ABSTRACT
BACKGROUND: Provision of enteral nutrition (EN) support is historically inadequate in the critically ill population. An interdisciplinary approach utilizing various strategies has been shown to improve initiation of timely EN support. The purpose of this study was to examine whether the implementation of a series of interventions led by an interdisciplinary team was associated with changes in the initiation of nutrition support in a level 1 trauma center. METHODS: Patients admitted between 2009 and 2013 with isolated closed head trauma injuries were identified through the hospital's trauma center database. The initial population consisted of 159 patients; after exclusion criteria, 141 patients were included in the statistical analyses. Two statistical analyses were conducted. The first calculated the average days to the initiation of nutrition start by admission year. The second estimated the association between admission year and time to nutrition initiation with a generalized linear model. RESULTS: Time to initiate nutrition therapy was estimated to decrease by 1.46 days (47.31%) from 2009 to 2013. The time to initiate nutrition in 2013 was 1.63 days. A significant association was found between the time to initiate nutrition and the 2012 and 2013 binary variables while controlling for confounding variables. The time frame was estimated to be 1.09 (P = .008) and 1.75 (P = .000) days shorter in 2012 and 2013 relative to 2009. CONCLUSIONS: An interdisciplinary effort utilizing multiple strategies identified and addressed barriers, resulting in a reduction of variability and a proactive approach to early EN.
Subject(s)
Craniocerebral Trauma/therapy , Critical Care , Critical Illness/therapy , Enteral Nutrition , Hospitalization , Quality Improvement , Trauma Centers , Adult , Aged , Aged, 80 and over , Evidence-Based Medicine , Female , Hospitals , Humans , Male , Middle Aged , New York , Patient Care Team , Program Evaluation , Time Factors , Young AdultABSTRACT
BACKGROUND: It is well known that hydrogen peroxide ingestion can cause gas embolism. OBJECTIVE: To report a case illustrating that the definitive, most effective treatment for gas embolism is hyperbaric oxygen therapy. CASE REPORT: We present a case of a woman who presented to the Emergency Department with acute abdominal pain after an accidental ingestion of concentrated hydrogen peroxide. Complete recovery from her symptoms occurred quickly with hyperbaric oxygen therapy. CONCLUSION: This is a case report of the successful use of hyperbaric oxygen therapy to treat portal venous gas embolism caused by hydrogen peroxide ingestion. Hyperbaric oxygen therapy can be considered for the treatment of symptomatic hydrogen peroxide ingestion.
Subject(s)
Embolism, Air/chemically induced , Embolism, Air/therapy , Hydrogen Peroxide/poisoning , Hyperbaric Oxygenation , Adult , Female , Humans , Portal SystemABSTRACT
El hipoclorito de sodio es ampliamente utilizado como agente irrigante durante la terapia endodóntica, ya que juega un importante papel como disolvente de los tejidos necróticos así como antiséptico. Es sabido también que puede producir reacciones tóxicas sobre los tejidos vivos adyacentes. El presente artículo reporta un caso de extrusión de hipoclorito a través del foramen apical,y comenta como prevenir el accidente, así como el protocolo de tratamiento a instaurar en caso del que mismo se produzca.
Sodium hypochlorite is broadly used as an irrigant during the endodontic therapy, since it plays an important rol as a solvent of the necrotic tissues as well as antiseptic. It is also known that it can produce toxic reactions on the soft periapical tissues. The present article reports a case of hypochlorite extrusion through the tooth apex, gives guidelines in order to prevent this accident and discusses the treatment protocol to establish in case this event takes place.
