BACKGROUND:Traumatic brain injuries are common and costly to hospital systems.Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines.This is a review of ...BACKGROUND:Traumatic brain injuries are common and costly to hospital systems.Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines.This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES:A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses,systematic reviews,and randomized controlled trials.RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas,maintain systolic blood pressure above 90 mmHg,oxygen saturations above 93%,euthermia,intracranial pressures below 20 mmHg,and cerebral perfusion pressure between 60-80 mmHg.CONCLUSION:Much is still unknown about the management of traumatic brain injury.The current practice guidelines have not yet been sufficiently validated,however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.展开更多
BACKGROUND:Fever in patients can provide an important clue to the etiology of a patient's symptoms.Non-invasive temperature sites(oral,axillary,temporal) may be insensitive due to a variety of factors.This has not...BACKGROUND:Fever in patients can provide an important clue to the etiology of a patient's symptoms.Non-invasive temperature sites(oral,axillary,temporal) may be insensitive due to a variety of factors.This has not been well studied in adult emergency department patients.To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature.METHODS:A retrospective chart review was made of 27 130 adult patients in a high volume,urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature.RESULTS:The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F(P<0.001),with 25.9%of the patients having higher rectal temperatures >2°F,and 5.0%having higher rectal temperatures >4 °F.The mean difference among the patients who received oral,axillary,and temporal temperatures was 1.2 °F(PO.001),1.8 °F(PO.001),and 1.2 °F(P<0.001) respectively.About 18.1%of the patients were initially afebrile and found to be febrile by rectal temperature,with an average difference of 2.5 °F(P<0.001).These patients had a higher rate of admission(61.4%,P<0.005),and were more likely to be admitted to the hospital for a higher level of care,such as an intensive care unit,when compared with the full cohort(12.5%vs.5.8%,P<0.005).CONCLUSIONS:There are significant differences between rectal temperatures and noninvasive triage temperatures in this emergency department cohort.In almost one in five patients,fever was missed by triage temperature.展开更多
July coincides with the beginning of the academic year in teaching hospitals across the United States of America (USA).The increased responsibility assumed by trainees transitioning to a higher role in the healthcare ...July coincides with the beginning of the academic year in teaching hospitals across the United States of America (USA).The increased responsibility assumed by trainees transitioning to a higher role in the healthcare team is hypothesized to lead to poorer patient outcomes,termed the“July Effect”.The consequence of a“July Effect”might be more severe in critical care settings,where the complexity of patients requires a higher level of experience and training.The only studies evaluating the“July Effect”in the ICU were published in the early 2000’s.;Since that time,several resident work-hour regulations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME).;These regulations have resulted in more frequent sign-outs,reduced continuity of care,and less clinical time for trainees,which in theory could increase the risk of errors among young trainees at the time they are most vulnerable.展开更多
文摘BACKGROUND:Traumatic brain injuries are common and costly to hospital systems.Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines.This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES:A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses,systematic reviews,and randomized controlled trials.RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas,maintain systolic blood pressure above 90 mmHg,oxygen saturations above 93%,euthermia,intracranial pressures below 20 mmHg,and cerebral perfusion pressure between 60-80 mmHg.CONCLUSION:Much is still unknown about the management of traumatic brain injury.The current practice guidelines have not yet been sufficiently validated,however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.
文摘BACKGROUND:Fever in patients can provide an important clue to the etiology of a patient's symptoms.Non-invasive temperature sites(oral,axillary,temporal) may be insensitive due to a variety of factors.This has not been well studied in adult emergency department patients.To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature.METHODS:A retrospective chart review was made of 27 130 adult patients in a high volume,urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature.RESULTS:The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F(P<0.001),with 25.9%of the patients having higher rectal temperatures >2°F,and 5.0%having higher rectal temperatures >4 °F.The mean difference among the patients who received oral,axillary,and temporal temperatures was 1.2 °F(PO.001),1.8 °F(PO.001),and 1.2 °F(P<0.001) respectively.About 18.1%of the patients were initially afebrile and found to be febrile by rectal temperature,with an average difference of 2.5 °F(P<0.001).These patients had a higher rate of admission(61.4%,P<0.005),and were more likely to be admitted to the hospital for a higher level of care,such as an intensive care unit,when compared with the full cohort(12.5%vs.5.8%,P<0.005).CONCLUSIONS:There are significant differences between rectal temperatures and noninvasive triage temperatures in this emergency department cohort.In almost one in five patients,fever was missed by triage temperature.
文摘July coincides with the beginning of the academic year in teaching hospitals across the United States of America (USA).The increased responsibility assumed by trainees transitioning to a higher role in the healthcare team is hypothesized to lead to poorer patient outcomes,termed the“July Effect”.The consequence of a“July Effect”might be more severe in critical care settings,where the complexity of patients requires a higher level of experience and training.The only studies evaluating the“July Effect”in the ICU were published in the early 2000’s.;Since that time,several resident work-hour regulations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME).;These regulations have resulted in more frequent sign-outs,reduced continuity of care,and less clinical time for trainees,which in theory could increase the risk of errors among young trainees at the time they are most vulnerable.
