Arch Surg Chicago
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Between 1983 and 1987, 114 adult patients with 131 pneumothoraces were treated utilizing catheter aspiration for simple pneumothorax as an alternative to tube thoracostomy. The causes of simple pneumothorax were as follows: 79 needle-induced, 36 spontaneous, and 16 traumatic. Thirty-eight of the pneumothoraces were small (less than 20% of volume), 55 were moderate (20% to 40% of volume), 36 were large (greater than 40% of volume), and 2 were of unknown size. ⋯ There were three complications (2.3%), including one hemothorax and two retained sheared catheter tips. The average cost per patient was +868 for catheter aspiration, and $6402 for a tube thoracostomy. These data support catheter aspiration as a safe, cost-effective, and successful technique for managing simple pneumothorax.
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The initial physical examination is frequently unreliable in identifying patients with blunt trauma at high risk for having serious intra-abdominal injury. Intra-abdominal injury may be associated with specific injuries or risk factors, but the usefulness of such objective clinical criteria in predicting intra-abdominal injury has not previously been determined. ⋯ Arterial base deficit less than -3 mEq/L, major chest injury, hypotension, and pelvic fractures were found to significantly increase the chance of intra-abdominal injury. Early diagnostic evaluation of the abdomen using diagnostic peritoneal lavage or computed tomography should be strongly considered in patients with blunt trauma who present with these associated factors.
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The clinical significance of various diagnostic tests and the length of monitoring required for myocardial contusion were evaluated in 172 patients. Cardiac isoenzyme levels, electrocardiograms, and echocardiograms were evaluated. Twenty-eight patients had a documented myocardial contusion based on at least one positive diagnostic study. ⋯ No patients developed positive diagnostic studies after 24 hours and, likewise, no clinical deterioration occurred late or in patients with a negative screening examination. The electrocardiogram and the clinical course were the therapeutic intervention. Cardiac isoenzyme levels had negligible significance on outcome, and the two-dimensional echocardiogram was not particularly valuable as a screening technique, If no abnormality is detected within 24 hours post injury, further investigation or monitoring does not appear warranted.
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The usefulness of skeletal muscle PO2 assessment in monitoring patients at risk of shock was evaluated in 20 critically ill patients. A shock score, inotropic score, and combined inotropic-shock score were calculated. ⋯ If inotropes were administered, no significant difference was found in the incidence of shock if skeletal muscle PO2 was below or above 22.5 mm Hg. Skeletal muscle PO2 assessment enables the determination of the severity of shock and determination of risk of shock in critically ill patients, provided no treatment with inotropes has been instituted.
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A method of quality assurance for a surgical intensive care unit is described. A system outcome score is devised, incorporating only easily obtained objective components that reflect the likelihood of death. Through the use of a derived outcome index, the actual mortality rate is compared with the predicted mortality rate as a method of monitoring the quality of care provided. Subroutines exist to identify errors in data entry, to detect malicious interference in patient care, to add nonscoring components for the purposes of clinical studies, and to facilitate retrieval of a concise summary of the major events during the stay of every patient admitted to the intensive care unit.