Acute Care Hospitals Research Papers (original) (raw)

Delivering good care for the elderly with cognitive issues in a large rapidly turning over acute hospital setting is often challenging at all levels. The elderly patients have multiple medical comorbidities, on multiple medications and... more

Delivering good care for the elderly with cognitive issues in a large rapidly turning over acute hospital setting is often challenging at
all levels. The elderly patients have multiple medical comorbidities, on multiple medications and often display challenging behaviors
which are not easy to manage, unless the care staffs have received training in Gerontology. The onset of challenging behaviors may
be the harbinger for something more urgent, and time and care should be promptly instituted, instead of managing the behavior
with sedatives or restraints. Diagnosis of delirium is often missed since the symptoms are vague and fluctuate throughout the day.
Nurses are perhaps the best partners for the doctors in screening and diagnosing delirium early.

Introduction: The unplanned removal of an endotracheal tube is a life-threatening incident. Critically ill trauma patients at an ACSdesignated level II trauma center were evaluated for variables leading to unplanned extubation (UE). Data... more

Introduction: The unplanned removal of an endotracheal tube is a life-threatening incident. Critically ill trauma patients at an ACSdesignated level II trauma center were evaluated for variables leading to unplanned extubation (UE). Data provided by the American College of Surgeons Trauma Quality Improvement Program (TQIP) was analyzed for reasons for UE. Materials and methods: A retrospective evaluation of trauma patients who experienced UE in a surgical critical care setting during a 12-month period was conducted. UE was identified as an unintended, premature removal of an endotracheal tube secondary to dislodgement due to activity, provision of patient care, or self-extubation by the patient. Results: A total of 20 cases of UE occurred among 17 patients in 144 ventilator days-(4.3 UEs/100 ventilator days). 19 (95 %) had no change to the ventilator settings; 15 (75 %) were restrained at the time of extubation; 13 (65 %) were perceived to have adequate analgesia; 12 (60 %) had no sedation administered and 11 (55 %) had no analgesia administered within 4 h of UE. Interestingly, 12 patients (60 %) did not require reintubation. Conclusion: Though most patients were perceived to have adequate analgesia and sedation by providers, a majority had not had an analgesic or sedative administered within 4 h preceding UE. We concluded that the currently utilized pain assessment tool may be less accurate in intubated patients. A new pain assessment scale was utilized based on the findings of this study which is currently in use. A larger prospective study analyzing factors leading to UE in the entire ICU is ongoing.

Background. Post-intensive care syndrome (PICS) is a constellation of new or worsening impairments in physical, mental, or cognitive abilities or a combination of these in individuals who have survived critical illness requiring intensive... more

Background. Post-intensive care syndrome (PICS) is a constellation of new or worsening impairments in physical, mental, or cognitive abilities or a combination of these in individuals who have survived critical illness requiring intensive care.

O ur patient, a 90 yr. old gentleman, weighing 70 kilogram, with a CT diagnosis of Stage IV Carcinoma bladder was scheduled for a palliative endoscopic fulgaration or transurethral resection of bladder tumor ( TURBT ) . His complaints... more

O ur patient, a 90 yr. old gentleman, weighing 70 kilogram, with a CT diagnosis of Stage IV Carcinoma bladder was scheduled for a palliative endoscopic fulgaration or transurethral resection of bladder tumor ( TURBT ) . His complaints were dysuria and hematuria for which he already had a Foleys catheter in situ. He was a known hypertensive for past 20 years on Tab Atenolol 25 mg once daily, Tab Indapamide 2.5 mg once daily, Tab Atorvastatin 40 mg once daily (at bed time) and Tab Aspirin 75 mg once daily. His investigations were as follows: Hemoglobin-11 gm%, Packed cell volume -32 %, Platelet count-1.8 lacs/cumm, Blood urea-27 mg%, Serum creatinine-1 mg%, Serum sodium-140 meq/L, Serum potassium-4 meq/L, random blood sugar-118 mg%. His 12 lead electrocardiogram and 2D echocardiogram were within normal limits. The Urologist informed us that it was a stage IV carcinoma bladder which was as a sessile growth on the right lateral wall of urinary bladder. He was worried because while if the obturator nerve gets stimulated during surgery, thebladder can get perforated. Hence we planned spinal anesthesia along with ultrasound guided right obturator nerve block for surgery. We per-