American journal of surgery
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Unplanned extubations are common, but can be life-threatening. ⋯ Our data support the use of water resistant tape to secure endotracheal tubes and the routine use of hand restraints.
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Comparative Study
Blood conservation strategies to minimize allogeneic blood use in urologic surgery.
Analysis of the net costs, efficacy, and cost-effectiveness of preoperative autologous blood donation (PAD), versus acute normovolemic hemodilution (ANH), in patients undergoing radical prostatectomy is presented. Currently, PAD is a standard of care for patients undergoing radical prostatectomy. Comparison of PAD with ANH showed no differences in risks or outcome, but ANH was less expensive. ⋯ The use of recombinant human erthropoietin in conjunction with PAD and ANH has optimized perioperative hematocrits and further minimized exposure to allogeneic blood. Intraoperative blood salvage, lower transfusion triggers, and other blood conservation strategies are discussed. The most cost-effective techniques currently available for decreasing allogeneic blood transfusions appear to be avoidance of blood loss, increased tolerance for decreased HCT levels, and autologous blood procurement via ANH.
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Because severe acidosis is an indicator of poor prognosis in trauma patients, medical records of these patients were analyzed to determine whether aggressive resuscitation was appropriate. ⋯ Severe acidosis alone is not a sufficiently powerful predictor of outcome to justify withholding resuscitation; however, when combined with coma and shock, this condition had no survivors in this small series.
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Medical practice guidelines have been promoted as a way to improve the cost-effectiveness of medical care. Algorithms for the transfusion of red blood cells, plasma, and platelets may be especially useful in the surgical setting if they incorporate point-of-care information that is both physiologic and patient-specific for transfusion decision making. Therefore, the goals of guidelines for surgical blood management should be twofold. They should (1) acknowledge patient-specific variability while addressing physician- and institution-dependent variables; and (2) improve blood component management by developing more physiologic clinical indicators of the need for allogeneic red blood cell transfusion.
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Routine performance of thoraco-lumbar (TL) spinal radiology in patients with blunt trauma is controversial. ⋯ These data suggest that patients who are awake, alert, and with no clinical evidence of injury do not require radiologic study of the TL spine. Patients with equivocal or positive clinical findings or with altered levels of consciousness should have complete TL spine evaluation.