LAC+USC Medical Center

About: LAC+USC Medical Center is a healthcare organization based out in Los Angeles, California, United States. It is known for research contribution in the topics: Population & Poison control. The organization has 1348 authors who have published 886 publications receiving 21927 citations. The organization is also known as: County/USC & Los Angeles County General.

Pulmonary embolism in transit: direct visualization of a PE passing through the heart using bedside ultrasonography.

Abstract: A 59-year-old man with a history of atrial fibrillation presented to the emergency department with several days of progressive dyspnea and three episodes of syncope. On physical examination, blood pressure was 154/124 mm Hg, pulse 149 beats/min, respiratory rate 28 breaths/min, and oxygen saturation 83% on room air. He was diaphoretic (but speaking fluently), had clear lungs, a rapid, irregular heartbeat without murmurs, and bilateral lower extremity edema. An electrocardiogram confirmed atrial fibrillation with rapid ventricular response, and a clinical ultrasound demonstrated no pericardial effusion, a moderately decreased left ventricular ejection fraction, no right ventricular (RV) strain, and a hyperechoic, mobile, serpiginous mass oscillating between the right atrium and right ventricle (Figures 1 and 2). Chest computed tomography (Figure 3) was performed to confirm the diagnosis and evaluate the extent of disease. Pulmonary embolism (PE) in transit refers to the direct visualization of distal thrombi passing through the right side of the heart. Cases with this echocardiogram finding are associated with significantly worse mortality. Recommendations are limited, but favor thrombolysis or embolectomy rather than anticoagulation alone. Although typical echocardiogram findings suggestive of PE include RV strain and McConnell’s sign (RV free wall hypokinesis with preserved apical contractility), this patient had neither of these findings, but the presence of a right-sided thrombus confirmed the likely diagnosis of PE and

Crisis in Adolescence: Parental Attitudes about Children's Behavior

Abstract: This paper presents data from a Parental Attitude Scale completed by 132 parents of adolescents in crisis admitted to the Los Angeles County-University of Southern California Medical Center Factor analysis of the attitude scale delineated three bipolar factors: (1) the gratifying adolescent versus the nongratifying adolescent, (2) the nondelinquent self-controlled adolescent versus the prodelinquent impulse-ridden adolescent, and (3) the loving adolescent versus the rebellious adolescent

Potential renal complications of anesthesia

Abstract: Summary Because the kidney receives a large blood supply and because of its function to concentrate substances in the tubular fluid, there is always the potential susceptibility for nephrotoxicty by even small amounts of toxins. Anesthetics can cause both direct and indirect renal effects. The direct effects seem to be limited to fluoride toxicity most epitomized by methoxyflurane, which is no longer used. The present day agents more commonly used, eg, halothane, enflurane, isoflurane, and the more recently introduced desflurane and sevoflurane, which have some potential for fluoride toxicity, but do not appear to cause significant renal toxicity except in extreme conditions. The indirect effects of anesthetics are of more importance. These effects are hemodynamic alterations, sympathetic activation and humoral regulatory changes. Many of these effects are mitigated when patients' preoperative anxiety is ameliorated, preoperative hydration is maximized, and their medical condition(s) is (are) well compensated. Even with controlled hypotension, the renal effects are usually transitory when the practitioner has a good understanding of the anesthetic agents used, the need for optimal hydration, and how to anticipate and modify the effects of clinical hemodynamics and surgical stress