Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit.

OBJECTIVE: The objective of the study was to use an ultrasound-based numerical scoring system for assessment of intravascular fluid estimate (SAFE) and test its validity. METHODS: A prospective, observational study was carried out in the surgical intensive care unit (ICU) of an urban tertiary care teaching hospital. Patient's intravascular volume status was assessed using the standard methods of heart rate, blood pressure, central venous pressure, cardiac output, lactate and saturation of venous oxygen, and others. This was compared with assessment using bedside ultrasound evaluation of the cardiac function, inferior vena cava, lungs, and the internal jugular vein. Applying a numerical scoring system was evaluated by Fisher's exact testing and multinomial logistic model to predict the volume status based on ultrasound scores and the classification accuracy. RESULTS: 61 patients in the ICU were evaluated. 21 (34.4% of total) patients diagnosed with hypovolemia, and their ultrasound volume score was -4 in 14 (66.7%) patients, -3 in 5 (23.8%) patients, and 0 in 2 (9.5%) patients (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and -1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and -1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and -1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and -1 in 1 (5.6%) patient (. CONCLUSION: Using the SAFE scoring system to identify the IVV status in critically ill patients significantly correlates with the standard measures. A SAFE score of -4 to -2 more likely represents hypovolemia, -1 to +1 more likely represents euvolemia, and +2 to +4 more likely to be hypervolemia.

A hospital-based violence prevention tour: a collaborative approach to empower youth.

BACKGROUND: Youth violence is a significant problem in the United States with high recidivism rates. Considering these high recidivism rates in youths after an initial injury, we hypothesized a hospital-based violence prevention program aimed at increasing awareness, empowering positive conflict resolution, and promoting future vocational goals would benefit at-risk youth before they are injured. METHODS: A feasibility study was completed on our Violence and Injury Prevention (VIP) tour program at our urban Level I trauma center. Participants were at-risk youth, aged 11 years to 17 years. Anonymous data were collected using an Audience Response System. RESULTS: One hundred eighty-five students participated from January 2007 to August 2008. Sixty-three percent were 6th to 8th graders, 70% were boys. Seventy-nine percent stated that they knew someone who had been injured or killed because of violence, with significantly more boys than girls (p = 0.05). More boys than girls stated that they have access to a gun (p < 0.05). Almost 60% of the participants stated that they had engaged in violence within the past 6 months, with no difference by gender (p = 0.085). Of the respondents, 84.2% reported an increase in their awareness on the consequences of violence. This was more significant for girls than boys (p < 0.05). Of the participants, 86.3% reported increased understanding of hospital care for a trauma patient. Participants stated that they would recommend VIP to others. CONCLUSION: VIP educated local urban youth about violence and increased their awareness of the injuries resulting from violence. In addition, at-risk youths were exposed to career opportunities in health care.

Propofol infusion syndrome.

Propofol (Diprivan) is an intravenous sedative hypnotic that is used in the induction and maintenance of anesthesia and sedation. High-dose infusions have been associated with several serious adverse effects and, when combined, they are known as propofol infusion syndrome (PRIS). Although PRIS is rare, it is frequently fatal if not identified early. The purpose of this article is to raise practitioner awareness to this syndrome, with recommendations for early identification, prevention, and treatment of PRIS.