A&A practice
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Acute pain intensity has conventionally been assessed with a patient self-reported, unidimensional pain scale. This approach can inadvertently underestimate analgesia and result in large cumulative opioid doses and greater dose-dependent side effects and complications. ⋯ The TAG comprises the level of acceptable pain intensity, the level and types of desired activities, and accomplishing other patient-centered functional goals. The TAG evolves throughout the patient's hospitalization to promote timely discharge.
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We used simulation as a job-specific functional capacity evaluation method after a distal radius fracture in an anesthesiologist. Treatment included open reduction followed by an internal fixation with an arthrodesis plate. ⋯ Data collected helped to guide the rehabilitation protocol, and to assess pain and the time to safely return to work. The patient began her clinical duties after 7 weeks of therapy and was able to fully perform her daily tasks with confidence, and full functional capacity.
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A 19-year-old man with mitral valve endocarditis and prolapse, intracerebral and intracerebellar hematoma, and a mycotic cerebral aneurysm underwent emergency mitral valve replacement during minimal cardiopulmonary bypass (total priming volume, 800 mL; autologous retropriming, activated clotting time <300 seconds) 1 day after undergoing endovascular coil embolization of the aneurysm. Postoperatively, there were no extensions of the intracerebral and intracerebellar hematoma. After intensive rehabilitation therapy, the patient recovered fully except for residual bilateral claudication because of preoperative bilateral embolism to both superficial femoral arteries.
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Postintubation subglottic stenosis is one of the most common causes of stridor in newborns and babies after prolonged mechanical ventilation. Management of this pathology is complex and requires highly trained personnel because it is associated with a high rate of airway-related mortality. This article presents the rescue of a difficult airway in a pediatric patient with subglottic stenosis with a new device available on the market, the Ventrain, offering certain advantages over those available until now.