Spontaneous extraperitoneal lumbar artery hemorrhage

BACKGROUND

Spontaneous extraperitoneal hemorrhage (SEH) is an uncommon complication of anticoagulation therapy. Cases of SEH that are unresponsive to management through correction of coagulopathy, fluid resuscitation, blood transfusion, and other supportive measures are typically treated with surgery. Nevertheless, treatment of SEH with the use of angiography and arterial embolization may provide a safe, efficacious alternative to surgery.

OBJECTIVES

This case is presented to increase awareness among Emergency Physicians of the management options for patients with SEH.

CASE REPORT

A 67-year-old man presented to the Emergency Department with hemodynamic collapse due to retroperitoneal bleeding secondary to spontaneous rupture of a lumbar artery. An emergency abdominal angiogram revealed an actively bleeding left lumbar vessel. The localized bleeding was treated with catheter embolization and detachable microcoil embolization. This resulted in stabilization of the patient's condition without surgical intervention.

CONCLUSION

Overall, the improvement in hemodynamic stability and the decreased percentage of transfusion requirements can be achieved safely without surgical intervention through the prompt use of coil or catheter embolization.

Sleepiness in critical care nurses: results of a pilot study

BACKGROUND

Sleep deprivation, compounded by circadian disruptions, is a common problem in health care workers. Sleepiness in nurses has important implications for patients as well as nurses' own safety.

OBJECTIVE

The objective of the study was to assess comprehensively sleepiness levels in post-night-shift nurses.

METHODS

Post-night-shift nurses in the ICU and on general floors (medicine and surgery) were assessed using subjective (Epworth Sleepiness Scale [ESS]) and objective (Mean Sleep Latency Test [MSLT]) measures.

RESULTS

ESS was abnormal (>8) in 7 of 10 ICU nurses compared with 2 of 10 floor nurses (P < .005), and mean ESS score was also higher (8.7 +/- 3.9 vs. 5.6 +/- 2.1, respectively; P = 0.042). MSLT values for the first nap period were in the pathologic range in the ICU nurses compared with the floor nurses (4.65 +/- 5.5 vs. 10.85 +/- 7.4 minutes, respectively; P < .05).

CONCLUSIONS

Post-night-shift RNs working in the ICU have a pathologic degree of sleepiness.

Practice patterns of screening for sleep apnea in physicians treating PCOS patients

Women with polycystic ovarian syndrome (PCOS) have been shown to have a very high prevalence of obstructive sleep apnea (OSA). Screening for OSA is recommended for PCOS patients. How far this is carried out in actual practice is unknown. To study practice patterns with regard to screening for OSA in physicians-both obstetrician/gynecologists (ObGyn) and endocrinologist-who manage PCOS. A secondary aim of this study was to identify practice differences, if any. Two hundred ObGyn and 140 endocrine academic institutions were contacted and mailed with questionnaires, if willing to participate. Responses were obtained from 50 (29.4%) ObGyn physicians and 29 (26.4%) endocrine physicians. The questionnaire was closed-ended. Physicians reported a high occurrence of obesity-36.7% of the physicians reported that 75-100% of their patients had morbid obesity. However, reported prevalence of symptoms was low-86.1% of the physicians felt their patients snored infrequently (<25% of the time) and 74.7% felt that their patients had excess daytime sleepiness (EDS) infrequently. Of the physicians, 92.4% ordered a sleep study <25% of the time. No significant difference in practice between the specialties was identified. Physicians who manage PCOS patients do not believe that these patients have significant symptoms nor warrant frequent testing for OSA. This may reflect lack of knowledge about the link or may imply that PCOS patients remain largely asymptomatic. Educating specialist physicians managing PCOS about OSA and improved tools for OSA screening may improve detection.

Sleep disorders in the elderly

Sleep disorders are common but frequently underdiagnosed in the elderly. Aggressive screening and appropriate therapy can significantly improve general health and well-being. Treating sleep disorders in the elderly requires appreciation of the physiologic changes of aging. Insomnia is common and frequently secondary to modifiable factors. Nonpharmacologic and behavioral approaches are underused. Pharmacotherapy should be used cautiously and conservatively.

Sleepy nurses: are we willing to accept the challenge today?

With a shortage of supply of nurses and the increasing demand for nursing care, hospitals require or allow nurses to work extended shifts (in excess of 12 hours) and many shifts per week (up to and in excess of 60 hours per week). The result of these excessive hours of work is that many nurses care for patients while suffering from sleep deprivation. Sleep deprivation has been shown to negatively impact judgment and performance resulting in errors and accidents. Sleep deprivation also negatively affects the health of individuals. Sleep deprivation in nurses is a significant issue that requires more attention.

Sleepiness in medical residents: impact of mandated reduction in work hours

OBJECTIVES

To assess the sleepiness among Family Practice residents using subjective data, the Epworth sleepiness scale (ESS), as well as objective assessment, the multiple sleep latency test (MSLT).

METHOD

We conducted the study on Family Practice residents at Texas A&M University, Corpus Christi. Sixteen residents, aged 21-40 yrs, were recruited and divided into two groups. The study group was comprised of residents who were on night-float rotation for at least three days and underwent MSLT post-call, and the control group was comprised of residents who were not on night-float and were not post-call. Daytime sleepiness was evaluated using both the ESS and MSLT. Respondents also completed a questionnaire assessing their beliefs regarding effects of sleep loss.

RESULTS

Sleep latencies <10 min were observed in 6 out of the 8 day shift-work interns, while only 1 out of 8 night-float residents had an average sleep latency <10 min (p=0.0195). Following night-float, despite less sleep, residents had sleep latencies which were higher [14.2 (+/-5.0) min] than those in the control group [8.4 (+/-5.4) min, (p=0.043)]. Despite the difference in objective sleepiness, subjective sleepiness (Epworth scores) did not differ. Over 80% of interns reported having driven while sleepy.

CONCLUSION

Sleepiness continues to be a significant issue among medical residents despite recently mandated reductions in resident work hours. MSLT values in the pathologic range are seen in the majority of residents studied, but in those who were post-night call there seemed to be a paradoxical improvement.

Successful urokinase treatment of massive pulmonary embolism in pregnancy

BACKGROUND

Thrombolytic agents have been used successfully to treat patients with massive pulmonary embolism and cardiorespiratory insufficiency, but experience with these drugs in pregnancy is limited.

CASE

A 20-year-old woman at 21 weeks' gestation was admitted with a massive pulmonary embolism. She was initially given intravenous heparin therapy but because of worsening clinical condition, urokinase was used. After two 12-hour periods of therapy, the urokinase was discontinued and the heparin restarted. She remained on subcutaneous heparin therapy for the remainder of her pregnancy, which was otherwise uncomplicated. She delivered a healthy male infant at term without complications and was discharged on warfarin therapy.

CONCLUSION

Thrombolytic therapy can be life-saving and should be considered in the treatment of hemodynamically significant pulmonary embolism in pregnancy.