ABSTRACT
A study was initiated to determine the prevalence and incidence of pressure ulcers in two long-term care facilities in Canada, one with 95 residents and the other with 92 residents. The prevalence study was conducted at both facilities on a single day. The incidence study was completed after 41 and 42 days, respectively, at each facility. Data were collected on demographics, medical information, and possible contributing factors. Each resident was assessed for the presence of a pressure ulcer. Each ulcer was staged and anatomical location was noted. The prevalence of pressure ulcers in the two long-term care facilities was 36.8% and 53.2%, respectively. The incidence of pressure ulcers in the two long-term care facilities was 11.7% and 11.6%, respectively. In conclusion, the pressure ulcer prevalence is higher than published figures for the long-term care setting. However, a pressure ulcer incidence of less than 12% in each facility suggests an equal and acceptable level of nursing care in both facilities. The disparity of pressure ulcer prevalence between the two facilities may be explained by a difference of case mix.
Subject(s)
Pressure Ulcer/epidemiology , Skilled Nursing Facilities/statistics & numerical data , Adult , Age Distribution , Aged , Aged, 80 and over , Canada/epidemiology , Comorbidity , Diagnosis-Related Groups/statistics & numerical data , Female , Humans , Incidence , Male , Middle Aged , Nursing Assessment , Pressure Ulcer/classification , Pressure Ulcer/etiology , Pressure Ulcer/prevention & control , Prevalence , Quality Indicators, Health Care , Quality of Health Care , Risk Factors , Severity of Illness Index , Sex Distribution , Skilled Nursing Facilities/standards , Total Quality ManagementABSTRACT
A case is presented of a primigravida with severe preeclampsia who, 24 hours after delivery, became hemiparetic and deeply comatose due to acute ischaemia of the left cerebral hemisphere. She was treated with high-dose pentobarbitone therapy when conventional treatment to control raised ICP had failed. A loading dose of pentobarbitone 400 mg (5 mg/kg) was followed by a continuous infusion of 1.0 to 2.5 mg/kg/hour. Withdrawal of the barbiturate after four days of therapy resulted in a rise in ICP above 20 mmHg which necessitated resumption of the drug. After an additional eight days of pentobarbitone therapy with normal ICP values the infusion was discontinued without any change in ICP. The patient made an excellent recovery with no neurologic deficit. The specific pathophysiologic features of pre-eclampsia which were encountered in the patient are detailed. The potential problems which may arise in the pre-eclamptic patient who requires intensive care in the puerperium are emphasised.
Subject(s)
Cerebrovascular Disorders/drug therapy , Pentobarbital/administration & dosage , Puerperal Disorders/drug therapy , Adult , Cerebrovascular Disorders/etiology , Female , Humans , Infusions, Parenteral , Intracranial Pressure/drug effects , Pre-Eclampsia/complications , Pre-Eclampsia/metabolism , PregnancyABSTRACT
The anaesthetic management of a patient with a coincidental giant lung bulla who underwent lumbar discectomy and laminectomy is described. The specific problems associated with anaesthesia in patients wih bullae, such as acute enlargement or rupture of the bullae, are discussed. Precautionary measures which may be taken during anaesthesia include the avoidance of nitrous oxide, the prophylactic use of a double-lumen tube, and the immediate availability of chest drains in the anaesthetizing area. Monitoring during operation may involve bilateral chest auscultation and arterial blood gas analysis.
Subject(s)
Anesthesia, General , Pulmonary Emphysema/pathology , Aged , Anesthesia, General/adverse effects , Humans , Intermittent Positive-Pressure Ventilation , Lung/pathology , Male , Preanesthetic MedicationABSTRACT
Five patients with blast injuries to the lungs after bomb explosions are reported. In each patient radiological changes were apparent on the initial chest film taken within 4 hours of the explosions. Arterial hypoxaemia was also present. Four patients were actively treated with continuous positive-pressure ventilation, which was adjudged effective therapy. Two patients died, one owing to bilateral pneumothorax which occurred during anaesthesia, and the other owing to overwhelming infection. Hypoxaemia persisted for 4 months in one of the survivors. Lung function tests which were performed on the same patient 10 monhts after the blast injuries, however, were normal.
Subject(s)
Blast Injuries/therapy , Lung Injury , Adult , Blast Injuries/diagnosis , Carbon Dioxide/blood , Female , Humans , Hypoxia/therapy , Lung/diagnostic imaging , Male , Oxygen/blood , Pneumothorax/etiology , Positive-Pressure Respiration/adverse effects , RadiographyABSTRACT
Hypertonus of masseter and chest wall muscle in one patient following intravenous suxamethonium is reported. Subsequent investigations including electromyography and muscle biopsy with in vitro pharmacological testing failed to reveal any abnormality to account for the response. The clinical problems presented to the anaesthetist when suxamethonium-induced hypertonus occurs are discussed. The relationship between a hypertonic reaction to suxamethonium and neuromuscular disease (including myotonic disorders and the malignant hyperpyrexia myopathy) is considered.
