1/9. Fat necks: modification of a standard surgical airway protocol in the pre-hospital environmental.We report two cases of trauma where a surgical airway was required. In both cases soft tissue swelling of the neck made modification of the Advanced Trauma life Support (ATLS) airway guidelines necessary. A gum elastic bougie was used to guide a standard endotracheal tube into a cricothyroidotomy incision and secure the airway. Slight departure from standard techniques may be required in difficult circumstances to achieve a definitive airway.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/9. hospitals without walls: a journey through the health-care system.The paper describes aspects of a journey through the health-care system following a domestic accident. The journey commenced in the accident and emergency department and, over a 3 month period, traversed the operating theatre, intensive care and an orthopaedic ward before moving into a Hospital in the Home programme and community health and district nursing services. The paper explores the experiences of the accident victim, a 56-year-old man, and his wife who is an experienced nurse and university lecturer. The paper supports the 'seamless delivery' concept of integrated care while, at the same time, sounding notes of caution. The principal messages in this paper are about the relationships that nurses build with patients and their families over long periods of care, the paradoxical sense of 'outsideness' that can occur when the home becomes medicalized and the importance of the home as a healing environment.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
3/9. Improving glycaemic control in a metabolically stressed patient in ICU.This article describes a clinical experience where the careful application of problem-solving skills has resulted in positive changes in glycaemic care in a critical care environment. The metabolic stress response to trauma injuries leads to episodes of hyperglycaemia. The application of a problem-solving process has resulted in greater understanding of best practice of the management of this problem. The importance of strict control of blood glucose levels in the critically ill patient is highlighted. Although the practice areas in this article is a specialized intensive care environment, in light of recent government-led recognition that many patients in hospital are increasingly ill (Department of health (DoH), 1998a), this situation may arise in many ward environments.- - - - - - - - - - ranking = 0.75keywords = environment (Clic here for more details about this article) |
4/9. Nerve sheath tumors involving the sacrum. Case report and classification scheme.Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
5/9. osteomyelitis caused by enterobacter cancerogenus infection following a traumatic injury: case report and review of the literature.We report a case of osteomyelitis caused by enterobacter cancerogenus resistant to aminopenicillins in a 56-year-old male who had a motorcycle accident and suffered from multiple bone fractures with abundant environmental exposure. E. cancerogenus has rarely been associated with human infections, and its clinical significance remains unclear.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
6/9. Complex pain consultations in the pediatric intensive care unit.The assessment and management of pain in children is not always easy and it is clearly more difficult in the critical care setting. pain management is further complicated in this vulnerable population by the nature of their critical condition, the complexity and multidimensionality of their illness or injuries, and the intensity of emotions in this environment. A variety of pain syndromes are encountered in the pediatric intensive care unit, and the staff there may not be familiar with or comfortable managing these cases. Pain assessment and treatment can be more appropriately managed when guided by the experts of a multidisciplinary pediatric pain service.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
7/9. hypothermia and trauma.hypothermia can induce profound physiologic changes. There are varying degrees of hypothermia, each requiring aggressive methods of treatment. Trauma patients have multisystem involvement, and hypothermia can increase the morbidity and mortality of the trauma patient. The degree of hypothermia is affected by age, severity of illness, environmental exposure, and the presence of open wounds. It is important for all nurses who work with trauma patients in the perioperative phase to incorporate the assessment and planning to prevent or minimize hypothermia in the trauma patient.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
8/9. Defective thermoregulation after traumatic brain injury. A single subject evaluation.Central fever is a known complication of traumatic brain injury (TBI), particularly in association with brain stem involvement. Chronic deficits in thermoregulation after TBI have not been reported. We describe a patient who had central fevers acutely after injury, but developed intermittent temperature elevations during thermal stress in the post-acute phase. A prospective evaluation of the patient's temperature control was conducted. The patient stayed in the laboratory for two half-day evaluation sessions. On the first day, the room temperature was raised by 10 degrees F each hour and rectal temperature was recorded hourly. On the second day, the room temperature was lowered by 10 degrees each hour in a similar fashion. The patient's core temperature rose above normal in the warm environment but did not drop in the cold environment. This suggests that the patient had a chronic deficit in either sensing temperature elevations or activating heat dissipation mechanisms under thermal stress.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
9/9. Effects of injury and therapy on brain parenchyma pO2, pCO2, pH and ICP following severe closed head injury.Simultaneous monitoring of brain parenchyma pO2, pCO2, and pH (PbO2, PbCO2 and pHb) has been tested in ICU environments using fiber optic sensors incorporated in probes 0.5 mm in diameter. An Institutionally approved protocol was used to test the concept and technology for monitoring PbO2, PbCO2 and pHb, and to observe the effects of injury and therapy interventions on each of the variables monitored, including ICP, the clinical standard. ICP and fiber optic pO2, pCO2 and pH probes were placed in 10 SCHI patients at bedside in the ICU using sterile technique. The probes remained in place for the duration of ICP monitoring, and were functional in the ICU environment for up to 10 days. Trend patterns recurred in this series of SCHI patients: Extreme PbCO2 (high) and pHb (low) are associated with poor perfusion; increasing pbCO2 and decreasing pHb may be early indicators of ICP crisis, i.e. ICP > 20 mm Hg that tends to be unresponsive to therapy, and; pentobarbital "loading" and maintenance is associated with increased pbO2. These preliminary results from monitoring pbO2, pbCO2 and pHb in SCHI patients indicate that fiber optic sensor technology functions and is able to be used in this application. Trend patterns from this data may further indicate practical utility as a more direct monitor of the delicate balance between tissue perfusion and cell metabolism than ICP alone.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |