Asunto(s)
Anestesiólogos , Antifibrinolíticos , Trasplante de Hígado , Ácido Tranexámico , Humanos , Ácido Tranexámico/administración & dosificación , Ácido Tranexámico/uso terapéutico , Ácido Tranexámico/efectos adversos , Antifibrinolíticos/uso terapéutico , Antifibrinolíticos/efectos adversos , Antifibrinolíticos/administración & dosificación , Pérdida de Sangre Quirúrgica/prevención & control , Resultado del Tratamiento , Anestesiología/métodos , Hemorragia Posoperatoria/prevención & control , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/inducido químicamenteRESUMEN
PURPOSE: The Rapid System Review (RSR) score was developed to predict the number of postanesthesia care unit (PACU) interventions. We hypothesized that if RSR score was <0, no PACU interventions were expected; however as the RSR score increased, the number of PACU interventions would also increase. DESIGN: Observational clinical study. METHODS: The RSR score was tabulated as 0 to 3, 4 to 6, 7 to 9, 10 to 12, and 13 to 15. The corresponding number of PACU interventions was expected to be 1 to 3, 4 to 6, 7 to 9, 10 to 12, and 13 to 15. FINDINGS: The Pearson correlation coefficient comparing RSR score and PACU interventions was 0.9 (P < 0.0001). The result was statistically significant. CONCLUSIONS: These results suggest that as RSR score changes, the number of interventions would also alter proportionally.
Asunto(s)
Admisión del Paciente , Enfermería Posanestésica , Femenino , Humanos , MasculinoRESUMEN
A 70-year-old man was scheduled for open reduction and internal fixation of his right knee fracture. When the tourniquet was deflated after 150 minutes, his arterial blood pressure and heart rate decreased precipitously. The patient was deemed to exhibit pulseless electrical activity. Cardiopulmonary resuscitation was initiated. The bispectral index reading improved to 25 to 30, but his end-tidal carbon dioxide was still very low (5 mm Hg). Transesophageal echocardiography showed a pulmonary embolism. Feedback from echo imaging improved the quality of chest compressions and motivated the resuscitation team to maintain the diastolic blood pressure>25 mm Hg. Although capnographic guidance was ineffective by itself, echocardiography monitoring was very helpful for showing the intracardiac events.
Asunto(s)
Reanimación Cardiopulmonar/métodos , Ecocardiografía Transesofágica , Paro Cardíaco/terapia , Embolia Pulmonar/diagnóstico por imagen , Anciano , Capnografía , Dióxido de Carbono/metabolismo , Paro Cardíaco/fisiopatología , Humanos , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/cirugía , Masculino , Examen Neurológico , Embolia Pulmonar/etiología , Factores de TiempoRESUMEN
An 81-year-old man with a history of villous adenoma of the duodenum was admitted with new-onset jaundice, abdominal pain, and pruritus, which raised concerns about disease progression and hepatobiliary obstruction. The patient had refused surgical resection of tumor on initial diagnosis 2 years earlier and opted out of it again at the current presentation because of his significant comorbidities. While discussing treatment options with his family, he developed symptoms suggesting myocardial infarction. Therefore, before anesthetizing this patient with escalating cardiac enzyme levels for an urgent noncardiac procedure, it was important to attend to the dynamics of the decision-making process.