...Stokes et al. BMC Health Services Research 2011, 11:135 http://www.biomedcentral.com/1472-6963/11/135 RESEARCH ARTICLE Open Access Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients Michael E Stokes1*, Xin Ye2, Manan Shah3, Katie Mercaldi4, Matthew W Reynolds4, Marcia FT Rupnow2 and Jeffrey Hammond2 Abstract Background: Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods: A retrospective analysis was conducted using Premier’s Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery) during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions) was examined, and hospital costs and length of stay (LOS) were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary...
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...management -GSWs most often injure the small bowel followed by the colon and liver Clinical thinking Does the patient have an adequate airway, and ability to protect it? Is the patient breathing? Is oxygenation and ventilation adequate? A GSW in the abdomen may penetrate the diaphragm and cause a significant thoracic injury -Does that patient have adequate blood volume and perfusion? How does the patient respond to resuscitation, does the pt take beta blockers that may mask an appropriate tachycardia? -evaluate the pts ability to follow commands and respond appropriately. Is neurological disability a central phenomenon from shock, or is there a direct spinal cord injury? The patient must always be adequately exposed to evaluate all injuries, don’t over look the axial, back, gluteal cleft, and perineum. Patients with penetrating abdominal injuries are best served by antibiotic therapy prior to operative intervention. Initial therapy should be broad, with coverage of both gram-positive and gram negative organisms. Current practice guidelines advise broad spectrum antibiotics prior to incision and throughout operation -tentanus toxoid upon admission The care of the trauma patient does not end with intraoperative repair of injuries. The hypothermic, coagulopathic laparotomy patient is prone to numerous postoperative complications: Expect...
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...prevent earlier apparition of recurrences and chronicity in adulthood. Spinal pain Spinal pain appears due to variety of symptoms, which are experienced at least once in a lifetime by approximately 80% of a general population [1]. Classification of spinal pain concerns affected region (cervical, thoracic, lumbar, or irradiation in the limbs), duration (acute, sub-acute, chronic), or level of functional disability [1]. Lumbar pain is determined as a pain, muscle tension or stiffness that occurs between the last thoracic vertebra and the lower gluteal folds, with or without leg pain [1–3]. Chronic low back pain appears more often by working population in adulthood [1] and fluctuates during time, appears at different occurrences with different intensities and disability [4]. The complexity of symptoms could be associated with physical, psychical and recently genetic factors, as well most efficiently managed using multidisciplinary approach [5]. Spinal pain is common problem also among children and adolescents [3,6]. A cross-sectional study of 806 pupils in Denmark shows that children between 8-10 years suffer more from thoracic pain and 14 to 16 old adolescents equally from thoracic and low back pain, all together with a monthly prevalence of 39%...
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...presentation * absence of other explanation or other underlying disease * absence of cutaneous lesions * otherwise normal neuro exam * Proceed with imaging (MRI) if * Atypical Presentation * Slowly progressive over 2-3 weeks * If no improvement in symptoms in 6 wks * Electrophysiology (CMAP) performed if complete facial paralysis remains after 1 week of treatment Treatment * PT management: modalities, facial exercise, massage * Manual closing of eye such as with tape while sleeping, lubricating eye drops * Steroids * +/-Acyclovir * Surgical Decompression – no good evidence to support Prognosis * 80% recover within weeks to months * If motor nerve conduction studies show evidence of...
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...Paramedic Case Studies Name Institution Table of Contents Introduction 3 1.1 Clinical plans are prior to arrival on the scene. 4 1.2 Patient selection Criteria for RSI 5 1.3 Steps in an RSI Procedure 6 Step 1 - Preparation 6 Step 2- Preoxygenation 6 Step 3- Pretreatment 7 Step 4- Rapid sequence Induction and Paralysis 7 Step 5- Protection and Positioning 7 Step 6- Placement of the Endotracheal Tube in the Trachea 8 Step 7- Post-intubation Management 8 1.4 Risks and benefits associated with RSI 9 Case 2 10 2.1 Discussion 10 2.2 Clinic plan and initial management 10 2.3 Notification of Arrival 11 Conclusion 11 Case 3 12 Introduction 12 Incident 1 12 Incident 2 13 Incident 3 13 Incident 4 14 Case 4 15 Conclusion 16 References 17 Introduction The basic concept of retrieval medicine is a combination of transfer and care of a patient from one medical institution, site of trauma, and pre-hospital management to a medical institution to provide higher and better level of care. The transfer and retrieval of severely ill and wounded patients entail high-risk activities (Ellis & Hooper, 2010). This paper looks into various case studies to determine the various control measures that might and should be put in place in various retrieval situations so as to increase patient safety and efficiency in pre-hospital care. This comprises of communication procedures, team resource management...
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...extremity. Examination of his shoulder girdles revealed an internally rotated left shoulder and shortened clavicular distance. He did have a visible deformation of his left clavicle when compared to the contralateral, uninjured side and had excruciating pain to palpation of the clavicular and sternoclavicular area. The patient had full flexion and extension at the elbow. Shoulder deltoid was intact as were internal and external rotation of his shoulder. Furthermore, the patient denied being short of breath, feeling dizzy, or with difficulty swallowing. Radiographs of the left clavicle and sternoclavicular joint (SCJ) at the initial visit were remarkable for a posterior dislocation of the clavicle. A magnetic resonance imaging (MRI) study of the left clavicle and SCJ revealed that it was posteriorly displaced and edema was present at the fracture site. The physeal attachment to the manubrium was intact. Furthermore, the anterior portion of the clavicle was abutting the brachiocephalic and left subclavian vein (Figure 1). The patient was admitted and a closed reduction was attempted. Postoperatively, the patient developed paresthesia of the fingers of his left hand. An urgent CT scan with contrast was performed to evaluate any potential bleeding from the subclavian vessels. No active bleeding was discovered, however, a retrosternal hematoma with mass-effect on the adjacent vasculature was identified and the...
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...EXHIBITS No. 1 No. 2 3-19-14 Ltr, Turner to Richards 11-14-13 Deposition Transcript Excerpt 86 86 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Page 3 Uh-huh. MS. TURNER: Mr. Christensen, these are the medical records because we didn't print them all out. MR. CHRISTENSEN: I figured. And you had sent me those, but I appreciate you bringing them. We might open them up and refer to them, actually. Q. Did you happen to have in your file your billing for your services at all? A. No. Q. And why is that? A. My wife takes care of that so I don't keep a record with me of billing. Q. How does she typically do that? MS. TURNER: Objection. Foundation. Answer it if you know. A. I give her the hours that I spent working on the case and then she sends an invoice. Q. And where is the documentation for your hours? Is it on your handwritten notes? A. So up at...
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...A Hybrid Operating Suite at Community Medical Center Russell F Stahl, M.D., Carmen Sciandria, CCP, Cassandra Cuesta, BA The Evolution of Treatment of Cardiovascular Disease Surgery for coronary artery disease (CABG), valve repair and replacement, and the treatment of aortic disease, all have a remarkable history of success and evolution. Just as with computer technology, the trend in surgery has been to become smaller, faster and better. The treatment of cardiovascular disease (CVD) is moving towards less invasive and, in many cases, catheter based technologies. First interventional radiologists, then cardiologists, and now cardiac and vascular surgeons have embraced this trend. Clinicians are encouraged by outcomes that appear to be at least as good, albeit with trade-offs, and a high level of patient acceptance. Hybrid operating rooms - rooms combining operating room sterility and functionality with fixed angiography and echocardiographic imaging- are rapidly growing in prevalence and gaining increased interest from hospital administrators. These rooms are used by cardiac surgeons, vascular surgeons, interventional cardiologists, and neuro-interventionalists, and are suited for both open and closed procedures, as well as collaborative “hybrid” procedures. Given the dynamic nature of this room, these investments require thoughtful preparation operationally and logistically, especially when planning for physician and support staff that will work and cover call in this...
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...The ORIGINAL ARTICLE Heart the MVand Short StaturePolicy implications CASE REPORT Sinking of Failure Doña Paz – II. in a 43 year-old male Table 1. Initial Laboratory Results Heart Failure recommendations to address these to hypothyroidism. with cardiomyopathy secondary factors. The patient had been born full term to a then 31-yearMethod. ReviewPara 3 (G4P3), the 4th of preparedness in the old Gravida 4 of the state of maritime 9 siblings, with an pre-disaster setting and the post-disaster responsefacilitated the apparently unremarkable delivery at home following by Table 2. Thyroid Doña Paz by the sinking of the MV Function Tests government and responsible a traditional birth attendant. He was noted to be normal agencies. A scrutiny Reference Value preparedness of concerned of the state of Result at birth. and subsequent response to thewith age was agencies The patient was allegedly at par0.02 disaster both Free T4 (0.8-2.0) ng/dL physically and mentally until formulating 24.75 Uiu/ml conducted with the objective of eight years old when he was recommendations TSH (0.4-6.0) said to have stopped growing in height. He was brought to which may lead to prevention and mitigate loss of lives. a private doctor, whose diagnosis was undisclosed, and he Results. Multiple factors to increase for the occurrence patient was given medications accounted height, which the of this tragedy. only one month with no improvement. Through the took for These factors include an inherent risk due...
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...151 Project Part A Abstract: This case study is about the application and effectiveness of massage modalities on resolving pain and tension issues based on chronic postural imbalances. In this case study there will be assessing of the client's conditions, facilitating techniques based on the symptoms and drawing conclusions of the efficacy of the applied techniques as a protocol for the given conditions. Introduction: 1. The therapeutic concern for my client is to relieve moderate and chronic pain that stems from the neck down the shoulder blade and into the upper arm and mid-back at rest and during daily activity. With the pain and tension comes a compromised active, passive, and resisted range of motion in the actions...
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...Robotic Surgery To Stay Or Not Too Stay The use of surgical robots has increased greatly and is continuing to grow. Although these robots are already being used they have advantages as well as disadvantages. Surgical robots are only going to improve the outcomes for the patients, surgeons, and hospitals and will keep improving as time goes on, overcoming the disadvantages that are seen today. Many different types of robots are being used to carry out surgical procedures such as the Endowrist, AESOP, Zeus, PROBOT, ROBODOC, SOCRATES and the da Vinci being the most popular. Also there are many specific types of surgical procedures that are being carried out robotically such as urological, gynecological, cardiac, and general surgeries. “Shorter hospital stays, smaller incisions, less blood loss, quicker recovery, less painful, reduced rates of bacterial infections and blood transfusions, eliminating the surgeons hand tremors, more comfort and decrease in fatigue for the surgeon, 3D view, superior suturing skills, reverse fulcrum” are some of the advantages that affect the patient. Disadvantages involved with robot assisted surgery are “high cost, the large size of the robot, lack of compatible instruments and equipment, lengthy set up times, longer operative times, lack of haptic tactile feedback,” but are believed to disappear with more research and time. Surgical robots could be the most successful and most used technology in surgery in the future. “A surgical robot...
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...Acquisitions Editor: Crystal Taylor Product Managers: Kelley A. Squazzo & Catherine A. Noonan Designer: Doug Smock Compositor: SPi Technologies First Edition © 2011 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street Baltimore, MD 21201 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the abovementioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market street, Philadelphia, PA 19103 USA, via email at permissions@lww.com, or via website at lww.com (products and services). Library of Congress Cataloging-in-Publication Data Lambert, Harold Wayne, 1972– Lippincott’s illustrated Q&A review of anatomy and embryology / H. Wayne Lambert, Lawrence E. Wineski ; with special contributions from Jeffery P. Hogg, Pat Abramson, Bruce Palmer. — 1st ed. p. ; cm. Includes index. ISBN 978-1-60547-315-4 1. Human anatomy—Examinations, questions, etc. I. Wineski, Lawrence E. II. Title. [DNLM: 1. Anatomy—Examination Questions...
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...Brandy Shields Mrs. Knutsen ENC1101-83 16 April 2014 Chronic Pain: Curable or Not Abstract Chronic Pain is an interesting problem in society today. The exact cause of Chronic Pain is not the same in every patient. In fact most patients present with different symptoms and associated pathologies, such as the strong link with depression. Treatment of Chronic Pain is often performed a single practitioner whether that be a Medical Doctor, Chiropractor, Nutritionist, or an alternative health care professional. Chronic Pain is often extremely complex, because of this treatment needs to be multidimensional. Effective care of Chronic Pain requires the collective cooperation of health care professionals Chronic pain is an increasing problem affecting society today. Chronic pain is a complex condition that affects 42 million-50 million Americans, according to the American Pain Foundation. A recent market research report indicates that more than 1.5 billion people worldwide suffer from chronic pain and that approximately 3- 4.5% of the global population suffers from neuropathic pain, Despite decades of research, chronic pain remains poorly understood and notoriously hard to control. A survey by the American Academy of Pain Medicine found that even comprehensive treatment with painkilling prescription drugs helps, on average, only about 58% of people with chronic pain. The frequency of pain has a great impact on business, with a recent report by the Institute of Medicine (Medicine) ...
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...Top of Form The ABCDE approach Underlying principles The approach to all deteriorating or critically ill patients is the same. The underlying principles are: Use the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach to assess and treat the patient. Do a complete initial assessment and re-assess regularly. Treat life-threatening problems before moving to the next part of assessment. Assess the effects of treatment. Recognise when you will need extra help. Call for appropriate help early. Use all members of the team. This enables interventions (e.g. assessment, attaching monitors, intravenous access), to be undertaken simultaneously. Communicate effectively - use the Situation, Background, Assessment, Recommendation (SBAR) or Reason, Story, Vital signs, Plan (RSVP) approach. The aim of the initial treatment is to keep the patient alive, and achieve some clinical improvement. This will buy time for further treatment and making a diagnosis. Remember – it can take a few minutes for treatments to work, so wait a short while before reassessing the patient after an intervention. First steps Ensure personal safety. Wear apron and gloves as appropriate. First look at the patient in general to see if the patient appears unwell. If the patient is awake, ask “How are you?”. If the patient appears unconscious or has collapsed, shake him and ask “Are you alright?” If he responds normally he has a patent airway, is breathing...
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...Case Study for Final Exam Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. The name myasthenia gravis, which is Latin and Greek in origin, literally means "grave muscle weakness." With current therapies, however, most cases of myasthenia gravis are not as "grave" as the name implies. In fact, for the majority of individuals with myasthenia gravis, life expectancy is not lessened by the disorder. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Certain muscles such as those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder. The muscles that control breathing and neck and limb movements may also be affected. Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction - the place where nerve cells connect with the muscles they control. Normally when impulses travel down the nerve, the nerve endings release a neurotransmitter substance called acetylcholine. Acetylcholine travels through the neuromuscular junction and binds to acetylcholine receptors which are activated and generate a muscle contraction. ...
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