Psychiatric problems are common in critically ill patients after discharge from an intensive care unit (ICU). The effect of intensive care unit (ICU) diaries on psychiatric symptoms after ICU discharge was investigated in this prospective study.
Enrolled were critically ill adult patients who were emergently admitted to an ICU and expected to stay for at least 2 days. These patients received ICU diaries filled out by healthcare professionals and family members. Comparison was made with a historical cohort from a previous trial conducted in the same ICU but without ICU diaries. The primary outcome was the presence of significant post-traumatic stress disorder (PTSD) symptoms 3 months after ICU discharge. Secondary outcomes included significant symptoms of anxiety and depression.
Among 61 patients with ICU diaries, questionnaires were sent to 44 patients 3 months after ICU discharge; 29 patients responded and were analyzed (ICU diary group). Seventy-four patients from a historical cohort were used as a control group. The proportion of patients with significant PTSD symptoms was 19% in the ICU diary group and 16% in the control group (adjusted odds ratio [aOR] [95% confidence interval: 95% CI]: 0.98 [0.26–3.70]). For anxiety and depression, the proportions were 25% and 29% in the ICU diary group, and 38% and 45% in the control group (aOR [95% CI]: 0.46 [0.15–1.38] for anxiety, aOR [95% CI] 0.40 [0.14–1.16] for depression).
ICU diaries were not associated with a reduced incidence of PTSD symptoms 3 months after ICU discharge.
Cardiac rupture is rare but has a high mortality rate. Cardiac rupture due to blunt trauma is generally caused by the heart being pinched into the bony thorax.
A 90-year-old man in shock was transported to the hospital after his precordium was stepped on by a cow. He developed right atrial rupture from penetration of the heart by fractured and calcified costal cartilage, with massive hemothorax, hemorrhagic shock, and respiratory failure. We immediately performed cardiac injury repair. The patient was discharged without sequelae.
Emergency physicians should be aware that secondary cardiac rupture can show a penetrating injury-like presentation due to calcified costal cartilage caused by blunt chest trauma.
Median arcuate ligament syndrome describes a clinical presentation associated with direct compression of the celiac artery by the median arcuate ligament. Decreased blood flow from the celiac artery and increased flow from superior mesenteric artery causes blood flow in the pancreatic arcade to increase, and aneurysms can form. We report our experience with six cases of retroperitoneal hemorrhage induced by median arcuate ligament syndrome in patients during the COVID-19 period.
The time from the onset of COVID-19 to that of abdominal pain in the patients ranged from 3 to 9 days. None of the patients required oxygen for COVID-19. We used contrast-enhanced computed tomography to diagnose retroperitoneal hemorrhage and formation of a visceral pseudoaneurysm or aneurysm due to median arcuate ligament syndrome. Five patients underwent transcatheter arterial embolization. One patient suffered complications of duodenal stenosis and another suffered portal vein thrombosis.
Retroperitoneal hemorrhage associated with median arcuate ligament syndrome is rare. However, it might be triggered by COVID-19 disease, resulting in arterial disruption and hemorrhage.
We report a case of zone II penetrating neck trauma with active bleeding in which endovascular treatment was performed prior to neck exploration to identify and control the bleeding point.
A man in his 50s presented to our emergency department in hemorrhagic shock stemming from a penetrating knife wound injury to the right side of his neck. He was bleeding massively from the right neck wound and oral cavity. Cervical angiography showed bleeding from the right external carotid artery and intimal injury to the right internal carotid artery. Balloon occlusion at the common carotid artery origin and distal to the injured internal carotid artery controlled active bleeding. During vascular balloon occlusion, definitive hemostatic treatment was achieved through ligation of the proximal external carotid artery.
Neck exploration combined with endovascular treatment may be one option as a treatment strategy for patients with zone II penetrating neck injury.
Acute kidney injury (AKI) is a devastating medical condition that occurs mostly in hospitalized patients after a serious illness or major surgery and imposes a great health and financial burden on patients. Craniotomy is one of the major surgeries in which people who undergo this operation experience critical clinical conditions. Systemic inflammation, hemodynamic variation, and pharmacological agents administered during and after craniotomy can lead to the development of AKI and a poor prognosis. Moreover, AKI itself could cause other significant complications and increase the mortality rate in patients who undergo craniotomy. Determining the pre-, peri-, and postoperative risk factors associated with AKI after craniotomy is important for its prevention. Efficient care of patients after craniotomy and effective treatment approaches should be implemented to maintain normal metabolism, enhance nerve function recovery, and control inflammation. Novel biomarkers have been recognized as reliable indicators for the diagnosis and prognosis of AKI after brain surgery. This study aimed to summarize the most relevant literature regarding the risk factors, postoperative complications, and mortality associated with AKI after craniotomy. Moreover, we reviewed the approaches to postoperative care, followed by an overview of the significant diagnostic or prognostic biomarkers of AKI following craniotomy to provide a basis for preventing and decreasing AKI.
To develop a trauma surgery training program using porcine organs and evaluate its usefulness. This program allows participants to experience the tactile sensation of organs and bleeding, which are impossible in trauma surgery training using a cadaver.
Resected organs (heart, lung, liver, spleen, kidney, small intestine, bladder, and external carotid artery) from slaughtered pigs for medical research were perfused with saline solution, flash-frozen in a deep freezer, and thawed naturally on the morning of training. The training program consisted of half-day practical training in suture repair of artificially created damage to the parenchymal organs and suture or anastomotic repair of damage to the luminal organs. We injected the parenchymal organs' arteries with porcine blood and the renal ureters with saline solution to create models of organ hemorrhage and urinary leakage. The training's usefulness was evaluated using a participant questionnaire that included an 11-point self-assessment of confidence level (SACL) form.
Nine training seminars were conducted from September 2018 to February 2023, attended by 67 participants who were in their 1st to 20th post-graduate year. The mean SACL significantly increased immediately after the seminar but decreased half-year thereafter. However, it was maintained for those with surgical residency. It was also maintained for those with no surgical residency through seminar repetition.
Training in trauma surgical techniques using porcine organs is beneficial regardless of whether the participant has prior surgical residency.
A 68-year-old woman was brought to the emergency department after being struck by a car from behind while walking. She complained of left hip pain and underwent pelvic radiography, computed tomography (CT), and three-dimensional CT, which revealed a fracture of the left femoral neck and insertion of the left femoral head into the left obturator foramen (Figure 1). Indirect traction was performed in the emergency room, and the femoral head, firmly seated in the obturator foramen, was removed later by an anterolateral approach to the hip, followed by total hip arthroplasty (THA). Obturator dislocation of the hip joint is rarely associated with a femoral neck fracture, and there are only nine reports of such cases in English literature.1 Anterior dislocation occurs when the hip is forced into abduction and external rotation, causing impingement of the femoral neck or greater trochanter and acetabulum, and the femoral head is pulled forward from the acetabulum.2 Anterior hip joint dislocation can be classified into obturator dislocation and suprapubic dislocation. However, obturator dislocation is reported to occur when the hip joint is externally rotated in the flexed position, and further forced external rotation can result in a femoral neck fracture.3 In some cases, osteosynthesis has been chosen for surgery in younger patients, but THA is recommended for elderly patients to avoid complications such as avascular necrosis and nonunion.1
The authors declare no conflicts of interest.
Approval of the research protocol: None.
Informed consent: Informed consent was obtained from the patient.
Registry and the registration no. of the study/trial: None.
Animal studies: None.
This study aimed to evaluate whether the use of an eligibility checklist uncovered potential corneal donors among deceased outpatients and increased the donation.
In this retrospective cohort study, we applied the eligibility checklist to nearly all outpatients (age ≥ 18 y/o) who were transferred to our emergency department and identified as deceased between 2012 and 2020. Whether the use of the checklist contributed to the increase in corneal donation was examined, and the reasons for refusal of the donation were also evaluated. Furthermore, yearly changes in the number of the donation were assessed, with the data obtained before initiation of the checklist in 2010–2011 as references. The primary outcome was the number of corneal donors, with yearly changes in donation numbers assessed using data from 2010 to 2011 as a reference before the checklist was introduced.
Among 1776 outpatients to whom the eligibility checklist was applied, 1169 patients were regarded as potential donors. Of them, 126 families gave consent and 80 patients finally donated cornea; medical diseases as a cause of death were less likely to retract donation offer (OR = 0.31 [95% CI: 0.09–0.99]). The number of corneal donors in 2010–2011 corresponded to 1.6% of the deceased outpatients but increased since the checklist was introduced the total number of donors reached 87 (4.3%) during 2012–2020.
A routine use of the eligibility checklist at the initial interview will reinforce the awareness of corneal donation among the families of patients and contribute to the increased number of corneal donors.
Febrile neutropenia (FN) is treated by a broad-spectrum antimicrobial. Subsequent antimicrobial therapy depends on identifying the source of the infection. Although urinary tract infections (UTIs) are common and urine culture (UC) is a valuable diagnostic tool, uncertainties remain about the specific indications for conducting UC in FN. This study examined whether performing routine UC would affect the subsequent antimicrobial therapy in FN.
All emergency department patients who received chemotherapy for malignancy and met the definition of FN (neutrophil count <0.5 × 109/L and fever >37.5°C) were included. The patient's demographic data, clinical symptoms, urinalysis results, urine and blood culture results, antibiotic therapy and duration, and patient outcomes were extracted from electronic medical records. UC was defined as positive if >105 colony-forming units/L were detected.
In total, 115 of the initial 124 cases were included in the analysis. Thirty-one cases met the Infectious Diseases Society of America guideline definition for recommending UC (recommended group) and 84 cases did not (non-recommended group). In the recommended group, 16 of 31 cases had a positive UC, and antibiotics were changed for nine, based on UC results. In the non-recommended group, 15 of 84 cases had a positive UC, and antibiotics were changed for two. The same organism were identified in blood cultures. Seven of 115 cases were detected for the same pathogen in blood and urine cultures.
Performing UC regardless of symptoms could diagnose several asymptomatic UTIs in FN, but seldom impact an antimicrobial treatment strategy.
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