RESUMEN
Papillary muscle rupture (PMR) is an uncommon mechanical complication of myocardial infarction which warrants timely diagnosis and urgent surgical intervention to maximize survival chances. Echocardiography is an essential diagnostic tool, whereas transesophageal echocardiography can provide accurate diagnosis and guide decision-making. We hereby present the case of a patient with partial PMR that presented for cardiac surgery in our institution, with the respective intraoperative echocardiographic findings.
Asunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Trombosis , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Puente Cardiopulmonar/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/cirugíaAsunto(s)
Anestesia/métodos , Anestésicos Intravenosos/administración & dosificación , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Oxigenación por Membrana Extracorpórea/métodos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Adulto , Relación Dosis-Respuesta a Droga , Humanos , MasculinoRESUMEN
BACKGROUND: A comprehensive whole-person approach might improve processes and outcomes of care for patients with cancer. OBJECTIVE: To assess the ability of NEST13+ (Needs of a social nature; Existential concerns; Symptoms; and Therapeutic interaction), a screening and assessment tool, to identify social, emotional, physical, and care-system needs and to improve clinical outcomes for cancer patients in tertiary care. DESIGN, SETTING, PATIENTS: A controlled trial involving 451 patients hospitalized for cancer care at a comprehensive cancer center. INTERVENTION: Patients responded to 13 screening questions regarding possible care needs. When an individual response exceeded threshold levels, additional in-depth questions for the relevant need were asked. For patients in the intervention arm, clinical recommendations for each dimension of need were generated based on a previously developed NEST-response-driven menu, and were reported to the clinical team. MEASUREMENTS: Documented needs, clinician response, patient perception of goals alignment, and overall quality of palliative care. RESULTS: Using the NEST13+ tool in the clinical setting facilitated greater documentation of illness-related needs than routine clinical assessment. Improvement in secondary outcomes was attenuated: changes in the clinician response were modest; changes in outcomes were not significant. CONCLUSION: The NEST13+ tool facilitated identification of a wider range of important needs than traditional evaluation, while care outcomes were not improved. Traditional evaluation may need improvement. Future trials of the NEST13+ should focus on more intensive clinician-directed interventions.