G. Montrucchio, G. Sales, S. Corcione, A. Curtoni, R. Urbino, L. Brazzi
{"title":"Providing background for antimicrobial stewardship strategy using costs data: a mission impossible?","authors":"G. Montrucchio, G. Sales, S. Corcione, A. Curtoni, R. Urbino, L. Brazzi","doi":"10.21037/jeccm-22-27","DOIUrl":"https://doi.org/10.21037/jeccm-22-27","url":null,"abstract":"","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45840047","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}
J. Vadhan, Alyssa J. Melo, Jeffery C. Shogan, Vishal Singh, Maria Carrillo
transplant recipients are at risk for fungal infections. Fusarium spp. , however, are a ubiquitous environmental fungus that has rarely been reported to cause invasive central nervous system (CNS) infection in patients post solid organ transplant. Case Description: We report a 57-year-old male with a recent heart transplant on immunosuppressive therapy who presented to the emergency department with right eye pain, headache, and focal neurologic deficits, and was subsequently diagnosed with CNS Fusariosis and endophthalmitis. Following intensive care and operative management, the patient ultimately suffered from acute transplant rejection and passed away shortly thereafter. One day following the surgery, the patient demonstrated signs of acute heart failure, and underwent emergent right heart catheterization with endomyocardial biopsy that revealed acute transplant rejection. Unfortunately, given the advanced stage of his infection coupled with transplant rejection, palliative care was consulted, and the patient was discharged to hospice. Conclusions: This is the 21st reported case of CNS Fusariosis. Of the reported cases, skin lesions were the most common presenting symptom (52.4%). Altered mental status was the most common neurologic symptom (23.8%). The cerebral cortex was the most frequently involved brain region involved (33.3%). Despite aggressive treatment, the mortality rate is extremely high (9.5%). We recommend a high index of suspicion and aggressive treatment for CNS Fusariosis given its heterogenous presentation, increasing number of reported cases, and fulminant disease course. with significant surrounding FLAIR hyperintensity suggesting vasogenic edema. FLAIR, fluid attenuated inversion recovery.
{"title":"Fast and Fusariosis: a systematic review and case report of a rapidly fatal central nervous system infection","authors":"J. Vadhan, Alyssa J. Melo, Jeffery C. Shogan, Vishal Singh, Maria Carrillo","doi":"10.21037/jeccm-21-125","DOIUrl":"https://doi.org/10.21037/jeccm-21-125","url":null,"abstract":"transplant recipients are at risk for fungal infections. Fusarium spp. , however, are a ubiquitous environmental fungus that has rarely been reported to cause invasive central nervous system (CNS) infection in patients post solid organ transplant. Case Description: We report a 57-year-old male with a recent heart transplant on immunosuppressive therapy who presented to the emergency department with right eye pain, headache, and focal neurologic deficits, and was subsequently diagnosed with CNS Fusariosis and endophthalmitis. Following intensive care and operative management, the patient ultimately suffered from acute transplant rejection and passed away shortly thereafter. One day following the surgery, the patient demonstrated signs of acute heart failure, and underwent emergent right heart catheterization with endomyocardial biopsy that revealed acute transplant rejection. Unfortunately, given the advanced stage of his infection coupled with transplant rejection, palliative care was consulted, and the patient was discharged to hospice. Conclusions: This is the 21st reported case of CNS Fusariosis. Of the reported cases, skin lesions were the most common presenting symptom (52.4%). Altered mental status was the most common neurologic symptom (23.8%). The cerebral cortex was the most frequently involved brain region involved (33.3%). Despite aggressive treatment, the mortality rate is extremely high (9.5%). We recommend a high index of suspicion and aggressive treatment for CNS Fusariosis given its heterogenous presentation, increasing number of reported cases, and fulminant disease course. with significant surrounding FLAIR hyperintensity suggesting vasogenic edema. FLAIR, fluid attenuated inversion recovery.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45315895","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}
{"title":"Prone cardiopulmonary resuscitation: an intensive care unit case series","authors":"Michael Semanco, Derek Hansen","doi":"10.21037/jeccm-22-26","DOIUrl":"https://doi.org/10.21037/jeccm-22-26","url":null,"abstract":"","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48024523","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}
Marica Faluomi, M. Cialini, Martina Naviganti, Amedeo Mastromauro, F. Marinangeli, Chiara Angeletti
{"title":"Organophosphates pesticide poisoning: a peculiar case report","authors":"Marica Faluomi, M. Cialini, Martina Naviganti, Amedeo Mastromauro, F. Marinangeli, Chiara Angeletti","doi":"10.21037/jeccm-22-64","DOIUrl":"https://doi.org/10.21037/jeccm-22-64","url":null,"abstract":"","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45126227","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}
Selvaraj Subramaniam, S. Jacobs, J. Moran, M. Kanhere
Zinc is an essential trace element in the body and has crucial roles in numerous enzymatic and metabolic processes, including gene transcription, immunoregulation, cellular restoration and protein synthesis (1). The liver plays an important role in zinc homeostasis. Zinc levels are abnormally decreased in chronic liver disease (CLD) and may lead to metabolic complications such as hepatic encephalopathy (2). Hypozincaemia is observed in the critically ill and is associated with increased mortality and illness severity scores (3). Zinc deficiency in CLD patients may increase their susceptibility to endotoxaemia by increasing intestinal barrier permeability via oxidative Original Article
{"title":"Plasma zinc status in critically ill patients with chronic liver disease","authors":"Selvaraj Subramaniam, S. Jacobs, J. Moran, M. Kanhere","doi":"10.21037/JECCM-21-48","DOIUrl":"https://doi.org/10.21037/JECCM-21-48","url":null,"abstract":"Zinc is an essential trace element in the body and has crucial roles in numerous enzymatic and metabolic processes, including gene transcription, immunoregulation, cellular restoration and protein synthesis (1). The liver plays an important role in zinc homeostasis. Zinc levels are abnormally decreased in chronic liver disease (CLD) and may lead to metabolic complications such as hepatic encephalopathy (2). Hypozincaemia is observed in the critically ill and is associated with increased mortality and illness severity scores (3). Zinc deficiency in CLD patients may increase their susceptibility to endotoxaemia by increasing intestinal barrier permeability via oxidative Original Article","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45424370","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}
Background: To examine the volume-outcome relationship in severe pediatric traumatic brain injury (TBI) using a retrospective analysis and to determine whether volume as a measure of broader trauma experience may generalize to favor improved pediatric TBI outcomes. Methods: We isolated all pediatric admissions for severe TBI (GCS admission score 3–8) to Pediatric ACS Level I and II Trauma Centers in the 2012–2015 National Trauma Data Bank. Using multivariate regression analysis, we examined the impact of four distinct volume variables—pediatric severe TBI, pediatric major trauma, adult severe TBI, and adult major trauma—on severe pediatric TBI short-term outcomes. Each volume measure was analyzed continuously as a primary independent variable. Our primary outcome variable was hospital discharge disposition. We adjusted for patient demographics, hospital characteristics, trauma severity metrics, and field-to-hospital time. Results: A total of 5,425 severe pediatric TBI patients were included in the final study population. Following multivariate analysis, only higher pediatric major trauma volume was associated with higher odds of favorable discharge [OR =1.073, 95% CI: (1.033, 1.114) per +100 patients, P<0.001]. Major pediatric trauma volume was also associated with shorter hospital ( ‒ 0.21 days per +100 patients, P=0.035) and ICU LOS ( ‒ 0.16 days per +100 patients, P=0.011). Both pediatric trauma and TBI volume were correlated with lower complication rates [Major Pediatric Trauma: OR =0.956, (0.921, 0.992) per +100 patients, P=0.018; Severe Pediatric TBI: OR =0.824, (0.728, 0.933) per +100 patients, P=0.002], particularly ARDS [Major Pediatric Trauma: OR =0.851, (0.783, 0.924) per +100 patients, P<0.001, Severe Pediatric TBI: OR =0.505, (0.372, 0.684) per +100 patients, P<0.001]. Conclusions: Among four different volume metrics, pediatric major trauma volume was correlated with more favorable discharge. General pediatric trauma experience was also associated with lower complication rates, particularly ARDS. An institution’s adult trauma and TBI experience did not significantly influence severe pediatric TBI outcomes. 17
{"title":"Generalizability of pediatric major trauma experience to severe pediatric traumatic brain injury at level 1 and 2 trauma centers","authors":"Anna R. Kimata, O. Tang, Wael Asaad","doi":"10.21037/JECCM-21-24","DOIUrl":"https://doi.org/10.21037/JECCM-21-24","url":null,"abstract":"Background: To examine the volume-outcome relationship in severe pediatric traumatic brain injury (TBI) using a retrospective analysis and to determine whether volume as a measure of broader trauma experience may generalize to favor improved pediatric TBI outcomes. Methods: We isolated all pediatric admissions for severe TBI (GCS admission score 3–8) to Pediatric ACS Level I and II Trauma Centers in the 2012–2015 National Trauma Data Bank. Using multivariate regression analysis, we examined the impact of four distinct volume variables—pediatric severe TBI, pediatric major trauma, adult severe TBI, and adult major trauma—on severe pediatric TBI short-term outcomes. Each volume measure was analyzed continuously as a primary independent variable. Our primary outcome variable was hospital discharge disposition. We adjusted for patient demographics, hospital characteristics, trauma severity metrics, and field-to-hospital time. Results: A total of 5,425 severe pediatric TBI patients were included in the final study population. Following multivariate analysis, only higher pediatric major trauma volume was associated with higher odds of favorable discharge [OR =1.073, 95% CI: (1.033, 1.114) per +100 patients, P<0.001]. Major pediatric trauma volume was also associated with shorter hospital ( ‒ 0.21 days per +100 patients, P=0.035) and ICU LOS ( ‒ 0.16 days per +100 patients, P=0.011). Both pediatric trauma and TBI volume were correlated with lower complication rates [Major Pediatric Trauma: OR =0.956, (0.921, 0.992) per +100 patients, P=0.018; Severe Pediatric TBI: OR =0.824, (0.728, 0.933) per +100 patients, P=0.002], particularly ARDS [Major Pediatric Trauma: OR =0.851, (0.783, 0.924) per +100 patients, P<0.001, Severe Pediatric TBI: OR =0.505, (0.372, 0.684) per +100 patients, P<0.001]. Conclusions: Among four different volume metrics, pediatric major trauma volume was correlated with more favorable discharge. General pediatric trauma experience was also associated with lower complication rates, particularly ARDS. An institution’s adult trauma and TBI experience did not significantly influence severe pediatric TBI outcomes. 17","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43009828","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}
: Compartment syndrome by itself is an emergency, but when it is combined with acute renal failure (ARF) secondary to exertional and toxin-induced rhabdomyolysis in the setting of methamphetamine use, it takes on a new dimension of complexity. We report the case of a 37-year-old male with no past medical history who was brought in by emergency medical services (EMS) after being found underneath a sink in a hotel room after a weekend of illicit drug use. On admission, the patient had a potassium of 7.7 mmol/L, creatinine of 2.71 mg/dL, and creatinine kinase (CK) of 228,635 U/L with severe agitation and confusion, and required admission to the intensive care unit (ICU). He was also noted to have severe tightness in his left posterior deltoid and triceps on exam, with compartment pressure of 40 mmHg. Immediately after hemodialysis (HD), the patient was taken for an emergent fasciotomy which showed marked duskiness of the muscles but no frank necrosis. After multiple sessions of HD, the patient continued to have markedly elevated CK levels which slowly began decreasing. Unfortunately, he was unable to remain euvolemic after HD and a transthoracic echocardiogram (TTE) showed acute heart failure with a reduced ejection fraction (HFrEF) of 40%. Swelling in his left upper extremity was slow to resolve and required closure with a continuous external tissue expander. After recovery from his multiple comorbidities the patient slowly regained functional capacity of his upper extremity despite the numerous complications. This patient’s lengthy and complicated medical course emphasizes the seriousness of this rare condition, and the cruciality of vigilance to ensure the best possible outcomes in cases of posterior deltoid compartment syndrome.
{"title":"Under (compartment) pressure in the intensive care unit: a case report","authors":"Michael Pietrangelo, J. Hess","doi":"10.21037/JECCM-20-163","DOIUrl":"https://doi.org/10.21037/JECCM-20-163","url":null,"abstract":": Compartment syndrome by itself is an emergency, but when it is combined with acute renal failure (ARF) secondary to exertional and toxin-induced rhabdomyolysis in the setting of methamphetamine use, it takes on a new dimension of complexity. We report the case of a 37-year-old male with no past medical history who was brought in by emergency medical services (EMS) after being found underneath a sink in a hotel room after a weekend of illicit drug use. On admission, the patient had a potassium of 7.7 mmol/L, creatinine of 2.71 mg/dL, and creatinine kinase (CK) of 228,635 U/L with severe agitation and confusion, and required admission to the intensive care unit (ICU). He was also noted to have severe tightness in his left posterior deltoid and triceps on exam, with compartment pressure of 40 mmHg. Immediately after hemodialysis (HD), the patient was taken for an emergent fasciotomy which showed marked duskiness of the muscles but no frank necrosis. After multiple sessions of HD, the patient continued to have markedly elevated CK levels which slowly began decreasing. Unfortunately, he was unable to remain euvolemic after HD and a transthoracic echocardiogram (TTE) showed acute heart failure with a reduced ejection fraction (HFrEF) of 40%. Swelling in his left upper extremity was slow to resolve and required closure with a continuous external tissue expander. After recovery from his multiple comorbidities the patient slowly regained functional capacity of his upper extremity despite the numerous complications. This patient’s lengthy and complicated medical course emphasizes the seriousness of this rare condition, and the cruciality of vigilance to ensure the best possible outcomes in cases of posterior deltoid compartment syndrome.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44203755","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}
A. Prishchepova, A. Abramovitz, Ronen Dudaie, P. Buchanan
Department of Critical Care, Mercy Hospital-St. Louis, St Louis, MO, USA; Department of Internal Medicine, SSM St. Mary’s Hospital-St. Louis, St Louis, MO, USA; Department of Critical Care, SSM St. Mary’s Hospital-St. Louis, St Louis, MO, USA; Department of Critical Care, Sparrow Medical Group, Lansing, MI, USA; St Louis University Center for Health Outcomes Research, St Louis, MO, USA Contributions: (I) Conception and design: All Authors; (II) Administrative support: RS Dudaie; (III) Provision of study materials or patients: AM Abramovitz, A Prishchepova; (IV) Collection and assembly of data: A Prishchepova, PM Buchanan; (V) Data analysis and interpretation: A Prishchepova, PM Buchanan, AM Abramovitz; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Anna Prishchepova. Department of Critical Care, Mercy Hospital, 625 South New Ballas Rd, Heart Hospital, S. 7020, St. Louis, MO, 63141, USA. Email: anna.prishchepova@mercy.net.
{"title":"Bedside ultrasound as an alternative to chest radiograph in detecting complications associated with central venous catheter placement: a retrospective cohort study","authors":"A. Prishchepova, A. Abramovitz, Ronen Dudaie, P. Buchanan","doi":"10.21037/JECCM-20-142","DOIUrl":"https://doi.org/10.21037/JECCM-20-142","url":null,"abstract":"Department of Critical Care, Mercy Hospital-St. Louis, St Louis, MO, USA; Department of Internal Medicine, SSM St. Mary’s Hospital-St. Louis, St Louis, MO, USA; Department of Critical Care, SSM St. Mary’s Hospital-St. Louis, St Louis, MO, USA; Department of Critical Care, Sparrow Medical Group, Lansing, MI, USA; St Louis University Center for Health Outcomes Research, St Louis, MO, USA Contributions: (I) Conception and design: All Authors; (II) Administrative support: RS Dudaie; (III) Provision of study materials or patients: AM Abramovitz, A Prishchepova; (IV) Collection and assembly of data: A Prishchepova, PM Buchanan; (V) Data analysis and interpretation: A Prishchepova, PM Buchanan, AM Abramovitz; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Anna Prishchepova. Department of Critical Care, Mercy Hospital, 625 South New Ballas Rd, Heart Hospital, S. 7020, St. Louis, MO, 63141, USA. Email: anna.prishchepova@mercy.net.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41579019","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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