Proceedings (Baylor University. Medical Center)
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Proc (Bayl Univ Med Cent) · Jul 2014
Physical therapy-driven quality improvement to promote early mobility in the intensive care unit.
Growing evidence shows that early mobilization of patients in the intensive care unit (ICU) is a safe and cost-effective strategy to improve patient outcomes. However, in ICUs where early mobilization has not been practiced, its adoption requires culture change by the multidisciplinary team, including physical therapists, nurses, respiratory therapists, and physicians. We describe a physical therapist-led program to introduce such changes in a medical-surgical and a cardiovascular ICU. ⋯ After the initiation of this program, the number of ICU patients receiving physical therapy evaluations increased from 364 in 2011-2012 to 542 in 2012-2013. In this article, we describe our experience from 21 patients who underwent early mobilization. A physical therapist-led initiative can help establish an ICU culture that supports early mobilization, but the change is slow and requires interdisciplinary collaboration to identify and overcome barriers.
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Proc (Bayl Univ Med Cent) · Jan 2014
Dexmedetomidine infusion for analgesia up to 48 hours after lung surgery performed by lateral thoracotomy.
Patients undergoing a lateral thoracotomy for pulmonary resection have moderate to severe pain postoperatively that is often treated with opioids. Opioid side effects such as respiratory depression can be devastating in patients with already compromised respiratory function. This prospective double-blinded clinical trial examined the analgesic effects and safety of a dexmedetomidine infusion for postthoracotomy patients when administered on a telemetry nursing floor, 24 to 48 hours after surgery, to determine if the drug's known early opioid-sparing properties were maintained. ⋯ Significant hypotension was noted in one patient in the dexmedetomidine group in conjunction with concomitant administration of a beta-blocker agent. The placebo group reported a higher number of opioid-related adverse events. In conclusion, the known opioid-sparing properties of dexmedetomidine in the immediate postoperative period are maintained over 48 hours.
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Currently, long-term outcomes are significant because health care system changes will likely lead to a single payment for each occurrence of care, including readmissions-the "bundled payment" system. Therefore, it is essential to understand the outcomes of trauma patients discharged alive from trauma centers. This article reviews the current knowledge base on the timing and causes of deaths after trauma. ⋯ Late deaths caused by multiple organ failure and sepsis have declined considerably, however. Also, the causes of death in this patient population remain constant. Lastly, a considerable number of deaths after discharge may be due to nontraumatic causes.
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A 75-year-old woman presented with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and edema. Macroglossia, generalized petechiae, raccoon eyes sign, and peripheral neuropathy were present, and an echocardiogram showed cardiac dilatation and left ventricular systolic dysfunction. Rectal biopsy and immune fixation electrophoresis confirmed the diagnosis of AL amyloidosis.