Arch Surg Chicago
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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.
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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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Clinical and laboratory studies have documented high susceptibility to pneumococcal infection in asplenic humans and animals. Splenic autotransplantation has been suggested as a method of preserving function. Autotransplantation of irreparably damaged spleens in humans preserved splenic functions. ⋯ Levels of IgM, which were initially significantly depressed, returned to normal and there were normal technetium Tc 99m sulfur colloid scans ten weeks after surgery. All patients are alive and healthy. Our data suggest that autotransplantation of spleen is a safe alternative method for preserving splenic function when total splenectomy is mandatory for hemostasis.
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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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The purpose of this study was to investigate the effect of 7.5% hypertonic saline solution (HTS) as the initial solution in resuscitation of a pig in shock. Twenty-two animals were bled 50% of their blood volume over 30 minutes and maintained in shock for 60 minutes. The 14 survivors were divided into two groups. ⋯ Only two animals in the LR group developed an adequate urine output. Hypertonic saline solution markedly improved survival, and there were significant improvements in hemodynamics. This was accomplished with smaller volumes of resuscitation fluid and may prove useful under conditions where intravascular access is limited.