Search PubMed⌕ Search

Biomedical subjects

R F Sing

Publications and source records attributed to R F Sing.

At least 55 records · Page 3Linked to original sources
PubMed2000

Bedside carbon dioxide cavagrams for inferior vena cava filters: preliminary results.

OBJECTIVE: The objective of this study was to evaluate the feasibility of using carbon dioxide (CO(2)) as a contrast agent in performing bedside inferior vena cavagrams before the insertion of vena cava filters. There was a consecutive series of patients undergoing bedside preinsertion cavagrams with inferior vena cava filter insertion. The setting was an 825-bed tertiary care hospital. The subjects were trauma patients undergoing inferior vena cava filter insertion. METHODS: The intervention used was vena cavagrams with CO(2) as the contrast agent. The main outcomes we measured were image quality, adverse reactions, cardiorespiratory changes, and renal failure. RESULTS: Ten patients underwent CO(2) cavography. All cavagrams were successful, demonstrating opacification of the inferior vena cava with identification of the renal veins and iliac bifurcation. There were no adverse reactions of renal failure. CONCLUSIONS: Carbon dioxide-contrasted vena cavagrams can be safely performed at the bedside, and they give good opacification of the inferior vena cava.

Adult↗
PubMed2000

Laparoscopic repair of a chronic diaphragmatic hernia.

Diaphragmatic injuries that remain undetected after an acute traumatic event may lead to the formation of a diaphragmatic hernia. Symptoms of a chronic diaphragmatic hernia are related to the incarceration of abdominal contents in the defect or to impingement of the lung, heart, or thoracic esophagus by abdominal viscera. A 49-year-old woman with a symptomatic chronic diaphragmatic hernia from an unrecognized iatrogenic injury to the left hemidiaphragm sought treatment. The diaphragmatic injury occurred 2 years earlier when a low, left-sided chest tube was placed for a persistent pleural effusion 2 weeks after a lower lobectomy for an aspergilloma. The patient's diaphragmatic hernia was diagnosed after an upper gastrointestinal series and an esophagogastroduodenoscopy. Approximately 75% of her stomach was incarcerated in the diaphragmatic defect. The diaphragmatic hernia was repaired laparoscopically using a 9 cm x 10-cm polytetrafluoroethylene patch sewn with nonabsorbable, interrupted, horizontal mattress sutures. Improvement of video technology, laparoscopic instruments, and surgical skills has allowed surgeons to expand the boundaries of advanced therapeutic laparoscopy. These factors facilitated the authors' standard tension-free prosthetic repair of a chronic diaphragmatic hernia using minimally invasive techniques.

Chronic Disease↗
PubMed1999

Bedside insertion of inferior vena cava filters in the intensive care unit.

BACKGROUND: Injured patients are at significant risk for venous thromboembolic complications. Multiple studies have reported a benefit of prophylactic inferior vena cava filter (IVCF) insertion in selected high-risk trauma patients. Often, these high-risk patients reside in the intensive care unit (ICU) and require mechanical ventilation, intracranial pressure monitoring, multiple intravenous infusions, and other invasive monitoring modalities. This puts these patients at risk for transport from the ICU. METHODS: We prospectively studied a series of consecutive patients undergoing bedside preinsertion contrast cavagram and IVCF insertion in the ICU. RESULTS: Thirty-two patients received IVCF. There were no failures to insert IVCF. One insertion-site hematoma occurred; however, there were no documented insertion-site deep venous thromboses. One patient death was unrelated to the IVCF, and one potential contrast-related acute renal failure occurred in an unstable patient who underwent IVCF insertion for a pulmonary embolus. CONCLUSION: Bedside IVCF insertion with a preinsertion cavagram is a percutaneous procedure that can be safely performed in the ICU. Bedside insertion of IVCF avoids the potential complications of transporting critically ill patients and may reduce costs.

Adolescent↗
PubMed1999

Use of ketorolac in renal colic.

Intravenously administered ketorolac tromethamine provided complete pain relief to a 54-year-old man with right-sided testicular pain and nausea and vomiting. The patient had a ureteral calculus documented by computed tomography. This patient's pain initially failed to respond to intravenously administered hydromorphone hydrochloride. Subsequently, he was admitted to the hospital and had operative removal of his ureteral calculus and placement of a ureteral stent. Based on their findings and review of the literature, the authors recommend that intravenous ketorolac be used as the first-line treatment for acute renal colic in patients in whom the medication is not contraindicated.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

Rapid sequence induction for intubation by an aeromedical transport team: a critical analysis.

Airway control is the initial priority in the management of the injured patient. The purpose of this investigation was to evaluate the experience of an aeromedical transport team in the utilization of rapid sequence induction (RSI) for endotracheal intubation in the prehospital setting. Records of a consecutive series of injured patients undergoing RSI between June 1988 and July 1992 by a university-based aeromedical transport team were reviewed for demographics, intubation mishaps, and pulmonary complications. The relationship between intubation mishaps and pulmonary complications was analyzed. Eighty-four patients were studied with a mean age of 30.8 +/- 15.3 years. The mean Revised Trauma Score was 11.3 +/- 2.4, and the mean Injury Severity Score (ISS) was 19.6 +/- 11.5. Intubation mishaps occurred in 15 patients (18%), and pulmonary complications developed in 22 (29%) of the 75 patients surviving longer than 24 hours. There was no relationship between intubation mishaps and pulmonary complications. Abbreviated Injury Scale (AIS) face score was significantly higher in patients with intubation mishaps, compared with patients without mishaps (1.1 +/- 1.2 and 0.5 +/- 0.9, respectively, P < .05, Wilcoxon rank-sum). ISS and AIS chest were higher in patients with pulmonary complications, compared with those without (25.7 +/- 12.6 and 17.4 +/- 10.3 and 2.2 +/- 1.8 and 1.0 +/- 1.5, ISS and AIS respectively; P < .05, Wilcoxon rank-sum). Eighty-one patients (96%) underwent successful RSI, 73 (87%) on the first attempt. Failure to intubate occurred in three patients (4%). Performed under strict protocol by appropriately trained aeromedical transport personnel, RSI is an effective means to facilitate endotracheal intubation in the injured patient requiring definitive airway control. Pulmonary complications were related to injury severity and not to intubation mishaps.

Adolescent↗
PubMed1998

Preliminary results of bedside inferior vena cava filter placement: safe and cost-effective.

The use of inferior vena cava filters (IVCFs) is increasing in patients at high risk for venous thromboembolism; however, there is considerable controversy related to their cost. We inserted eight percutaneous IVCFs at the bedside. The hospital charges for bedside IVCF insertion were substantially lower compared with those for IVCF insertion performed in the Radiology Department or operating room. There was one death (unrelated to the procedure) and one asymptomatic caval occlusion believed to be caused by thrombus trapping. Bedside IVCF insertion is safe and cost-effective in selected patients. This practice averts the potential complications associated with transporting critically ill patients.

Adult↗
PubMed1997

Shotgun wounds in children. Not just accidents.

OBJECTIVE: To characterize the demographic characteristics of shotgun wounds in children and adolescents across various regions within a state. DESIGN: Retrospective case study. SETTING: Accredited trauma centers in Pennsylvania. PATIENTS: All patients less than 18 years old who sustained shotgun wounds. DATA COLLECTION: Patient data were collected from the Pennsylvania Trauma Systems Foundation statewide trauma registry for January 1987 through December 1994. Data reviewed included age, race, sex, region, nature of injury, assailant, location of incident, length of stay in the hospital and intensive care unit, Injury Severity Score, organs injured, death, and discharge disposition. RESULTS: Over 8 years there were 95 shotgun wounds in patients with a mean +/- SD age of 14.0 +/- 3.7 years; the male-to-female ratio was 5.8:1. The incidence of shotgun wounds in urban areas increased threefold during the second half of the study; the incidence in nonurban regions was unchanged. Eighteen deaths (19%) occurred, 17 (94%) within 24 hours and 10 (56%) because of intracranial injury. Overall, unintentional shotgun wounds were most common (n = 46 [48%]), followed by assaults (n = 37 [39%]) and suicides (n = 8 [8%]). The highest per capita incidence of shotgun wounds occurred in urban areas, typically the result of an assault (n = 30 [73%]). In nonurban areas, shotgun wounds were usually unintentional (n = 36 [67%]); 34 (63%) occurred in the home. In contrast, in urban areas, 26 shotgun wounds (63%) occurred on the street. Overall, 14 fatal shotgun wounds (78%) occurred in the home. Operative intervention was required for 57 patients (60%). Ultimately, 67 patients (71%) were discharged to home. CONCLUSIONS: In urban areas, shotgun wounds are increasing in incidence, often occur on the street, and often result from assault. In nonurban areas, shotgun wounds are usually unintentional, often occur in the home, and are more often lethal than shotgun wounds in urban areas. Multiple-organ injury, surgery, and lengthy hospital stays are common.

Accidents↗
PubMed1997

Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy.

OBJECTIVE: Tracheostomy is one of the most commonly performed surgical procedures in the critical care setting. The early use of tracheostomy as a method of primary airway management has been proposed as a means to decrease pulmonary morbidity and to shorten the number of ventilator, intensive care unit, and hospital days. We set out to (1) determine whether hypercarbia occurs during tracheostomy of the critically ill patient and (2) determine the extent to which the partial pressure of carbon dioxide in arterial blood (PaCO2) rises during percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy. DESIGN: Prospective, open clinical trial. SETTING: Surgical intensive care unit and operating room in teaching hospitals. PATIENTS: During mechanical ventilation, patients underwent either percutaneous endoscopic (PET), percutaneous Doppler (PDT), or standard surgical tracheostomy (ST), based on surgeon preference. Arterial blood gas readings were obtained approximately every 4 min throughout each procedure. MEASUREMENTS AND RESULTS: All tracheostomies were successfully performed. No serious complications (including hypoxia) occurred during the study. Significant (p < 0.05 vs PDT and ST) hypercarbia (maximum delta PaCO2 24 +/- 3 mmHg) and acidosis (maximum delta pH -0.16 +/- 0.02) developed during PET. The changes in PaCO2 and pH during PDT (maximum delta PaCO2 8 +/- 2 mmHg; maximum delta pH -0.07 +/- 0.02) and ST (maximum delta PaCO2 3 +/- 1 mmHg; maximum delta pH -0.04 +/- 0.01) were markedly less pronounced. CONCLUSIONS: Continuous bronchoscopy during percutaneous tracheostomy contributes significantly to early hypoventilation, hypercarbia, and respiratory acidosis during the procedure. Percutaneous tracheostomy, when performed using the Doppler ultrasound method to position the endotracheal tube, significantly reduces CO2 retention when compared to PET. Because of a possible rise in intracranial pressure, the potential for hypercarbia should be considered when choosing the method of tracheostomy in the critically ill and/or head-injured patient, where hypercarbia may be detrimental. If PET is to be performed, steps to minimize occult hypercarbia, such as using the smallest bronchoscope available, minimizing suctioning during bronchoscopy, and minimizing the length of time the bronchoscope is in the endotracheal tube, should be undertaken.

Acidosis↗
PubMed1997

Laparoscopic transdiaphragmatic diagnostic pericardial window in the hemodynamically stable patient with penetrating chest trauma. A brief report.

We report two cases of laparoscopically performed transdiaphragmatic diagnostic pericardial window following diagnostic laparoscopy for a penetrating wound to the central anterior thorax below the sixth intercostal space. In the hemodynamically stable patient, this approach permits evaluation of the diaphragm, abdominal viscera, and pericardial space using a single, minimally invasive surgical technique.

Adolescent↗