A Guideline-Based Policy to Decrease Intensive Care Unit Admission Rates for Accidental Hypothermia.

RATIONALE: Despite guidelines advising passive rewarming for mild accidental hypothermia (AH), patients are frequently admitted to intensive care unit (ICU) for active rewarming using a forced-air warming device. We implemented a new policy at our institution aimed at safely reducing ICU admissions for AH. We analyzed our practice pre- and post-policy intervention and compared our experiences with acute care hospitals in Connecticut. METHODS: A retrospective chart review was performed on 203 participants with AH identified by primary and secondary discharge codes. Our new policy recommended passive rewarming on the medical floors for mild hypothermia (>32°C) and ICU admission for moderate hypothermia (<32°C). Practices of other Connecticut hospitals were obtained by surveying ICU nurse managers and medical directors. RESULTS: Over a 3-year period, prior to rewarming policy change, 64% (n = 92) of patients with AH were admitted to ICU, with a mean ICU length of stay (LOS [SD]) of 2.75 (2.2) days. After the policy change, over a 3-year period, 15% (n = 9) were admitted to ICU (P < .001), with an ICU LOS of 2.11 (0.9) days (P = 0.005). In both groups with AH, altered mental status, infection, and acute alcohol intoxication were the most common diagnoses at presentation. Alcohol intoxication was more prevalent in the post-policy intervention group, pre 17% versus post 46% (P < .001). No complications such as dermal burns or cardiac arrhythmias were noted with forced-air warming device use during either time period. Among the 29 hospitals surveyed, 20 used active rewarming in ICU or intermediate care units and 9 cared for patients on telemetry units. Most hospitals used active external rewarming for core body temperature of <35°C; however, 37% of hospitals performed active rewarming at temperatures >35°Cor lacked a policy. CONCLUSIONS: Reserving forced-air warming devices for the treatment of moderate-to-severe hypothermia (<32°C) significantly reduced ICU admissions for AH.

A Case of Lung Adenocarcinoma Originating from an Old Posttraumatic Scar in a Young Patient.

A relationship between lung scarring and cancer has been recognized for many decades but more evidence is needed to strengthen this association. A 34-year-old nonsmoker male with a history of left lower lobe lung scar secondary to a pulmonary contusion from a motor vehicle accident in 2012 was admitted with shortness of breath and cough. A computed tomography (CT) angiography of the chest demonstrated bilateral pulmonary emboli, left lower lobe mass, left lung septal thickening, and mediastinal lymphadenopathy. A CT-guided biopsy of the mass was performed, and pathology was consistent with lung adenocarcinoma. Staging work-up revealed a widely metastatic disease. The patient developed severe complications requiring hospitalization after the first cycle of chemotherapy and subsequently passed away. Lung scar carcinoma originates around peripheral scars resulting from a variety of infections, injuries, and lung diseases. It has poor prognosis because it metastasizes from relatively small lesions. Our case further endorses that lung scarring can potentially lead to the development of cancer. Furthermore, we want to highlight the need to conduct studies to determine if monitoring this patient population with periodic imaging can have a survival benefit.