The prognostic value of initial serum lactate for survival in postcardiac arrest patients undergoing cardiac catheterization.

OBJECTIVES: We sought to investigate the prognostic value of serum lactate on survival in patients postcardiac arrest. BACKGROUND: Patients who experience cardiac arrest, in- or out-of-hospital, may have a poor outcome. Initial electrocardiograms may suggest ischemia as an underlying cause and urgent referral for catheterization occurs. It remains unclear which of these patients may suffer a poor outcome. METHODS: We retrospectively reviewed all patients at our institution taken for urgent catheterization after cardiac arrest between January 2014 and September 2018. Three hundred and eighty four patients were referred urgently to the cath lab during this period, 50 with prior arrest. RESULTS: Sixty six percent underwent coronary intervention. The mean age of the entire cohort was 57 years. Thirty four percent were female, 40% had a history of coronary artery disease, and 94% were intubated at the time of cardiac catheterization. Overall survival to discharge was 40%. Survival in patients who underwent coronary intervention compared with those who did not was similar (45.5 vs. 29.4%, p = .27). Mean lactate level in survivors versus nonsurvivors was 4.7 ± 3.8 and 9.8 ± 4.7 mmol/L, respectively (p < .05). When divided into tertiles by serum lactate (< 4.5, 4.5-9, 9 mmol/L), survival to discharge was 75, 29.4, and 17.6%, respectively (p < .05). Initial serum lactate and age were independent predictors of in-hospital mortality. CONCLUSIONS: In patients undergoing cardiac catheterization following cardiac arrest, routine measurement of serum lactate is a useful and available laboratory test that may help identify patients at risk for a poor outcome.

Takotsubo cardiomyopathy in a patient with ileus: a case report.

BACKGROUND: Takotsubo cardiomyopathy (TCM) is a form of stress-induced cardiomyopathy featured by the dilatation of the apex of the left ventricle during systole. Whereas the pathogenesis of this disorder is not well understood, it usually occurs after an emotional or physical stress such as acute asthma, surgery, chemotherapy, and stroke. However, its occurrence in ileus patients is rarely reported. We hereby report probably the first case of TCM after ileus in the literature and discuss its implications. CASE PRESENTATION: An 85-year-old man was brought to the Emergency Department due to vomiting, abdominal pain, and no stool passages for 2 days. His abdomen was markedly distended, and ileus pattern was observed in the plain film of abdomen. Electrocardiogram showed right axis deviation, poor R-wave progression, and diffuse ST-segment elevation in the anterior leads, and cardiomegaly was observed by roentgenogram. A ventriculography showed an ejection fraction of 33% and confirmed the apical dilation consistent with TCM. He was treated with medication and discharged without remarkable adverse events. A follow-up transthoracic echocardiogram 4 months later showed normalization of his left ventricular systolic functions. CONCLUSION: The precise mechanisms of the development of TCM are still unknown, but it is widely believed that it is triggered by the catecholamine surge produced in response to stress. This case demonstrated that such a stress can be of various forms, including ileus and other conditions that may lead to severe abdominal pain, and highlight the importance of awareness in diagnosing this rare but potentially lethal condition.

Data mining nursing care plans of end-of-life patients: a study to improve healthcare decision making.

PURPOSE: To reveal hidden patterns and knowledge present in nursing care information documented with standardized nursing terminologies on end-of-life (EOL) hospitalized patients. METHOD: 596 episodes of care that included pain as a problem on a patient's care plan were examined using statistical and data mining tools. The data were extracted from the Hands-On Automated Nursing Data System database of nursing care plan episodes (n = 40,747) coded with NANDA-I, Nursing Outcomes Classification, and Nursing Intervention Classification (NNN) terminologies. System episode data (episode = care plans updated at every hand-off on a patient while staying on a hospital unit) had been previously gathered in eight units located in four different healthcare facilities (total episodes = 40,747; EOL episodes = 1,425) over 2 years and anonymized prior to this analyses. RESULTS: Results show multiple discoveries, including EOL patients with hospital stays (<72 hr) are less likely (p < .005) to meet the pain relief goals compared with EOL patients with longer hospital stays. CONCLUSIONS: The study demonstrates some major benefits of systematically integrating NNN into electronic health records.

Studies on spinal ascending pathway for effect of acupuncture analgesia in rabbits.

The effect of acupuncture needling in hindlimb points on the threshold of pain arising from the radiant heat applied to the snout of the rabbit has been evaluated both before and after various surgical lesions produced in the spinal cord. Section of the dorsal column alone at the level of T12-L1 could not produce any detectable change either of the pain threshold or of the effect of acupuncture on the pain threshold. Nor could the superficial lateral cordotomy seriously affect the analgesic effect of acupuncture. However, a lesion placed in the ventral two thirds of the lateral funiculus on the contralateral side could abolish almost completely this effect.