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At least 217 records · Page 12Linked to original sources
PubMed1991

Early diagnosis and treatment of sinusitis in the critically ill trauma patient.

Sinusitis is an important cause of sepsis in the critically ill patient and may be difficult to diagnose. Four patients admitted to the surgical intensive care unit with closed head trauma were found to have sinusitis as the cause of persistent bacteremia. All patients received pharmacologic doses of corticosteroids for treatment of head injury and had prolonged nasotracheal and/or nasogastric intubation. A bedside procedure was used for diagnosis and management. Under local anesthesia, a 16-gauge angiocatheter was inserted under the inferior turbinate and into the maxillary sinus. After purulent fluid was aspirated, the sinuses were irrigated with normal saline. All four patients defervesced within 24 to 48 hours of this procedure, and facial x rays demonstrated clearing of the maxillary sinus. It was concluded that: 1) Sinusitis is a complication of closed head trauma in critically ill patients and should be included in the differential diagnosis when persistent bacteremia occurs; 2) The use of corticosteroids in the treatment of head injury may increase the risk of sinus infection; 3) Facial x rays showing air-fluid levels and/or opacification are a valuable screening test for paranasal sinusitis; and 4) bedside aspiration of the maxillary sinus is an effective diagnostic and therapeutic technique for management of sinusitis in the critically ill.

Adolescent↗
PubMed1991

Incidence of pulmonary aspiration in intubated patients receiving enteral nutrition through wide- and narrow-bore nasogastric feeding tubes.

A descriptive study was performed to compare the incidence of pulmonary aspiration in 25 critically ill patients who had endotracheal tubes in place and were receiving enteral nutrition through a narrow-bore nasogastric tube (n = 10) or a wide-bore nasogastric tube (n = 15). Results of chi-square analysis of this comparison were not significant, p less than 0.05. Aspiration occurred in one subject. The amount and rate of tube feeding delivered was examined. The number of checks for residual feeding was found to be significantly greater in the wide-bore tube group. A comparison of the assessment of nasogastric tube placement on x-ray examination showed that tube placement was reported on x-ray results with more frequency in the wide-bore group. Questions are raised by these observations regarding the use of narrow-bore tubes in the critically ill population with endotracheal tubes in place.

Adolescent↗
PubMed1989

Selected anatomic burn pathology review for clinicians and pathologists.

Selected examples of burn pathology having special teaching value for burn care during the initial 72 h are briefly summarized with specific recommendations to aid initial management and to enhance, rather than hinder, subsequent care by a specialist in burn therapy. A new concept relating fibrin degradation products to the development of shock lung is presented.

Burns, Inhalation↗
PubMed1988

Gastrointestinal complications in gynecologic surgery: a review for the general gynecologist.

A working familiarity with the management of common perioperative gastrointestinal complications is required for all general gynecologists. Thermal gastrointestinal injury requires resection of the damaged portion of bowel unless the injury involves only the bowel serosa and is less than 0.5 cm in diameter. Small intraoperative lacerations of the intestine can be closed primarily, whereas larger lacerations often require resection. Some degree of postoperative ileus may be expected, but prolonged ileus requires nasogastric suctioning while excluding bowel obstruction, peritonitis, or electrolyte imbalance. Small-bowel obstruction, most likely to be caused by postoperative adhesions, can often be treated successfully by gastrointestinal intubation. Steps required in the initial management of an enterocutaneous fistula include institution of parenteral nutritional supplementation and antibiotics, skin protection, and investigative studies of the fistula. Preventive measures may be used at the time of any surgical procedure to reduce the incidence of many of these complications.

Digestive System↗
PubMed1987

[Significance of percutaneous endoscopically controlled gastrostomy in the prevention and therapy of esophagotracheal fistula following long-term intubation].

An esophago-tracheal fistula, which developed during long-term artificial ventilation, is a vital threat to the life of a patient. The esophago-tracheal fistula is caused by pressure lesion of the mucosa of the posterior tracheal and anterior esophageal wall. The adverse mechanic factors are the blocked tube cuff on the one hand and the nasogastric tube being usually required for enteral nutrition on the other hand. Replacement of a nasogastric tube through a percutaneous, endoscopically controlled gastrostomy relieves the esophagus and thus prevents pressure lesion of the anterior esophageal wall. A percutaneous endoscopic gastrostomy, if performed in time, is suggested to reduce the incidence of an esophago-tracheal fistula, which develops in the course of long-term artificial ventilation.

Enteral Nutrition↗
PubMed1986

Preventing complications from lines and tubes.

Rather than providing an exhaustive list of known complications of all tubes and lines used in the NICU, we have highlighted the potentially traumatic nature of their use and outlined general principles of prevention. Most complications of care are more easily avoided if we know about them in advance. Attention to simple details, while recognizing that use of indwelling tubes and lines has both benefits and hazards, should lessen some of these morbidities.

Catheterization↗
PubMed1987

[Knotting of stomach and endotracheal tubes].

After transnasal placement of a tracheal and a gastric tube, the latter did not function properly. Several attempts to remove the gastric tube were unsuccessful, but this could not be explained on several laryngoscopic inspections. The palpating finger finally found a knot of tracheal and stomach tubes high in the epipharynx. This incident underlines the importance of faultless functioning of tracheal and stomach tubes, especially in patients with intended intermaxillary fixation.

Adolescent↗
PubMed1985

Management of Landry-Guillain-Barré syndrome in pregnancy.

The criteria for Landry-Guillain-Barré syndrome are reviewed and a case of a patient requiring respirator support during pregnancy is presented. Based on a current review of the literature, a total of 29 cases have been reported with an estimated fetal survival rate of 96% (26 of 27). The syndrome is not affected by pregnancy or pregnancy termination. Respirator support has the highest risk of maternal morbidity and mortality but should be minimized with modern pulmonary treatment. Additional management considerations are discussed.

Adult↗
PubMed1985

Iatrogenic bronchopleural fistula caused by feeding tube insertion.

Nutritional supplements administered through flexible small caliber feeding tubes are an increasingly popular substitute for parenteral hyperalimentation. Small and large caliber nasogastric tubes can inadvertently pass into the tracheobronchial tree, even in the presence of an endotracheal tube with an inflated cuff. We report three patients who had small caliber feeding tubes passed through the tracheobronchial tree perforating into the pleural space. Potential complications include immediate or delayed pneumothorax, tension pneumothorax, hydropneumothorax, and empyema. Prompt post-insertion chest radiography is required to verify correct placement of small caliber feeding tubes.

Aged↗
PubMed1985

Difficult intubations: aids and alternatives.

Physicians who are likely to encounter emergency situations should know how to secure an airway with techniques other than the standard methods of oral and nasal intubation. The approach and the equipment used depend on the clinician's abilities and experience. Aids and alternative techniques include use of the fiberoptic laryngoscope, guided retrograde transcricoid intubation, esophageal devices, cricothyrotomy, tracheotomy and transtracheal jet ventilation.

Cricoid Cartilage↗