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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: October 2008 (Page 1 of 2)

Human protein C concentrates in adult septic patients

Abstract

Some case reports and case series suggest that protein C concentrates may improve the outcome in patients with congenital or acquired protein C deficiency (not only in those with sepsis induced purpura fulminans). We reviewed the published literature on the use of protein C concentrates in adult septic patients and found that it is limited to less than 70 patients reported in observational studies with a 70% survival, and added our personal experience (two adult patients with sepsis and contraindications to recombinant activated protein C).

Key words: sepsis, protein C, cardiac surgery

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Perioperative Cardiac Arrests

Abstract

Perioperative cardiac arrests represent the most serious complication of anesthesia and surgery. It is believed that the incidence and mortality of cardiac arrest has declined, however, a more recent review questioned whether these rates have changed over the last 5 decades. It is difficult to compare the reports from different epochs, because medical practice has advanced, surgical acuity increased, and patients in extremes of age undergo surgery today. In the present article we review the information regarding the incidence of perioperative cardiac arrests and predictors of survival covering the period since the first comprehensive report by Beecher and Todd in 1954. We focus on our publications that report perioperative cardiac arrest at Mayo Clinic for adult noncardiac surgery, during regional anesthesia, and arrests in our pediatric surgical practice.

Key words: anesthesia, cardiac arrest, mortality

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Urinary peritonitis caused by gangrenous cystitis

Abstract

We report a case of a young man who developed severe urinary sepsis, on the 21st day of hospitalization (DH), which was treated with ciprofloxacin and gentamicin. On the 30th DH, he developed bloodstream and urinary infections due to Acinetobacter baumannii which had been treated with colistin and rifampicin. On the 55th DH, he developed urinary peritonitis and necrosis of the anterior and posterior bladder wall. Bilateral ureterostomy was performed. The patient was treated with colistin and imipenem. Peritoneal fluid culture yielded Enterobacter cloacae susceptible to imipenem. An enterocystoplasty was performed. The outcome was favourable.

Keywords: peritonitis, Acinetobacter baumannii, colistin, rifampicin

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Variation of vascular ring as a cause of extubation failure

Abstract

We report on an unexpected extubation failure in a two year old boy. In our patient, failure of extubation led to a diagnostic examination. The result of our examination was discovery of a congenital anomaly of the aortic arch and great vessels (vascular ring) with compression of the trachea. The presence of this anomaly in this patient was unknown to us before. A successful surgical procedure eliminated the underlying cause of the persistent extubation failures.

Key words: tracheal compression, vascular ring, extubation failure

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A brief reeducation in cardio-pulmonary resuscitation after six months-the benefit from timely repetition

Abstract

Objectives. Sudden cardiac death is a major cause of death in today’s world. During the minutes passing from the onset of cardiac arrest to the arrival of professional help, the cardiac arrest victim can only rely upon cardio-pulmonary resuscitation (CPR) provided by educated bystanders. Our aim was to explore the possibility of whether a short and affordable course of CPR reeducation could have a significant effect on skills retention and quality of CPR delivered.
Methods. We performed a prospective randomized study that included 72 first and second year medical students who had no clinical experience and no prior training in CPR. Subjects were educated in CPR in accordance with a standardized CPR education protocol. Six months later, half of the studied group (randomly chosen) underwent short reeducation in CPR. One year after initial education they were all tested for CPR skills. The results were printed and filmed.
Results. Students who attended the short reeducation were significantly better in approaching the victim safely, in obtaining a clear airway and in checking the pulse of the victim.
Conclusions. A short and inexpensive course of reeducation, carried out six months after initial education, may render CPR performance more effective for the victim and safer for the rescuer.

Key words: medical education, resuscitation, medical students, basic life support

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