Acute Medicine & Surgery最新文献

Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20–40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.

A 22-year-old male construction worker in Eastern Samar, Philippines, was bitten on his right leg by a black and yellow snake in the coastal area. Despite receiving a local remedy, he was later brought to the emergency department. Twelve hours post-bite, careful examination revealed mild bilateral ptosis, with the patient struggling to keep his eyes open, especially during upward gaze (Figure 1A). The bite site showed mild swelling, tenderness, and two fang marks. Although the snake responsible was not conclusively identified, based on the geographical distribution, snake description, and clinical signs, Naja samarensis envenomation was suspected. Intravenous administration of Purified Cobra Antivenom (Research Institute for Tropical Medicine)¹ significantly improved eye-opening ability within 30 min: the patient could open his eyes fully and sustain eye-opening (Figure 1B).

Although the literature reports a limited number of cases, Naja samarensis, Samar cobra, is a WHO category I venomous snake in the Philippines.² Often, snakebite envenomation diagnosis depends on clinical observations due to limited diagnostic tools.³ As demonstrated in our image of the probable Naja samarensis case, detection of bilateral ptosis is crucial in recognizing neurological snakebite envenomation. This sign is vital to identify neurotoxic envenomation from various snakes globally, including exotic species.

The authors declare no conflicts of interest.

Approval of the research protocol: N/A.

Informed Consent: Informed consent was obtained by the patient.

Registry and the Registration No. of the study/trial: N/A.

Animal studies: N/A.

A 66-year-old woman presented to the emergency department with sudden throat tightness. The patient was uncomfortable and could not speak. No pain, dysphagia, drooling, labored breathing, or snoring were noted, and she had an unremarkable medical and allergic history. Oral examination revealed a 4-cm bloody blister in the middle of the soft palate (Figure 1A). Blood examination revealed no coagulopathy or anemia.

The patient was diagnosed with angina bullosa haemorrhagica (ABH). Puncture drainage was suggested to prevent airway obstruction. Preparation for airway management, including cricothyrotomy, was performed. However, the patient's blister spontaneously ruptured, and symptoms disappeared. A shallow ulcer formed at the post-rupture site (Figure 1B).

ABH was first reported by Badham in 1967 as the rapid formation of a bloody blister on the oral mucosa.¹ Its diagnosis relies on the patient's clinical symptoms. Most cases of ABH are 1–2 cm in diameter, and no reports are found on a similar size to our case.^{2, 3} Most are resolved without treatment, but several cases of airway obstruction have been reported, one of which required puncture drainage to secure the airway.^{4, 5} Therefore, airway obstruction should be considered when large ABH in the oropharynx or severe symptoms are present.

The authors have no financial relationships relevant to this article.

Approval of the research protocol: N/A.

Informed consent: Consent was obtained from the patient in the form of British Medical Journal.

Registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.

Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU). It occurs either during the ICU stay or following ICU discharge and is related to the patients' long-term prognosis. The same concept also applies to pediatric patients, and it can greatly affect the mental status of family members. In the 10 years since post-intensive care syndrome was first proposed, research has greatly expanded. Here, we summarize the recent evidence on post-intensive care syndrome regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatments. We highlight new topics, future directions, and strategies to overcome post-intensive care syndrome among people treated in an ICU. Clinical and basic research are still needed to elucidate the mechanistic insights and to discover therapeutic targets and new interventions for post-intensive care syndrome.