Showing papers by "Clinical Emergency Hospital Bucharest published in 2018"

Pain distress: the negative emotion associated with procedures in ICU patients

Abstract: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain. Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0–10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects. A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19–1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15–1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure. Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient’s pain experience.

Neuromuscular monitoring: an update.

Abstract: This review makes an advocacy for neuromuscular blockade monitoring during anaesthesia care, by: (i) describing the fundamental principles of the methods currently available, at the same time emphasizing quantitative recording measurements; (ii) describing the different ways in which muscles respond to the effect of neuromuscular blockade and their use in clinical practice; (iii) presenting results of different studies on timing and agents of neuromuscular block reversal, including a recommendation for sugammadex use and experimental results with calabadion and (iv) in the end emphasizing the need for implementing neuromuscular monitoring as a practice that should be used every time a neuromuscular block is required.

Effects of neuromuscular electrical stimulation in patients with heart failure - review.

Abstract: Research conducted in the last two decades suggests that neuromuscular electrical stimulation of the lower limb muscles (NMES) may be a "bridge" to conventional exercise or an alternative for patients with advanced chronic heart failure (CHF), non-compliant or non-responsive to physical training. Through stimulating the work of the skeletal muscles, NMES increases the functional capacity, muscle mass and endurance in patients with CHF. A beneficial effect of NMES on functional capacity, vascular endothelial function, quality of life and aerobic enzymes activity has been shown. A significant benefit of this novel therapy in heart failure is the fact that the procedure can be home-based, after prior guidance of the patient.

Understanding Red Blood Cell Rheology in Sepsis and its Role in Clinical Practice. From Biomolecular Aspects to Possible Therapeutic Interventions

Abstract: Abstract Erythrocyte rheology is of interest in understanding microcirculation and oxygen delivery and consumption alterations induced by sepsis and septic shock. Several mechanisms are proposed: (i) direct or indirect RBC membrane alterations, (ii) abnormal intraerythrocytic homeostasis, (iii) RBCs interaction with other cells and extracellular molecules, (iiii) increased reactive species production and altered redox homeostasis. In this review, we describe in part these mechanisms and what’s the impact of these hemorheological disturbances on the outcome and mortality rate. Also, we outline the possible therapeutic interventions and further perspectives regarding sepsis and septic shock management.

Procedural Sedation and Analgesia in Adults - new trends in patients safety

Abstract: Abstract Sedation and analgesia may be needed for many interventional or diagnostic procedures, whose number has grown exponentially lately. The American Society of Anesthesiologists introduced the term “procedural sedation and analgesia” (PSA) and clarified the terminology, moderate sedation and Monitored Anesthesia Care. This review tries to present a nondissociative sedation classification, follow ing ASA guidelines as well as pre-procedural assessment and preparation, in order to choose the appropriate type and level of sedation, patient monitoring and agents, which are most commonly used for sedation and/or analgesia, along with their possible side effects. The paper also lists the possible complications associated with PSA and a few specific particularities of procedural sedation.

Endoscopic ultrasound-guided choledochoduodenostomy using a lumen apposing metal stent for acute cholangitis.

Abstract: We present the case of a 51-year-old woman with a history of uterine cancer who presented to the emergency room with a clinical picture of acute cholangitis. An abdominal ultrasound and a computed tomography scan were performed, revealing a gigantic lymphadenopathy mass compressing the common bile duct and the duodenum. After failure to perform an endoscopic retrograde cholangiopancreatography (ERCP) due to a modified anatomy, we performed an endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and placed a Hot AXIOS 10Fr/10 mm stent with efficient biliary drainage. In addition, we inserted a duodenal uncoated 120/22 mm expandable metallic stent. EUS-CDS presents a valid alternative in patients with failed ERCP and should be considered as an important option for rapid biliary decompression in patients with acute cholangitis.

Ectopic pancreas mimicking gastrointestinal stromal tumor in the stomach fundus

Abstract: Ectopic or heterotopic pancreas refers to healthy pancreatic tissue that lacks anatomical, vascular or neural communication with the normal pancreas. However, heterotopic pancreas is seldom considered as a diagnostic hypothesis when symptomatic or when located outside of the gastric antral wall [1]. This case report describes the clinical and paraclinical features of pancreatic heterotopia in the gastric fundus in a previously healthy 25-year-old woman. Initially, a gastrointestinal stromal tumor (GIST) was highly suspected because of its endoscopic (location and shape; ▶Video1), endoscopic ultrasound (emerging layer; ▶Fig. 1, ▶Fig. 2), and computed tomography characteristics; however, the histopathological evaluation revealed pancreatic heterotopia (▶Fig. 3). Although the patient was asymptomatic, we opted for surgical treatment because of the large size of the lesion, the atypical location in a highly vascularized part of the stomach, and the patient’s young age. On postsurgical follow-up, only a small granuloma was found on the suture site, even though the surgery was not curative (R1 with remaining pancreatic tissue on one margin of the resection specimen) (▶Fig. 4). We emphasize the unusual location of the pancreatic heterotopia (gastric fundus – despite up to 95% of cases being found in the antral location), and the layer from which the tissue developed (muscularis propria – which is seen in only 17% of cases) [2]. Moreover, we emphasize the difficulty in making an accurate diagnosis, which can only be obtained after surgery, and the need for regular postoperative follow-up to assess for remaining pancreatic rests, as some studies have shown up to 12.7% malignant transformation in pancreatic rests [3]. Despite the fact that ectopic pancreas is a rare condition, one must consider the differential diagnosis of extramucosal gastric lesions. Even though endoscopic Video 1 Endoscopic appearence of a submucosal lesion, with central ulceration, in the gastric fundus. Narrow-band imagining revealed regular microvascular and surface patterns, except for the central zone, which had irregular surface and vascular patterns.

Bilateral papillary oedema - case report.

Abstract: Objective We report one case of malignant high blood pressure with no systemic signs but with ocular complaints. Methods The paper presents the case of a 31-year-old male who complained of sudden loss of visual acuity in both eyes. The ophthalmological examination revealed bilateral papillary oedema. General and cardiological examinations revealed he was suffering from malignant high blood pressure. Results The pathogenic treatment resulted in resolution of signs and symptoms with favourable ophthalmological evolution and almost entirely functional recovery. Clinical, paraclinical and imagistic data suggested the diagnosis of pheochromocytoma. Conclusion This case highlighted ocular complications of high blood pressure. The paper summarizes the differential diagnosis and management of high blood pressure and reviews the most common causes of secondary hypertension in young patients.

Non-arteritic anterior ischemic optic neuropathy - Case report.

Abstract: We present a case of Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION) with uncertain etiology but a good recovery with a total gain of central visual acuity.

Guidance and Guideline-recommendations for the treatment of femoral neck fractures Romanian Society of Orthopaedics and Traumatology- SOROT 2018

Abstract: Abstract Two types of femoral neck fractures are nowadays identified: those resulting from low energy trauma, usually by direct by falling on the hip, in patients with affected bone stock (the so-called “fragility fractures”) and those produced by high energy trauma, even in younger people, with normal bone stock. These recommendations are addressed to the first category. for which impaired mineral bone density (MBD), osteopenia, and osteoporosis represent major enabling factors. These recommendations refer to classification-based local and general treatment of femoral neck fractures (excluding the basilar neck ones). The presumptive and definitive diagnoses include the precise description of the fracture pattern, by complete imagistic evaluation. The treatment depends on the type of the patient (demanding or non-demanding), on the type of the fracture (stable or unstable), as well as on the facility of early treatment, in certain cases. The main therapeutic goal in femoral neck fractures is early social and professional reinsertion of the patient, by gaining a status as close as possible to the one before the trauma; stable stabilization allowing early mobilization has a key role in fulfilling this objective Therefore, complete evaluation and monitoring of the patient by a multidisciplinary team is mandatory in order to perform a proper evaluation of the anaesthetic and surgical risk ( as these patients usually have pre-existing health problems, sometimes severe) , a safe and adapted (form the point of view of invasivity) surgery and an appropriate post-operative local and general treatment. Therefore, these recommendations have numerous connections with those involving the intervention of physicians from other specialities with whom orthopaedic surgeons must cooperate in these cases

Factors influencing functional results after surgery for ankle fractures

Abstract: Abstract Ankle fractures are frequent and have a significant impact upon the function of the lower limb, as this joint has a crucial role in standing and especially in walking. Several classification systems have been developed concerning these fractures, connecting the traumatic mechanism to their treatment. Due to their character of articular fractures, functional restoration of local anatomy is necessary; therefore, surgery is mandatory in displaced fractures, affecting the congruency, the stability or the mobility of the ankle joint. The purpose of this paper is to describe the factors influencing the results of surgical treatment in these fractures, as it results from the experience of a level 1 Trauma Centre.

Using External Fixation in distal tibial fractures- good principle, debatable application- Case presentation

Abstract: Abstract Distal tibial fractures usually result from high-energy trauma, affecting young, active people, producing long-term disability and numerous complications. Their treatment is difficult, especially in type C fractures, which affect both the articular surface and the metaphysis, are quite frequent comminuted fractures, and are accompanied by soft tissue injuries. In these situations, External Fixation (EF) is used as a temporary bridging method, either for treating concomitant soft tissue injuries (in open fractures) or for achieving and maintaining reduction in order to prevent blisters or compartment syndrome, possibly resulting from severe displacement, bleeding or oedema. It must be however underlined that EF is rarely a definitive method for these fractures, especially when the ankle is splinted, and it must be followed by definitive Internal Fixation (IF) - the so-called “sequential method”, otherwise restoration of a normal ankle anatomy and function is improbable, resulting in ankle stiffness or even osteoarthritis. This paper presents a case in which this principle was only partially applied, thus requiring corrective surgery followed by a long-term recovery period.

Clinical Signs and Electrocardiography

Abstract: Right ventricular failure is a complex clinical syndrome that can result from any structural or functional cardiovascular disorder that impairs the ability of the right ventricle to fill or to eject blood. The approach to the patient with known or suspected right heart pathology begins with a directed history and targeted physical examination, the scope of which depends on the clinical context at the time of presentation. These exams are augmented by a series of paraclinic tests that help to accurately establish etiology and classify severity. Symptoms of right heart disease are often due to the underlying disease and depend on the severity of the condition. In acute life threatening situations, i.e. acute pulmonary embolism or right ventricular myocardial infarction, the clinical presentation may be dominated by hemodynamic instability even progressing to cardiogenic shock. The clinical signs encountered in patients with chronic right heart pathology are initially due to the development of pulmonary hypertension; afterwards, they are completed by the development of right ventricular hypertrophy and a typical picture of right ventricular failure, dominated by systemic congestion.