RESUMEN
An 18-year-old, previously healthy man admitted with abdominal pain, high-grade fevers, nausea and emesis was found to have multiple hepatic abscesses. Aspiration cultures grew Fusobacterium necrophorum, a rare bacterium causing potentially fatal liver abscesses in humans. Following sequential percutaneous drainages and narrowing of antibiotics, the patient was discharged on a 6-week antibiotic course and showed no signs of infection. A week after presentation it was discovered that he had experienced upper respiratory symptoms and sore throat prior to presentation. Because oropharyngeal infections are a potential source of bacteremia, they must be considered in the differential diagnosis of patients presenting with hepatic abscesses and no evidence of immunocompromise.
Asunto(s)
Cardiopatías/etiología , Traumatismos Torácicos/complicaciones , Trombosis/etiología , Vena Cava Inferior/lesiones , Heridas por Arma de Fuego/complicaciones , Adolescente , Anticoagulantes/uso terapéutico , Reposo en Cama , Femenino , Escala de Coma de Glasgow , Cardiopatías/diagnóstico , Cardiopatías/terapia , Hematócrito , Heparina/uso terapéutico , Humanos , Laparotomía , Tiempo de Tromboplastina Parcial , Flebografía , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/terapia , Trombosis/diagnóstico , Trombosis/terapia , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/terapiaRESUMEN
PURPOSE: To define the extent and nature of the End-of-Life (EOL) decision-making process in critically ill patients. MATERIALS AND METHODS: Retrospective review of all deaths in adult medical and surgical intensive care units of a tertiary care hospital over a one-year period. RESULTS: There were sixty-one deaths in the study period. The mean age was 68 years, and 30 patients (49%) were female. Nearly one-third of patients had advance directives: eight patients presented advance directives on hospital admission, and 10 families produced advance directives at EOL. Seventy-six percent were admitted to the ICU as Code I (full care) and 24% were Code II (selective modification of care). At EOL, 10 patients were Code I, 14 were Code II, and 38 were transitioned to Code III (comfort care only). In the Code III population, the change in code status was initiated by the family in 12 cases. CONCLUSIONS: In a substantial number of instances transitioned to comfort care at EOL, the family initiated the code-status change. Interestingly, in several cases the family initially withheld advance directives. Critically ill patients and their families are assuming an active role in EOL care.
Asunto(s)
Cuidados Críticos , Cuidado Terminal , Anciano , Toma de Decisiones , Familia , Femenino , Humanos , Masculino , Planificación de Atención al Paciente , Estudios RetrospectivosRESUMEN
Traumatic fistula involving the renal artery and IVC is a rare event, and typically is a result of penetrating injury. A case of right renal artery to IVC fistula following a gunshot wound to the abdomen is reported, and illustrates the significant hemodynamic changes that accompany these fistulae. We also emphasize the importance of thorough initial exploration of retroperitoneal hematomas following penetrating trauma, and review management options in the treatment of renal arteriovenous fistulae.
