Saturday February 3, 2007
MUST protocol
The Multiple Urgent Sepsis Therapies (MUST) Protocol combines current evidence-based sepsis therapies into a single practical pathway. The MUST Protocol originated at the Beth Israel Deaconess Medical Center and was first implemented in November, 2003.
Click here to get MUST Protocol Handbook
(take little time to download, 24 pages - pdf file)
Click here to get MUST Protocol flowsheet
References: Please click to get abstract
1. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol - Critical Care Medicine. 34(4):1025-1032, April 2006.
Saturday, February 3, 2007
Friday, February 2, 2007
Friday February 2, 2007
Q; 65 year old female admitted to ICU 9 days ago with small bowel obstruction. Pt. is now stable and actually is about to get transferred out of unit. Patient suddenly start complaining of choking sensation with two hands on neck. Monitor shows oxygen desaturation. Patient intubated emergently. No laryngeal or vocal edema seen on laryngoscope but vocal cord paralysis noted.
A; Nasogastric tube syndrome
Nasogastric tube syndrome was described about 25 years ago by Sofferman and coll. It is a life-threatening complication of an indwelling (more than a week) nasogastric tube. The syndrome may present as complete vocal cord abductor paralysis. The syndrome is thought to result from perforation of the NG tube-induced esophageal ulcer and infection of the posterior cricoid region (postcricoid chondritis) with subsequent dysfunction of vocal cord abduction. Unilateral paralysis of cord is also described. Treatment is protection of airway, removal of NG tube and antibiotics. Some advocates antireflux therapy too. Another variant is described with no esophageal ulcer but possibly because of ischemia of the laryngeal abductor muscle secondary to physical compression of the postcricoid blood vessels by NG tube.
References: Please click to get abstract
1. The nasogastric tube syndrome: two case reports and review of the literature. Head Neck. 2001 Jan;23(1):59-63.
2. A variant form of nasogastric tube syndrome. Intern Med. 2005 Dec;44(12):1286-90.
3. Case Report - Nasogastric Tube Syndrome: The Unilateral Variant - Medical Principles and Practice Vol. 12, No. 1, 2003
4. Sofferman, R.A. and Hubbell, R.N., "Laryngeal Complications of Nasogastric Tubes," ANNALS OTOLOGY, RHINOLOGY, AND LARYNGOLOGY, 90:465-468, 1981.
Q; 65 year old female admitted to ICU 9 days ago with small bowel obstruction. Pt. is now stable and actually is about to get transferred out of unit. Patient suddenly start complaining of choking sensation with two hands on neck. Monitor shows oxygen desaturation. Patient intubated emergently. No laryngeal or vocal edema seen on laryngoscope but vocal cord paralysis noted.
A; Nasogastric tube syndrome
Nasogastric tube syndrome was described about 25 years ago by Sofferman and coll. It is a life-threatening complication of an indwelling (more than a week) nasogastric tube. The syndrome may present as complete vocal cord abductor paralysis. The syndrome is thought to result from perforation of the NG tube-induced esophageal ulcer and infection of the posterior cricoid region (postcricoid chondritis) with subsequent dysfunction of vocal cord abduction. Unilateral paralysis of cord is also described. Treatment is protection of airway, removal of NG tube and antibiotics. Some advocates antireflux therapy too. Another variant is described with no esophageal ulcer but possibly because of ischemia of the laryngeal abductor muscle secondary to physical compression of the postcricoid blood vessels by NG tube.
References: Please click to get abstract
1. The nasogastric tube syndrome: two case reports and review of the literature. Head Neck. 2001 Jan;23(1):59-63.
2. A variant form of nasogastric tube syndrome. Intern Med. 2005 Dec;44(12):1286-90.
3. Case Report - Nasogastric Tube Syndrome: The Unilateral Variant - Medical Principles and Practice Vol. 12, No. 1, 2003
4. Sofferman, R.A. and Hubbell, R.N., "Laryngeal Complications of Nasogastric Tubes," ANNALS OTOLOGY, RHINOLOGY, AND LARYNGOLOGY, 90:465-468, 1981.
Thursday, February 1, 2007
Thursday February 1, 2007
How Frequent Is Venous Thromboembolism (VTE) with HIT in Heparin-Treated Patients
Interesting meta-analysis of 10 studies done from Texas looking into frequency of DVT / VTE in heparin treated patients (include IV and SQ unfractionated heparin as well as SQ low-molecular-weight heparin (LMWH) - due to Heparin-Induced Thrombocytopenia (HIT).
They found that VTE is associated with HIT less than 1% in LMWH-treated patients, but one in eight cases in unfractionated heparin treated patients.
Clinical significance:
1. LMWH like Lovenox may be a better choice for DVT prophylaxis and other treatments than unfractionated heparin due to high incidence of HIT with it.
2. Physicians should suspect the possibility of HIT if DVT / VTE develops during or soon after unfractionated heparin use.
Reference:
How Frequently Is Venous Thromboembolism in Heparin-Treated Patients Associated With Heparin-Induced Thrombocytopenia? Chest. 2006;130:681-687
How Frequent Is Venous Thromboembolism (VTE) with HIT in Heparin-Treated Patients
Interesting meta-analysis of 10 studies done from Texas looking into frequency of DVT / VTE in heparin treated patients (include IV and SQ unfractionated heparin as well as SQ low-molecular-weight heparin (LMWH) - due to Heparin-Induced Thrombocytopenia (HIT).
They found that VTE is associated with HIT less than 1% in LMWH-treated patients, but one in eight cases in unfractionated heparin treated patients.
Clinical significance:
1. LMWH like Lovenox may be a better choice for DVT prophylaxis and other treatments than unfractionated heparin due to high incidence of HIT with it.
2. Physicians should suspect the possibility of HIT if DVT / VTE develops during or soon after unfractionated heparin use.
Reference:
How Frequently Is Venous Thromboembolism in Heparin-Treated Patients Associated With Heparin-Induced Thrombocytopenia? Chest. 2006;130:681-687
Subscribe to:
Posts (Atom)