Pub Date : 2024-07-31DOI: 10.17479/jacs.2024.14.2.63
Qi Xuan Lim, Yuxin Guo, Christopher Wei Guang Ho, Xiaojin Zheng
Acute appendicitis represents one of the most common causes of acute abdomen that may warrant emergency surgery. Necrotizing fasciitis complicated by acute appendicitis is considered a rare complication with life-threatening implications. A 65-year-old man presented with abdominal pain, where a scan, revealed a perforated appendicitis complicated by an anterior abdominal wall collection. He underwent percutaneous drainage, but subsequently developed extensive necrotizing fasciitis requiring extensive debridement and reconstruction. The rapid progression of necrotizing fasciitis calls for early recognition and prompt intervention. The key management principles employed were broad spectrum antibiotics and aggressive surgical debridement. This case demonstrated the use of vacuum-assisted closure dressing and multidisciplinary care in wound healing and coverage. To ensure early diagnosis and intervention for acute appendicitis complicated by necrotizing fasciitis, a high degree of clinical suspicion and awareness of this complication is required.
{"title":"A Case of Acute Appendicitis Complicated by Necrotizing Fasciitis Requiring Abdominal Wall Reconstruction","authors":"Qi Xuan Lim, Yuxin Guo, Christopher Wei Guang Ho, Xiaojin Zheng","doi":"10.17479/jacs.2024.14.2.63","DOIUrl":"https://doi.org/10.17479/jacs.2024.14.2.63","url":null,"abstract":"Acute appendicitis represents one of the most common causes of acute abdomen that may warrant emergency surgery. Necrotizing fasciitis complicated by acute appendicitis is considered a rare complication with life-threatening implications. A 65-year-old man presented with abdominal pain, where a scan, revealed a perforated appendicitis complicated by an anterior abdominal wall collection. He underwent percutaneous drainage, but subsequently developed extensive necrotizing fasciitis requiring extensive debridement and reconstruction. The rapid progression of necrotizing fasciitis calls for early recognition and prompt intervention. The key management principles employed were broad spectrum antibiotics and aggressive surgical debridement. This case demonstrated the use of vacuum-assisted closure dressing and multidisciplinary care in wound healing and coverage. To ensure early diagnosis and intervention for acute appendicitis complicated by necrotizing fasciitis, a high degree of clinical suspicion and awareness of this complication is required.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"51 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case of isolated cecal necrosis (ICN) associated with acute appendicitis in a geriatric patient in order to underline the didactic, diagnostic and therapeutic interest. This was a 70-year-old widowed female farmer living in a rural area who presented with localized abdominal pain in the right iliac fossa. The diagnosis of acute appendicitis was made. A Mac Burney incision approach revealed ICN and an inflamed appendix. The patient had an ileostomy and a partial cecal necrosectomy with an epiploic patch. A digestive fistula occurred on postoperative Day 60. The patient was transferred to a more technical center where she had a right hemicolectomy with latero-lateral ileocolic anastomosis. The prognosis was poor. The patient died 4 days later in respiratory distress.
{"title":"The Association of Isolated Cecal Necrosis Symptoms with Acute Appendicitis: A Case Report","authors":"Signe Cyrielle, Esseme Camille Harold, Mekieje Tumchou Maï-Pamela, Kohpe Kapseu Stéphane, Ouedraogo Souleymane","doi":"10.17479/jacs.2024.14.2.59","DOIUrl":"https://doi.org/10.17479/jacs.2024.14.2.59","url":null,"abstract":"We report a case of isolated cecal necrosis (ICN) associated with acute appendicitis in a geriatric patient in order to underline the didactic, diagnostic and therapeutic interest. This was a 70-year-old widowed female farmer living in a rural area who presented with localized abdominal pain in the right iliac fossa. The diagnosis of acute appendicitis was made. A Mac Burney incision approach revealed ICN and an inflamed appendix. The patient had an ileostomy and a partial cecal necrosectomy with an epiploic patch. A digestive fistula occurred on postoperative Day 60. The patient was transferred to a more technical center where she had a right hemicolectomy with latero-lateral ileocolic anastomosis. The prognosis was poor. The patient died 4 days later in respiratory distress.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"13 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.17479/jacs.2024.14.2.67
Lal Meher Pradeep Vankadaru, Snigdha Bellapukonda
Subcutaneous emphysema is a known but rare complication in shoulder arthroscopies. Addition of complications like bilateral hydrothorax confuse the situation to the intensivist. We report the case of a patient posted for shoulder arthroscopy who developed subcutaneous emphysema but later diagnosed to have bilateral hydrothorax. The perplexity in the diagnosis was cleared by investigating further. This case report attempts to resolve the diagnostic confusion involved in managing complications after shoulder arthroscopy.
{"title":"Management of Respiratory Failure in Shoulder Arthroscopy: A Case Report","authors":"Lal Meher Pradeep Vankadaru, Snigdha Bellapukonda","doi":"10.17479/jacs.2024.14.2.67","DOIUrl":"https://doi.org/10.17479/jacs.2024.14.2.67","url":null,"abstract":"Subcutaneous emphysema is a known but rare complication in shoulder arthroscopies. Addition of complications like bilateral hydrothorax confuse the situation to the intensivist. We report the case of a patient posted for shoulder arthroscopy who developed subcutaneous emphysema but later diagnosed to have bilateral hydrothorax. The perplexity in the diagnosis was cleared by investigating further. This case report attempts to resolve the diagnostic confusion involved in managing complications after shoulder arthroscopy.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"49 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.17479/jacs.2024.14.2.41
Jung Min Bae
diagnostic modalities in SBB are performed. However, the small bowel is beyond the reach of these diagnostic modalities. A large amount of bleeding in GIB is a key factor leading to a poor prognosis. Appropriate and prompt diagnostic and treatment strategies are needed. Several diagnostic and management algorithms have been proposed. However, the processing of algorithm is complex and frequent mistakes are happened. Because of surgical aspects and sudden or gradual development of hemodynamic instability in SBB, algorithms considering surgical role and treatment have been published. The intra-operative enteroscopy (IOE) is a gold-standard method for detecting lesions in SBB. The primary goal of IOE is to detect specific bleeding focus in SBB. The determining the resection range is the secondary goal. In most cases in SBB, segmental resection is treatment of choice. However, in bleeding distal duodenum from distal to the ampulla of Vater to Treitz ligament, pancreas preserving distal duodenectomy could be performed. In terminal ileum bleeding, after resection of pathologic bowel, the reconstruction option is ileo-colic anastomosis or end enterostomy. Because of frequently developed postoperative morbidity and mortality, post-operative critical care is perfectly fit for an acute care surgeon’s role. Therefore, in the entire management process, an interprofessional team or multidisciplinary approach is critical for improving the quality of care of SBB and decreasing mistakes.
{"title":"Difficult Small Bowel Bleeding in Surgical View","authors":"Jung Min Bae","doi":"10.17479/jacs.2024.14.2.41","DOIUrl":"https://doi.org/10.17479/jacs.2024.14.2.41","url":null,"abstract":"diagnostic modalities in SBB are performed. However, the small bowel is beyond the reach of these diagnostic modalities. A large amount of bleeding in GIB is a key factor leading to a poor prognosis. Appropriate and prompt diagnostic and treatment strategies are needed. Several diagnostic and management algorithms have been proposed. However, the processing of algorithm is complex and frequent mistakes are happened. Because of surgical aspects and sudden or gradual development of hemodynamic instability in SBB, algorithms considering surgical role and treatment have been published. The intra-operative enteroscopy (IOE) is a gold-standard method for detecting lesions in SBB. The primary goal of IOE is to detect specific bleeding focus in SBB. The determining the resection range is the secondary goal. In most cases in SBB, segmental resection is treatment of choice. However, in bleeding distal duodenum from distal to the ampulla of Vater to Treitz ligament, pancreas preserving distal duodenectomy could be performed. In terminal ileum bleeding, after resection of pathologic bowel, the reconstruction option is ileo-colic anastomosis or end enterostomy. Because of frequently developed postoperative morbidity and mortality, post-operative critical care is perfectly fit for an acute care surgeon’s role. Therefore, in the entire management process, an interprofessional team or multidisciplinary approach is critical for improving the quality of care of SBB and decreasing mistakes.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"23 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.17479/jacs.2024.14.2.45
Do Wan Kim, Jeong-Min Kim, Yong-Sang Seong, Reverien Habimana, Hwajin Cho, I. Jeong
Purpose: The objective of this study was to evaluate the effect of Polymyxin B hemoperfusion (PMX-HP) on patients with sepsis.Methods: A systematic review and meta-analysis was performed using relevant articles retrieved from 3 databases (PubMed, Cochrane Library, EMBASE). Randomized studies from 1 January 1999 to 28 February 2022 were examined to determine the clinical results of PMX-HP. A meta-analysis was carried out using the random-effects method, meta-regression with clinical variables, and assessment of risk of bias (ROB) tool (Cochrane ROB assessment tool). Mortality was evaluated within 60 days of hospitalization (in-hospital death 28-day, 30-day, and 60-day mortality) and predictors associated with mortality were determined using meta-regression.Results: There were 11 randomized studies with 548 patients included in the meta-analysis. The pooled mortality was 35% (95% CI, 27%-42%, 95% CI 0.53-0.96). Further subgroup analysis was performed according to the duration of PMX-HP. An extension of PMX-HP treatment beyond 2 hours (pooled mortality, 43%; 95% CI, 9%-76%) compared with a 2-hour session (pooled mortality, 33%. 95% CI, 27%-38%) showed an increase in mortality rates. However, this was not statistically significant. Univariate meta-regression showed that patient’s age, the acute physiology and chronic health evaluation score, and the sequential organ failure assessment score did not significantly impact mortality.Conclusion: While PMX-HP is valuable in the management of septic shock, treatment duration should be based on careful assessment of the patient's condition, the risks and benefits of prolonged therapy, and the overall treatment strategy including antimicrobial management and source control.
{"title":"The Effect of Polymyxin B-Immobilized Fiber Column Hemoperfusion for Sepsis: A Systemic Review and Meta-Analysis","authors":"Do Wan Kim, Jeong-Min Kim, Yong-Sang Seong, Reverien Habimana, Hwajin Cho, I. Jeong","doi":"10.17479/jacs.2024.14.2.45","DOIUrl":"https://doi.org/10.17479/jacs.2024.14.2.45","url":null,"abstract":"Purpose: The objective of this study was to evaluate the effect of Polymyxin B hemoperfusion (PMX-HP) on patients with sepsis.Methods: A systematic review and meta-analysis was performed using relevant articles retrieved from 3 databases (PubMed, Cochrane Library, EMBASE). Randomized studies from 1 January 1999 to 28 February 2022 were examined to determine the clinical results of PMX-HP. A meta-analysis was carried out using the random-effects method, meta-regression with clinical variables, and assessment of risk of bias (ROB) tool (Cochrane ROB assessment tool). Mortality was evaluated within 60 days of hospitalization (in-hospital death 28-day, 30-day, and 60-day mortality) and predictors associated with mortality were determined using meta-regression.Results: There were 11 randomized studies with 548 patients included in the meta-analysis. The pooled mortality was 35% (95% CI, 27%-42%, 95% CI 0.53-0.96). Further subgroup analysis was performed according to the duration of PMX-HP. An extension of PMX-HP treatment beyond 2 hours (pooled mortality, 43%; 95% CI, 9%-76%) compared with a 2-hour session (pooled mortality, 33%. 95% CI, 27%-38%) showed an increase in mortality rates. However, this was not statistically significant. Univariate meta-regression showed that patient’s age, the acute physiology and chronic health evaluation score, and the sequential organ failure assessment score did not significantly impact mortality.Conclusion: While PMX-HP is valuable in the management of septic shock, treatment duration should be based on careful assessment of the patient's condition, the risks and benefits of prolonged therapy, and the overall treatment strategy including antimicrobial management and source control.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"19 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.17479/jacs.2024.14.2.52
Richa Patel, Geeta Sandeep Ghag, Sandhya Iyer, V. Nandu
Purpose: Trauma is a common cause of death worldwide and head injury is the most common form of trauma presented at the Emergency Department. Physiological scores are better for predicting outcome than anatomical scores. To reduce mortality rates, this study compared the capacity of the revised trauma scores (RTS) and the Glasgow coma scale- age- pressure (GAP) scores to predict the survival of patients and effectively channel resources.Methods: An observational study of head trauma patients aged 12 to 80 years was performed at a tertiary care center (N = 500). We noted demographic information, RTS and GAP trauma scores, and outcomes in terms of mortality or survival at 24 hours, 48 hours, and 7 days.Results: Of the 500 patients who were enrolled, 414 (82.8%) survived 24 hours, 373 (74.6%) survived 48 hours, and 265 (53%) survived after 7 days. Using the Receiver Operating Characteristic curve, the RTS score was a significantly better predictor of survival in patients with head trauma than the GAP score at 24 hours (p = 0.044) and 48 hours (p = 0.049) of admission. The results were not significantly different at 7 days (p = 0.240). Mortality or survival outcomes were not significantly different between the RTS and GAP scores (p = 0.373).Conclusion: RTS appears to be a better early predictor for mortality (within 48 hours of admission) than the GAP score. The RTS was more effective in directing the triage of patients which improved survival rates in head trauma patients.
{"title":"The Revised Trauma Score: A Better Early Predictor for Survival of Head Trauma Patients than the Glasgow Coma Scale-Age-Pressure Score","authors":"Richa Patel, Geeta Sandeep Ghag, Sandhya Iyer, V. Nandu","doi":"10.17479/jacs.2024.14.2.52","DOIUrl":"https://doi.org/10.17479/jacs.2024.14.2.52","url":null,"abstract":"Purpose: Trauma is a common cause of death worldwide and head injury is the most common form of trauma presented at the Emergency Department. Physiological scores are better for predicting outcome than anatomical scores. To reduce mortality rates, this study compared the capacity of the revised trauma scores (RTS) and the Glasgow coma scale- age- pressure (GAP) scores to predict the survival of patients and effectively channel resources.Methods: An observational study of head trauma patients aged 12 to 80 years was performed at a tertiary care center (N = 500). We noted demographic information, RTS and GAP trauma scores, and outcomes in terms of mortality or survival at 24 hours, 48 hours, and 7 days.Results: Of the 500 patients who were enrolled, 414 (82.8%) survived 24 hours, 373 (74.6%) survived 48 hours, and 265 (53%) survived after 7 days. Using the Receiver Operating Characteristic curve, the RTS score was a significantly better predictor of survival in patients with head trauma than the GAP score at 24 hours (p = 0.044) and 48 hours (p = 0.049) of admission. The results were not significantly different at 7 days (p = 0.240). Mortality or survival outcomes were not significantly different between the RTS and GAP scores (p = 0.373).Conclusion: RTS appears to be a better early predictor for mortality (within 48 hours of admission) than the GAP score. The RTS was more effective in directing the triage of patients which improved survival rates in head trauma patients.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"15 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.17479/jacs.2024.14.2.71
Sehyeon Yu, Hanyoung Lee, Jae-Myeong Lee
The A-1000 (Elmeca, Co. Ltd., Seoul, Korea) electrical automatic airway suction device, was designed to operate as a customizable repeated closed suction device. It can be used for patients with intubation or tracheostomy tubes. This is the first recorded case of the use of the A-1000 in a general ward patient with a tracheostomy tube. A 91-year-old man presented having attempted suicide by hanging and was admitted to this institution. Although extubation was performed in the intensive care unit, the patient required 2 reintubations. The tracheostomy was performed, and the A-1000 was applied. After weaning from mechanical ventilation, the patient was transferred to the General Ward with a tracheostomy tube in place for effective removal of sputum by the A-1000. The tracheostomy tube was successfully removed, and the patient was discharged. The effectiveness and safety of the A-1000 needs further study by expanding the applications of this device.
{"title":"Application of an Automatic Suction Device to a Patient with A Tracheostomy Tube in the General Ward: A Case Report","authors":"Sehyeon Yu, Hanyoung Lee, Jae-Myeong Lee","doi":"10.17479/jacs.2024.14.2.71","DOIUrl":"https://doi.org/10.17479/jacs.2024.14.2.71","url":null,"abstract":"The A-1000 (Elmeca, Co. Ltd., Seoul, Korea) electrical automatic airway suction device, was designed to operate as a customizable repeated closed suction device. It can be used for patients with intubation or tracheostomy tubes. This is the first recorded case of the use of the A-1000 in a general ward patient with a tracheostomy tube. A 91-year-old man presented having attempted suicide by hanging and was admitted to this institution. Although extubation was performed in the intensive care unit, the patient required 2 reintubations. The tracheostomy was performed, and the A-1000 was applied. After weaning from mechanical ventilation, the patient was transferred to the General Ward with a tracheostomy tube in place for effective removal of sputum by the A-1000. The tracheostomy tube was successfully removed, and the patient was discharged. The effectiveness and safety of the A-1000 needs further study by expanding the applications of this device.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"16 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141795457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.17479/jacs.2023.13.3.134
Rumi Nakabayashi, Y. Miyachi, Minami Torai, K. Mitsuoka, Gen Shimada, Toshimi Kaido
A male pedestrian in his 30’s was hit by a car and immediately taken to hospital by ambulance. On arrival, his blood pressure was 83/64 mmHg and his heart rate was 140 beats/min. Computed tomography showed extravasation of contrast medium from the lateral segment of the liver. Given the exacerbation caused by hypotension, an emergency laparotomy was performed. Temporary hemostasis was achieved by packing with gauze and a subsequent transcatheter arterial embolization. At the 2nd laparotomy, a small amount of active bleeding from the injury site was noted; therefore, an emergency lateral segmentectomy was performed. The postoperative course was uneventful and he was discharged home 8 days later. The pathology of the liver specimen revealed that a 2.5 cm hepatic hemangioma was the cause of bleeding. Traumatic rupture of hepatic hemangiomas is rare, and most reported cases are of giant hemangiomas. Our case demonstrated that even a small hemangioma can elicit life-threatening bleeding in blunt abdominal trauma.
{"title":"Small Hepatic Hemangioma Leading to Life-Threatening Bleeding Following Blunt Abdominal Trauma: A Case Report","authors":"Rumi Nakabayashi, Y. Miyachi, Minami Torai, K. Mitsuoka, Gen Shimada, Toshimi Kaido","doi":"10.17479/jacs.2023.13.3.134","DOIUrl":"https://doi.org/10.17479/jacs.2023.13.3.134","url":null,"abstract":"A male pedestrian in his 30’s was hit by a car and immediately taken to hospital by ambulance. On arrival, his blood pressure was 83/64 mmHg and his heart rate was 140 beats/min. Computed tomography showed extravasation of contrast medium from the lateral segment of the liver. Given the exacerbation caused by hypotension, an emergency laparotomy was performed. Temporary hemostasis was achieved by packing with gauze and a subsequent transcatheter arterial embolization. At the 2nd laparotomy, a small amount of active bleeding from the injury site was noted; therefore, an emergency lateral segmentectomy was performed. The postoperative course was uneventful and he was discharged home 8 days later. The pathology of the liver specimen revealed that a 2.5 cm hepatic hemangioma was the cause of bleeding. Traumatic rupture of hepatic hemangiomas is rare, and most reported cases are of giant hemangiomas. Our case demonstrated that even a small hemangioma can elicit life-threatening bleeding in blunt abdominal trauma.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139200356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.17479/jacs.2023.13.3.138
Gurleen Kaur, Tanya Singh, S. Goyal, Robin Kaushik, Simrandeep Singh
Splenic abscess is a rare entity encountered during clinical practice, with a high mortality rate. Formation of gas in splenic abscess is usually localized to the left upper quadrant of the abdomen. Here we report a case where the splenic abscess ruptured and presented with generalized peritonitis. The erect chest radiograph showed free air under the right dome of the diaphragm, thus masquerading a hollow viscera perforation (most common cause of pneumoperitoneum).
{"title":"Ruptured Splenic Abscess with Pneumoperitoneum: A Rare Presentation","authors":"Gurleen Kaur, Tanya Singh, S. Goyal, Robin Kaushik, Simrandeep Singh","doi":"10.17479/jacs.2023.13.3.138","DOIUrl":"https://doi.org/10.17479/jacs.2023.13.3.138","url":null,"abstract":"Splenic abscess is a rare entity encountered during clinical practice, with a high mortality rate. Formation of gas in splenic abscess is usually localized to the left upper quadrant of the abdomen. Here we report a case where the splenic abscess ruptured and presented with generalized peritonitis. The erect chest radiograph showed free air under the right dome of the diaphragm, thus masquerading a hollow viscera perforation (most common cause of pneumoperitoneum).","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":" 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139207065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.17479/jacs.2023.13.3.124
Soyeon Yoon, Jinjoo Kim, Yoon Jung An, Jeonghui Ok, Y. Jung
Purpose: This study aimed to investigate the incidence rate, types and risk factors for delirium in patients admitted to the surgical Step-Down Unit (SDU).Methods: This study was a retrospective study of the electronic medical records of patients admitted to a surgical SDU from February 2020 to July 2020. The delirium assessment was conducted using the short Confusion Assessment Method (a tool that allows quick and easy screening of delirium) and the incidence and risk factors for delirium were determined.Results: Among a total of 227 patients in the study, the incidence rate of delirium was 35 cases (16.7%). It predominantly occurred on the first day (n = 16, 45.7%) and the second day of admission (n = 15, 42.8%). The peak occurrence of delirium was between 14:00 and 22:00 (n = 30, 85.7%). The most common type of delirium was hypoactive (n = 19, 54.3%). The results of multiple logistic regression analysis indicated that the factors influencing the occurrence of delirium in the surgical step down unit (SDU) were age, hypertension, stroke, white blood cell count, and the use of restraints.Conclusion: Considering the characteristics of high-risk groups for delirium in the surgical SDU, it is necessary to establish nursing practice guidelines to minimize delirium.
{"title":"Characteristics and Risk Factors for Delirium in The Surgical Step-Down Unit","authors":"Soyeon Yoon, Jinjoo Kim, Yoon Jung An, Jeonghui Ok, Y. Jung","doi":"10.17479/jacs.2023.13.3.124","DOIUrl":"https://doi.org/10.17479/jacs.2023.13.3.124","url":null,"abstract":"Purpose: This study aimed to investigate the incidence rate, types and risk factors for delirium in patients admitted to the surgical Step-Down Unit (SDU).Methods: This study was a retrospective study of the electronic medical records of patients admitted to a surgical SDU from February 2020 to July 2020. The delirium assessment was conducted using the short Confusion Assessment Method (a tool that allows quick and easy screening of delirium) and the incidence and risk factors for delirium were determined.Results: Among a total of 227 patients in the study, the incidence rate of delirium was 35 cases (16.7%). It predominantly occurred on the first day (n = 16, 45.7%) and the second day of admission (n = 15, 42.8%). The peak occurrence of delirium was between 14:00 and 22:00 (n = 30, 85.7%). The most common type of delirium was hypoactive (n = 19, 54.3%). The results of multiple logistic regression analysis indicated that the factors influencing the occurrence of delirium in the surgical step down unit (SDU) were age, hypertension, stroke, white blood cell count, and the use of restraints.Conclusion: Considering the characteristics of high-risk groups for delirium in the surgical SDU, it is necessary to establish nursing practice guidelines to minimize delirium.","PeriodicalId":34662,"journal":{"name":"Journal of Acute Care Surgery","volume":"36 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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