ED visits each year are due to AHF, with over 80% resulting in hospital admission. Existing risk prediction tools for AHF have not impacted admission rates. The authors hypothesize that evaluating both physiological risk factors and barriers to self-care, along with strategies to overcome barriers and shared decision making between providers and patients, could allow more patients to be safely discharged from the ED or observation units rather than admitted. This approach may help reduce hospital admissions, readmissions, and costs while improving long-term management of heart failure.
This document discusses controversies surrounding genetic testing for hypertrophic cardiomyopathy (HCM). It summarizes that:
1) Genetic testing is recommended for any patient diagnosed with HCM to help identify mutations in family members at risk.
2) The yield of genetic testing varies depending on clinical phenotype, with some phenotypes having an 80% yield while others are below 5%.
3) Genetic results should not be the sole factor in deciding whether to implant an implantable cardioverter defibrillator, as some positive results are uncertain and family history must also be considered.
This document provides a summary of the 31st ISACON MP 2017 conference held in Bhopal, Madhya Pradesh from September 30th to October 2nd, 2017. It was well attended by approximately 300 delegates from India and abroad. Pre-conference workshops were held on the 30th covering difficult airways, ultrasound in anesthesia, and chronic pain management. The scientific sessions on the 1st included guest lectures on the history of ISA MP chapter and goal directed fluid therapy. The Dr. S.K. Mehta oration was delivered on low flow anesthesia. Inaugural ceremonies included the welcoming of government officials and the felicitation of senior members. Paper presentations were made for the Dr. T.N.
Ethical Considerations around Urgent Hip Hemiarthroplasty during COVID-19: A ...asclepiuspdfs
Ethical discussion surrounding management of hip fractures in the elderly has always been challenging, but the recent coronavirus disease-19 (COVID-19) pandemic has superimposed additional difficulties that have to be addressed by clinicians. We present a case report of elderly gentleman with a history of moderate to advanced dementia, who was diagnosed with an intertrochanteric femoral fracture after a fall, and was incidentally found to be COVID-19 positive. After a lengthy discussion with next of kin, he had operative management of his hip fracture, followed by a brief convalescence, and eventual discharge to his nursing facility where he passed away.
A retrospective chart review was conducted of 91 patients admitted with sepsis between 2013-2014 to examine outcomes of central venous catheters (CVCs) and arterial catheters (ACs). 52 CVCs were placed in 36 patients and 48 ACs in 37 patients, with 32 receiving both. Of those with CVCs, 7 complications occurred in 10 patients (19% rate). Of those with ACs, 3 complications in 4 patients (8.1% rate). Logistic regression found no significant difference in mortality between those who received lines and those who did not, including among patients with higher illness scores. The study concludes that CVC and AC placement confers no significant improvement in survival for sepsis patients and can lead to unnecessary complications
Elevated Tissue Doppler E/E' on Index Admission Can Help Identify Patients at...crimsonpublishersOJCHD
Readmissions for congestive Heart Failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E'), during the index admission for CHF could independently predict 30 day readmission.
One year mortality rate after hip fracture in the western region of saudi ara...Prof. Hesham N. Mustafa
Background:
The mortality rate of elderly patients who sustain a hip fracture is high compared to the general population. Identifying risk factors can help predict patients at risk of hip fracture to reduce the mortality rate. No studies have shown the mortality rate of patients with hip fractures in the western region of Saudi Arabia. Therefore, this study aimed to identify the risk factors associated with the mortality of patients with hip fractures admitted to the King Abdulaziz Hospital and compare the results with other studies.
Methods:
The mortality rate (within 1 yr or less) in 177 patients over the age of 60 yr who were admitted to the university hospital between July, 2007, and September, 2012, with hip fractures was retrospectively studied. The patients were assessed with regard to gender, age, type of hip fracture, and type of surgical intervention.
Results:
The overall mortality rate 1 yr after hip fracture was 12.43%, and the mean age was 77.77 yr old. The risk factors most associated with mortality were as follows: advanced age (71 to 80 and 81 to 90 yr old), male, peritrochanteric (extracapsular) fracture, and operative fixation with dynamic hip screw.
Conclusions:
The mortality rate of patients with hip fractures within 1 yr has a high-risk potential, especially for male patients over 71 yr of age with peritrochanteric (extracapsular) fractures. Surgical treatment with dynamic hip screw also was shown to be a risk factor between the different treatment options.
Level of Evidence:
Level IV.
Advancingdialysis.org cardiac arrhythmia in thrice weekly hemodialysisAdvancingDialysis.org
This study used continuous cardiac monitoring to examine arrhythmias in hemodialysis patients over 6 months. It found that:
- Nearly all patients (97%) experienced arrhythmias, with clinically significant arrhythmias occurring in 2/3 of patients. Bradycardia was the most common arrhythmia.
- Arrhythmia rates were highest during the first dialysis session of the week and the long interdialytic gap between sessions. Bradycardic events peaked late in the long gap.
- Atrial fibrillation spiked during dialysis and gradually decreased after, climbing again in the last 36 hours of the long gap.
- Dialysis prescriptions like higher dialysate
Comparison of Infection Episodes in CKD Patients with or without Hemodialysis...ijtsrd
This study compared infection episodes in chronic kidney disease (CKD) patients with and without hemodialysis. A cross-sectional study of 56 CKD patients found that those undergoing hemodialysis had higher rates of chills, increased white blood cell count, and elevated erythrocyte sedimentation rate compared to non-hemodialysis patients. The study concluded that CKD patients on long-term hemodialysis were more prone to developing infections than those not on hemodialysis, likely due to factors such as catheter insertion for hemodialysis. Better infection prevention strategies are needed for CKD patients undergoing hemodialysis.
Advancing dialysis: Recasting kidney failure as cardiovascular diseaseAdvancingDialysis.org
This document discusses issues related to end-stage renal disease (ESRD) and dialysis treatment in the United States. It notes that ESRD represents 7% of the Medicare budget while only treating 1% of the US population. Total Medicare spending on dialysis has risen steadily to over $35 billion per year. The dialysis patient population has also increased over time and now exceeds 500,000 patients, though the annual growth rate has fallen below 2%. Despite increased spending, health outcomes like mortality and hospitalization rates have stabilized in recent years. The document suggests that the main challenge for dialysis is in managing chronic conditions like hypertension, left ventricular hypertrophy, and heart failure, which are major drivers of morbidity and mortality
Presented November, 3 2017.
Peter McCullough, MD, MPH, FACC, FACP, FCCP, FAHA, FNKF
Baylor University Medical Center
EMERGING PRESCRIPTION PROTOCOL FOR MORE FREQUENT HEMODIALYSIS
Ultrafiltration controlled prescription guide that improves treatment tolerability, reduces dialysis-induced cardiomyopathy, addresses chronic fluid overload while meeting clinical targets.
Discussion lead:
Allan Collins, MD, FACP
University of Minnesota School of Medicine
Chief Medical Officer, NxStage Medical, Inc.
CURBSIDE CONSULTATION: HOME DIALYSIS PATIENT CONSIDERATIONS
Biochemical, health-related quality of life, and economic factors when transitioning patients home.
Discussion lead:
Paul Komenda, MD, MHA, FRCPC
Seven Oaks General Hospital
REAL LIFE EXPERIENCE: PHYSICIAN AND PATIENT LEARNINGS
Dr. Kraus will discuss the prescribed regimen while Mr. Davis shares his clinical and lifestyle experiences as a more frequent hemodialysis patient.
Discussion leads:
Michael Kraus, MD, FACP
Indiana University School of Medicine
Evernard Davis III
Current Dialysis Patient, Retired Energy Consultant:
Reversal of warfarin associated coagulopathy prothrombin complex concentratesTÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Should atrial fibrillation patients with only 1 nongender related cha2 ds2-v...Bhargav Kiran
1) The study investigated outcomes in AF patients with 0 or 1 non-gender related (NGR) stroke risk factor (CHA2DS2-VASc score of 0-1 in males and 1-2 in females) who were treated or not treated with oral anticoagulation (OAC).
2) Among 2208 AF patients with 0-1 NGR risk factors, those not treated with OAC and with 1 risk factor had higher rates of stroke/embolism (2.09% per year) compared to those with 0 risk factors (adjusted hazard ratio 2.82).
3) Treating patients with 1 NGR risk factor with OAC was associated with a positive net
This document provides an overview of the internal educational program (IEP) of the Vanderbilt University Division of Trauma, Emergency Surgery and Surgical Critical Care. The goal of the IEP is to explore topics related to trauma care from pre-hospital care to injury prevention. The program will outline the full continuum of care provided to trauma patients. It then introduces the trauma team members and multidisciplinary liaisons that will be involved in the educational sessions. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
This document discusses patient safety in healthcare. It defines patient safety as the absence of preventable harm during healthcare. It notes that most patient harm is due to systemic flaws rather than individual negligence. It then discusses various types of patient safety concerns like medical errors, adverse events, infections, and falls. International patient safety goals are also presented, such as properly identifying patients, improving communication, and reducing healthcare-associated infections. The document emphasizes that improving safety requires efforts across many areas to protect patients from harm.
Surgical Risk Assessment is an Important Factor in any Surgical TreatmentJohnJulie1
Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
Surgical Risk Assessment is an Important Factor in any Surgical Treatmentsuppubs1pubs1
Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
This document discusses patient safety and medical errors. It defines key terms like adverse events, near misses, and sentinel events. Errors can be caused by active failures from individuals or latent system issues. The Swiss cheese model of accident causation illustrates how multiple factors can align to cause harm. A just culture approach examines systems instead of blaming individuals. International patient safety goals aim to reduce errors through practices like proper patient identification and hand hygiene. Communication failures and lack of labeling contributed to a case where epinephrine was given instead of saline. Overall, patient safety requires a systems approach rather than blaming individuals.
This document discusses the use of tranexamic acid (TXA) in trauma patients to reduce hemorrhage and mortality. It summarizes two major studies on TXA - the CRASH-2 trial and the MATTERs study. The CRASH-2 trial found TXA reduced mortality in trauma patients, though some critique the applicability of the results to severely injured patients in developed trauma systems. The MATTERs study in military patients also found reduced mortality with TXA. However, both studies found a potential increased risk of thrombosis with TXA use. Overall, the document examines the evidence for and criticisms of using TXA to reduce hemorrhage in trauma patients.
Patient harm during healthcare is a leading cause of death and disability worldwide. Each year over 134 million adverse events occur in hospitals in low- and middle-income countries resulting in 2.6 million deaths. Medication errors, healthcare-associated infections, unsafe surgical practices, and diagnostic errors are some of the biggest causes of patient harm. Ensuring safe healthcare is a prerequisite for achieving universal health coverage and strengthening health systems. The World Health Organization works to advance patient safety globally by setting priorities, developing guidelines, and building capacity in member states.
2015 ESC Guidelines on Infective Endocarditis ppt. by Dr Abhishek Rathore MDdrabhishekbabbu
The document summarizes guidelines for the management of infective endocarditis (IE). It recommends an endocarditis team approach in a reference center for complicated IE cases. It emphasizes the importance of early diagnosis, antibiotic therapy, and consideration of early surgery. It also discusses new recommendations for specific IE situations, antibiotic prophylaxis, surgical management, and the roles of imaging and multidisciplinary care in IE management.
This document provides guidelines for resuscitation of adult cardiac arrest victims. It summarizes changes from 2010 guidelines, emphasizing the importance of coordination between emergency dispatchers, bystander CPR, and automated external defibrillators (AEDs) to improve survival. Key changes include endorsing chest compressions-only CPR; maintaining a compression depth of 5-6 cm and rate of 100-120 per minute; and encouraging public access AED programs in locations where cardiac arrests are frequently witnessed. The guidelines apply basic life support techniques like CPR and use of AEDs to increase chances of survival when sudden cardiac arrest occurs.
The document discusses quality improvement initiatives in several countries aimed at reducing patient harm and mortality in healthcare. It outlines specific interventions and goals for the UK, Scotland, Denmark, Canada, Wales, and the US including reducing surgical complications, preventing central line infections, reducing harm from high-risk medicines, and preventing MRSA infections. Evidence is presented on the impact of certain interventions like proper use of antibiotics, beta blockers, and venous thromboembolism prophylaxis in surgery.
This document discusses a quality improvement initiative to reduce hospital acquired venous thromboembolism (VTE). VTE includes deep vein thrombosis and pulmonary embolism, which can be fatal. The document outlines Donabedian's framework for assessing healthcare quality using structure, process, and outcomes measures. It then applies this framework to assess the structure, processes, and intended outcomes of a VTE prevention strategy implemented at a healthcare organization. This included compulsory VTE risk assessment, appropriate prophylaxis ordering and administration, staff education, and ongoing performance monitoring to continuously improve outcomes of reducing hospital acquired VTE events.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
This document discusses sepsis case studies and the importance of timely diagnosis and treatment of sepsis. It defines sepsis and its criteria according to SIRS (Systemic Inflammatory Response Syndrome). Early diagnosis is important as each hour of delayed treatment can increase mortality rates by 5-10%. While microbiological cultures are traditionally used for definitive diagnosis, they can take 48-72 hours for results. Biomarkers like PCT and CRP can provide faster results and guide early empiric therapy.
This document provides an overview of venous thrombo-embolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It discusses the prevalence and impact of VTE, defining key terms like anticoagulants and thrombolytics. The presentation contents are outlined as covering the prevalence, diagnostic modalities and algorithm, and updates to the medical management of VTE. Diagnostic tests for VTE include ultrasound Doppler, D-dimer testing, and imaging studies like CT scans. Treatment involves anticoagulation or thrombolysis to prevent clots from growing or causing harm.
The WHO has established patient safety as a global health priority in response to the large burden of harm that occurs from unsafe healthcare worldwide. Millions of patients are injured or die each year due to errors, and many common medical practices like medication errors, healthcare-associated infections, and unsafe surgery contribute significantly to this burden. In recognition of this issue, the World Health Assembly designated September 17 as World Patient Safety Day to increase awareness and promote global action. The WHO is working to provide leadership, guidelines, and support to help countries strengthen patient safety, including initiatives to reduce healthcare-associated infections, improve surgical safety, and ensure medication is used safely.
Patient safety is a fundamental principle of healthcare. Medical errors harm millions of patients annually, costing billions of dollars. Up to 15% of hospital activity results from preventable adverse events, many of which are infections, pressure ulcers, or complications from unsafe medication practices and medical radiation. Investing in improved safety measures like hand hygiene could reduce patient harm and healthcare costs significantly.
Whole body ct adult versus ped centers (iep)bahlinnm
1) The study analyzed over 30,000 pediatric trauma patients treated at level I or II adult or pediatric trauma centers to compare the use of whole body CT (WBCT) scans between facilities.
2) It found WBCT scans were used significantly more often on pediatric patients treated at adult trauma centers (31.4%) compared to pediatric centers (17.6%).
3) After adjusting for factors, pediatric patients treated at adult centers were 1.8 times more likely to receive a WBCT, increasing their radiation risk without improving outcomes, as mortality did not differ between the groups. The study concludes guidelines are needed to minimize unnecessary WBCT use across centers.
This document discusses isolated head injuries in pediatric trauma patients and the association with shock and hypotension. The key points are:
1) A study found that among pediatric patients with isolated head injuries, rates of hypotension were highest in those aged 0-4 years, with 1/3 of hypotension cases associated with isolated head injuries in that age group.
2) Several potential causes for this association between isolated head injuries and hypotension in young pediatric patients were hypothesized, including neurogenic or autonomic responses.
3) Due to the risks of cerebral edema from large fluid volumes, providers may need to adjust treatment to include early vasopressors or anticholinergic drugs to support blood pressure in these
Vanderbilt is implementing a new CME attendance recording system that allows participants to text their attendance to update their transcript in real time and manage external credits online. To use the new system, users must log into the CME website with their VUnetID and ePassword, enter their cell phone number, and save the toll-free number 855-776-6263 in their phone so they can text their attendance at future sessions instead of using sign-in sheets.
The internal educational program (IEP) of Vanderbilt University's Division of Trauma, Emergency Surgery and Surgical Critical Care aims to provide educational opportunities on topics related to trauma care from pre-hospital care to post-discharge requirements. The IEP will outline the care provided to trauma patients from point of injury through completion of care. The trauma team includes surgeons, nurses, and liaisons from emergency medicine, orthopedics, neurosurgery, anesthesia, and radiology, with the shared goal of improving trauma patient care in a consistent and caring manner and preventing injuries in the local region. Participants are asked to review provided materials and complete an evaluation.
This document discusses the importance of dental and vision care, and challenges that homeless individuals face in accessing these services. It notes that dental problems can cause pain, infection, and negatively impact quality of life and employment prospects. Similarly, untreated vision issues affect daily functioning and long-term health. However, many homeless people lack insurance or ability to pay for these services. The document describes innovative programs that health care for the homeless clinics have implemented to improve access, such as on-site dental and vision clinics, mobile services, and partnerships with outside providers. It emphasizes the importance of preventive care and dedicated clinics that understand homeless patients' needs.
This document provides an overview of a training module on proper prescribing of controlled prescription drugs. It discusses the objectives of the training, which are to discuss the controlled prescription drug epidemic, define misprescribing, compare the roles of the medical board and DEA, and determine one's risk for misprescribing. It also provides information on the rights and responsibilities around the materials, introduces the topics that will be covered, and gives instructions for how to complete the module.
This document outlines a planning worksheet to link learning objectives with educational activities and assessment plans. The worksheet lists learning objectives in the first column and pairs them with corresponding educational activities in the second column and assessment strategies in the third column to evaluate student learning and achievement of objectives.
This document provides guidance for course directors on assessment strategies for Advanced Clinical Electives (ACE) and Acting Internships (AI) at Vanderbilt School of Medicine. It emphasizes that assessment drives learning and should serve both summative and formative functions. The document outlines best practices for assessment including linking learning objectives to instructional activities and assessments, using multiple assessment methods, providing timely feedback, and ensuring fairness and consistency across courses. Examples are provided to illustrate how learning objectives can be aligned with educational activities and assessments. The overall message is that assessment is important for evaluating student progress and should be designed to both evaluate learning and guide future improvement.
This document provides guidance for writing learning objectives for Advanced Clinical Electives (ACEs) or Acting Internships (AIs) at Vanderbilt University School of Medicine. It aims to equip course directors with tools to write objectives using a standardized format. The document defines a learning objective as a clear target for learners to acquire new knowledge, skills, or attitudes. It also assumes course directors will want to increase their knowledge about constructing learning objectives and understand why they are essential elements of a course curriculum.
The document provides guidance on writing learning objectives for an educator development program at Vanderbilt School of Medicine. It discusses considering the categories/domains of objectives, components that comprise objectives, and verbs commonly used. Examples of objectives for an Immersion Course are provided. The document stresses writing objectives that are specific, measurable, attainable, relevant and time-sensitive. It indicates standardized objectives will be provided for different course types and instructors should create 2-4 additional course-specific objectives.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
1. Greetings,
Welcome to the internal educational program (IEP) of the Vanderbilt University Division of Trauma,
Emergency Surgery and Surgical Critical Care. Our goal is to provide an opportunity to pursue topics
germane to trauma from all aspects of the team. My hope is to explore all areas of interest throughout the
course of the year including pre-hospital care, acute care issues, post-discharge requirements, as well as
injury prevention. We will attempt to outline the care provided to our trauma patient population from
point of injury until the patients care is completed.
As you know, the trauma team consists of the Chief of the Division, Dr. Rick Miller, our Trauma Program
Manager, Melissa Smith, RN, the Performance Improvement Director, Dr. Tim Nunez, the Outreach and
Prevention coordinator, Cathy Wilson, RN, the Trauma Resuscitation Manager, Kevin High, RN, as well as
the entire trauma faculty and Acute Care Surgery Fellows. Our multidisciplinary liaison team includes
Tyler Barrett (EM), Robert Boyce (Ortho), Joe Neimat (Neurosurgery), Shannon Kilkelly (Anesthesia),
Peter Bream (Radiology) and the LifeFlight team. Our goal is to improve the care of the trauma patient in
a caring and consistent manner and to help minimize injury in the Middle Tennessee region through
outreach and prevention efforts determined by the needs of the community. Please take the time to
review this material and complete the test and evaluation.
Yours Truly,
Oscar Guillamondegui
The ACS trauma education requirement (for faculty
who are not liaisons) may be met by documenting
acquisition of 16 hours of trauma-related CME per
year on average or by demonstrating participation in
an internal educational process (IEP) conducted by
the trauma program based on the principles of
practice-based learning and the PIPs program.
A Message from the
TraumaMedical Director,
Oscar Guillamondegui,MD
Winter 2016
2. 2
ACS Filming for the Rural Trauma Team Development
Course (RTTDC)
On November 14th, the American
College of Surgeons was at
Vanderbilt to film the
communication videos for the
RTTDC. Vanderbilt was selected
as the host site thanks to the
Division of Trauma putting on
over 13 courses over 1.5 years
(18 total since it’s inception), the
most in the country. Dr. Richard
Sidwell (ACS-RTTDC Chair) got
wind of this and selected our site.
The Rural Trauma Team
Development Course (RTTDC)
emphasizes a team approach to
the initial evaluation and
resuscitation of the trauma
patient at a rural facility. The
course assists health care
professionals in determining
the need to transfer the patient
to a higher level of care. The
one-day course includes
interactive lectures on both
medical procedures and
communication strategies and
three team performance
scenarios.
Recently Dr. Brad Dennis had the opportunity to present a paper on the Rural Trauma Team
Development course and how Vanderbilt was able to decrease time to transfer for Trauma patients. Dr.
Dr. Dennis presented this paper at the 74th Annual AAST meeting in Las Vegas on September 10th. The
authors who worked on this paper and helpd coordinate these courses were: Brad Dennis, MD; Oliver
Gunter, MD; Melissa Smith, MSN, RN; Cathy Wilson, MSN, RN; Michael Vella, MD; Mayur Patel, MD; Tim
Nunez, MD; and Oscar Guillamondegui, MD.
3. 3
1. 1. The risk of requiring hospitalization after a fall in an 85 year old is how many times more likely than fora
65 year old?
a. 1
b. 2
c. 5
d. 10
e. 15
2. All of the followingare perceptions that elderly have about the use of fall prevention measures such as canes
or walkers, EXCEPT
a. They underestimate their fall risk
b. Bracing on a piece of furniture or the wallis just as accessible as a cane
c. They only need the walker when they are leaving their home
d. They don’t believe useof a caneor walkercanreducetheirriskof fall
3. Age related changes in gait include whichof the following:
a. Shorter strides
b. Decreased cadence
c. Wider strides
d. Decreased powerduring toe-off phase
e. All of the above
4. Whichof the following statements is true regarding elderly patients that fall?
a. They are likely to be dead in less than a year
b. COPD may bea contributingfactor
c. The risk of traumatic brain injury after a fallis 55%
d. Canes definitively reduce the risk of a fall
5. All injury types in the elderly are problematic, the one with the highest impact on life or lifestyle
a. Humerus fracture
b. Hip fractures
c. TraumaticBrainInjuries
d. Grade 2 spleen injury
Answer Key for Summer 2015 Trauma IEP Newsletter
(answers are in bold and Italics below)
4. 4
Presented By: Michael Krzyzaniak, MD
Transfusion reactions are rare events in the modern era of trauma resuscitation or during any blood
product resuscitation for any reason. The symptoms of a transfusion reaction can be subtle to profound and
life threatening. The most frequently occurring symptoms are urticaria, pruritis, flushing, fever or chills,
and a maculopapular rash. Some more serious symptoms indicating a severe transfusion reaction are chills
with rigors, hypotension, back or abdominal pain, hematuria, severe shortness of breath, and loss of
consciousness.[1]
The cause of acute transfusion reactions in situations of blood type mismatch favors a two-hit model,
which can lead to a hemolytic process or TRALI. Human error leading to the administration of an incorrect
ABO blood type to an incompatible recipient remains the most common cause of transfusion reaction.[2] In
this scenario, if not stopped quickly enough, as little as 50mL of transfused incompatible ABO blood has a
lethality rate of 20%.[3] In the two-hit model, the first hit is an underlying patient factor like infection or
systemic inflammation which primes inflammatory cells, both of which frequently apply to the severely
injured trauma patient. The second hit is the result of transfused blood products leading to activation of
primed cells.[4, 5] Hemolytic transfusion reactions occur in two forms. If IgM is the driving mediator,
complement fixation occurs with ensuing large scale intravascular hemolysis which can be life threatening.
If IgG is the predominant mediator, this typically leads to red blood cells getting tagged for destruction or
eliminated by the reticuloendothelial system causing a much more indolent and less severe form of
hemolysis.[3, 4] Although, IgG can cause complement fixation under rare circumstances, this is far less
common than IgM.
Transfusion-related acute lung injury or TRALI is clinically uncommon, but remains a risk of blood
product transfusion with a high associated mortality. TRALI is reported to occur in anywhere from 0.1% to
15% of transfused patients at time periods anywhere from 6 to 72 hours after product transfusion with
mortality rates from 5 to 8%.[6] Because of the ill-defined time period of diagnosis as well as nonspecific
diagnostic criteria, the true incidence of TRALI is unknown. The two-hit model of neutrophil sequestration
and pulmonary endothelial priming followed by transfusion of blood products is accepted as the etiology.
That said, despite knowing the etiology, the treatment strategy remains supportive.
Identification of a transfusion reaction demands increased awareness and vigilance by the team of
health care providers. The mainstay of therapy is to immediately stop the transfusion and notify the
responsible physician caring for the patient. Detailed information about what processes to initiate in the
instance of a transfusion reaction are outlined in section VII of the Vanderbilt Blood Product Adminstration
policy available online at http://www.mc.vanderbilt.edu/root/vumc.php?site=vmcpathology&doc=39142.
Much is known and has been written on prevention strategies to avoid transfusion reactions. Vamvakas and
Blajchman nicely summarize 6 strategies to reduce transfusion-related mortality. They include: 1) avoid
Blood Transfusion Reactions
5. 5
unnecessary transfusions using evidence-based guidelines, 2) reduce the risk of TRALI associated with
platelet transfusion by using single male donor or nulliparous female donors, 3) augment patient
identification procedures to prevent hemolytic transfusion reactions, 4) avoid pooled blood products, 5)
WBC reduction of cellular blood components administered to in cardiac surgery, and 6) pathogen reduction
of platelet and plasma components.[7]
What to do if you suspect a blood transfusion reaction at Vanderbilt:
A. Monitor and observe for signs and symptoms of Transfusion Reaction which include: Urticaria, chills,
headache, flushing rigors, jaundice, oliguria, fever (1 degree centigrade or 2 degrees Fahrenheit rise
in temperature from the pre-transfusion temperature), back pain, abdomen pain, or chest pain, heat
or pain at the infusion site, respiratory distress, anaphylaxis, wheezing, laryngeal edema, dyspnea,
hyper/hypotension, peripheral circulatory collapse, brady/tachycardia, hemoglobinuria (red or pink
urine), excessive bleeding, or shock.
B. If a Transfusion Reaction is suspected:
1. Stop the transfusion immediately.
2. Obtain vital signs.
3. Disconnect the blood tubing directly at the vascular access device hub and preserve the sterility of
the blood tubing. Flush the vascular access device.
4. Confirm (recheck) patient identification and verify against blood product and TAR.
5. Notify the provider.
6. If the provider chooses to continue the transfusion in the presence of symptoms consistent with a
Transfusion Reaction, a provider’s order is obtained from the provider authorizing the continued
transfusion and documented. Continue the transfusion as ordered.
Do not proceed to the following steps. See References for policy on Physician Notification of Change
in Patient Condition.
7. If the provider chooses NOT to restart the transfusion, proceed to the following steps.
8. Notify the Blood Bank (extension 2-2233) and obtain a Suspected Transfusion Reaction form from
E-Docs.
9. Document in the medical record that a suspected Transfusion Reaction has occurred.
10. Send the following to the Blood Bank:
a. Remainder of the blood product, including the IV solution and IV set (needle removed);
b. Scan or copy of the TAR;
c. Completed Report of Suspected Transfusion Reaction form; and
d. Post-transfusion patient blood product sample, purple top (EDTA), properly labeled for
Blood Bank.
11. Contact the provider for further instructions. Some additional interventions may include:
Obtaining a chest x-ray, placing a urinary catheter to track urine output and sending a urine
sample (urinary analysis), peripheral blood smear, lactate dehydrogenase (LDH) bilirubins,
haptoglobin, repeat CBC to the laboratory, giving a diuretic, and administering IV fluids,
antihistamines, antipyretics, or steroids.
6. 6
References:
1. Squires, J.E., Risks of transfusion. South Med J, 2011. 104(11): p. 762-9.
2. Linden, J.V., et al., Transfusion errors in New York State: an analysis of 10 years' experience.
Transfusion, 2000. 40(10): p. 1207-13.
3. Flegel, W.A., Pathogenesis and mechanisms of antibody-mediated hemolysis. Transfusion, 2015. 55
Suppl 2: p. S47-58.
4. Zimring, J.C. and S.L. Spitalnik, Pathobiology of transfusion reactions. Annu Rev Pathol, 2015. 10: p.
83-110.
5. Reddy, D.R., et al., Transfusion-Related Acute Lung Injury After IVIG for Myasthenic Crisis. Neurocrit
Care, 2015. 23(2): p. 259-61.
6. Kim, J. and S. Na, Transfusion-related acute lung injury; clinical perspectives. Korean J Anesthesiol,
2015. 68(2): p. 101-5.
7. Vamvakas, E.C. and M.A. Blajchman, Blood still kills: six strategies to further reduce allogeneic blood
transfusion-related mortality. Transfus Med Rev, 2010. 24(2): p. 77-124.
8. Vanderbilt University Blood Administration Policy found at
http://www.mc.vanderbilt.edu/root/vumc.php?site=vmcpathology&doc=39142
To ensure that you get full credit, once you finish
reading the IEP, be sure to complete the 5 questions
and the evaluation and then hit COMPLETE. Your
credits will automatically upload to your CME
transcript.
7. 7
Melissa Smith – Trauma Program Mgr
melissa.d.smith@vanderbilt.edu
Oscar Guillamondegui – Trauma Medical
Director
Oscar.guillamondegui@vanderbilt.edu
Tim Nunez – Trauma PI Director
Timothy.c.nunez@vanderbilt.edu
Cathy Wilson – Trauma Outreach & Injury
Prevention Coordinator
Catherine.s.wilson@vanderbilt.edu
Michael Krzyzaniak– ACS Fellow/IEP
editor
michael.krzyzaniak@vanderbilt.edu
Upcoming Courses
2015 Courses:
ATLS Refresher Dec 9
ATLS Refresher Jan 21
ATLS Provider Feb 18-19
ASSETFeb 26
ATLS Refresher Mar 17
ASSETApril 14
ATLS Provider April 21-22
This year the 7th Annual TQIP Scientific Meeting
and Training was held in Nashville. The Trauma
Quality Improvement Program is a
benchmarking program for trauma centers that
works to elevate the quality of care for trauma
patients in their institution.
Oscar Guillamondegui (Trauma Medical
Director and Melisa Smith (Trauma Program
Manager were on hand to give the Opening
Ceremonies and to represent Vanderbilt
Trauma.
Cathy Maxwell, PhD (Vanderbilt School of
Nursing) was on hand as well to present her
work on Geriatric Trauma. She was invited as a
speaker and to sit on a panel about Palliative
Care. After her session on Geriatric Trauma and
the Need for Proactive Palliative Care, she was
awarded the TQIP Best PI Abstract Award!!
Help us in congratulating our very own Cathy
Maxwell!!
8. Division of Trauma and Surgical Critical Care
For any questions in regards to the IEP or Trauma cases
please contact:
Melissa Smith: 322.6745
or
Oscar Guillamondegui: 936.0180