Southern medical journal
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Southern medical journal · Jun 2007
ReviewRecognizing and managing severe sepsis: a common and deadly threat.
Through a literature review, the epidemiology and pathophysiology, including alterations in inflammation, coagulation, and impaired fibrinolysis that occur in the course of severe sepsis, is presented. Treatment guidelines that are evidence-based and endorsed by 11 professional societies representing multispecialty groups are described. Severe sepsis is common; 750,000 cases are estimated to occur annually in the United States. ⋯ Severe sepsis exists along a continuum initiated by a localized infection that triggers a systemic response. A cascade of inflammation and activation of the coagulation system associated with impaired fibrinolysis leads to alterations in microvascular circulation associated with organ dysfunction, severe sepsis, multiple organ dysfunction syndrome, and death. In an attempt to improve care and reduce mortality, the Surviving Sepsis Campaign and The Institute for Healthcare Improvement (IHI) have created two sepsis treatment bundles.
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Penetrating brain injury resulting from nail-gun use is a well-characterized entity, one that is increasing in frequency as nail guns become more powerful and more readily available to the public. We present a case and offer management strategies for a 50-year-old male with two intracranial penetrating nail gun injuries. Nail gun brain injuries are commonly intentionally self-inflicted. ⋯ The primary preoperative concern is formation of a traumatic pseudoaneurism, which prompts both preoperative and follow-up cerebral angiography. Surgery for combined intracranial and extracranial injury may require the collaborative expertise of colleagues from the fields of ophthalmology, otolaryngology, and oral maxillofacial surgery. A rational management strategy should permit these patients to be discharged with no additional injury.
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Southern medical journal · May 2007
Letter Case ReportsPhytophotodermatitis due to puncture from lime tree thorn.
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Southern medical journal · Apr 2007
Case ReportsHigh-riding superior pericardial recess: temporal change can help distinguish from mediastinal pathology.
A high-riding superior pericardial recess is an infrequently encountered normal variant which may mimic mediastinal pathology. We present a patient in whom a high-riding superior pericardial recess could confidently be diagnosed on a neck CT due to its change in size and shape demonstrated on a chest CT which was done 4 minutes later.
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Southern medical journal · Apr 2007
Comparison of propofol and sevoflurane for laryngeal mask airway insertion in elderly patients.
Sevoflurane and propofol have been widely used for anesthesia induction. This study compared the efficacies of sevoflurane and propofol inductions for laryngeal mask airway (LMA) insertion in elderly patients. ⋯ Sevoflurane 8% using the TVB technique provides a smoother induction with a stable hemodynamic profile, less apnea and technical demand, but requiring longer time for LMA insertion in unpremedicated elderly patients.