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Chang H, Silva M, Giner A, Diaz Y, Sosa MA, Knudsen G, Mahavadi AK, Ellis J, Cameron A, Núñez CAQ, Wynter MA, O'Phelan K, Komotar RJ, Cajigas I. Ventriculostomy supply cart decreases time-to-external ventricular drain placement in the emergency department. Surg Neurol Int 2021; 12:362. [PMID: 34350056 PMCID: PMC8330128 DOI: 10.25259/sni_371_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Minimizing time-to-external ventricular drain (EVD) placement in the emergency department (ED) is critical. We sought to understand factors affecting time-to-EVD placement through a quality improvement initiative. Methods: The use of process mapping, root cause analyses, and interviews with staff revealed decentralized supply storage as a major contributor to delays in EVD placement. We developed an EVD “crash cart” as a potential solution to this problem. Time-to-EVD placement was tracked prospectively using time stamps in the electronic medical record (EMR); precart control patients were reviewed retrospectively. Results: The final cohorts consisted of 33 precart and 18 postcart cases. The mean time-to-EVD in the precart group was 99.09 min compared to 71.88 min in the postcart group (two-tailed t-test, P = 0.023). Median time-to-EVD was 92 min in the precart group compared to 64 min in the postcart group (rank sum test, P = 0.0165). Postcart patients trended toward improved outcomes with lower modified Rankin score scores at 1 year, but this did not reach statistical significance (two-tailed t-test, P = 0.177). Conclusion: An EVD “crash cart” is a simple intervention that can significantly reduce time-to-EVD placement and may improve outcomes in patients requiring an EVD.
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Affiliation(s)
- Henry Chang
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Michael Silva
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alexander Giner
- Department of Emergency, Jackson Memorial Hospital, Miami, Florida, United States
| | - Yvonne Diaz
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Marie Ann Sosa
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Grace Knudsen
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Anil K Mahavadi
- Department of Neurosurgery, University of Alabama Birmingham School of Medicine, Birmingham, Alabama, United States
| | - June Ellis
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Arlene Cameron
- Department of Orthopedic, Division of Neurology and Surgery, Jackson Memorial Hospital, Miami, Florida, United States
| | | | - Millicent A Wynter
- Department of Nursing Education, Jackson Memorial Hospital, Miami, Florida, United States
| | - Kristine O'Phelan
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Iahn Cajigas
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
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Esteban Garcia JM, Mato Mañas D, Marco De Lucas E, Garcia Catalan G, Lopez Gomez P, Santos Jimenez C, Laez RM. Invisible compression, anterior fossa tumor causing trigeminal neuralgia. Surg Neurol Int 2021; 12:106. [PMID: 33880211 PMCID: PMC8053474 DOI: 10.25259/sni_371_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 02/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Trigeminal neuralgia secondary to posterior and middle fossae tumors, whether ipsilateral or contralateral, has been well described. However, this disabling disease has never been reported in the context of anterior fossa neoplasms. Case Description: A 75-year-old female with right hemifacial pain was diagnosed with an anterior clinoid meningioma. Despite neuroimaging did not show any apparent anatomical or neurovascular conflict, a detailed MRI analysis revealed a V3 hyperintensity. Not only symptoms completely resolved after surgical resection but also this radiological sign disappeared. Nowadays, the patient remains asymptomatic and V3 hyperintensity has not reappeared during her follow-up. Conclusion: A surgical definitive treatment can be offered to patients suffering from trigeminal neuralgia secondary to lesions adjacent to Gasserian ganglion or trigeminal branches. In this respect, posterior and middle fossae tumors are well-reported etiologies. Nevertheless, in the absence of evident compression, other neoplasms located in the vicinity of these critical structures and considered as radiological findings may be involved in trigeminal pain. Microvascular and pressure gradient changes could be an underlying cause of these symptoms in anterior skull base lesions. Here, we report the case of a patient with uncontrollable hemifacial pain resolved after anterior clinoid meningioma removal.
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Affiliation(s)
| | - David Mato Mañas
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Enrique Marco De Lucas
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Guillermo Garcia Catalan
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Patricia Lopez Gomez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Carlos Santos Jimenez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Ruben Martin Laez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Silva VFD, Lazzari DD, Reisdorfer N, Michaelsen SC, Kuhnen AE. Analyzing the operational conditions of crash carts in clinical and surgical hospitalization units. Rev Esc Enferm USP 2021; 55:e03693. [PMID: 33886918 DOI: 10.1590/s1980-220x2019040003693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the operational conditions of crash carts in all clinical and surgical hospitalization units of public hospitals in a region in Southern Brazil. METHOD Quantitative, cross-sectional study to evaluate crash carts in adult clinical and surgical hospitalization units. The data were collected through a checklist containing 16 continuous variables. RESULTS Nineteen crash carts in nineteen units were evaluated. Analysis shows that the most frequent problems were excess of equipment and its lack of organization, medication in incorrect compartments and/or with no identification, and inappropriate environment for transportation. CONCLUSION The most relevant factors that possibly interfere with the operational conditions of crash carts are directly related to the organization and management of material resources, which may lead to the reduction of its functionality during patient care. Such problem may be solved by readjusting items and performing frequent verification.
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Affiliation(s)
| | | | - Nara Reisdorfer
- Hospital Regional Dr. Homero de Miranda Gomes, Florianópolis, SC, Brazil
| | | | - Adriana Eich Kuhnen
- Hospital Universitário Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
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López-Herce Cid J, Rodríguez Núñez A, Carrillo Álvarez Á, Zeballos Sarrato G, Martínez Fernández-Llamazares C, Calvo Macías C. Materials for the paediatric resuscitation trolley or backpack: Expert recommendations. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Jacquet GA, Hamade B, Diab KA, Sawaya R, Dagher GA, Hitti E, Bayram JD. The Emergency Department Crash Cart: A systematic review and suggested contents. World J Emerg Med 2018; 9:93-98. [PMID: 29576820 DOI: 10.5847/wjem.j.1920-8642.2018.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specifically discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients. METHODS The authors performed a systematic review of EDCC-specific literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council (ERC) guidelines for resuscitation, and the 2013 American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS) 9th edition. RESULTS There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the final four articles specific to EDCC, and proposes a set of suggested contents for the EDCC. CONCLUSION Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.
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Affiliation(s)
- Gabrielle A Jacquet
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Bachar Hamade
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karim A Diab
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - Rasha Sawaya
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamil D Bayram
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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López-Herce Cid J, Rodríguez Núñez A, Carrillo Álvarez Á, Zeballos Sarrato G, Martínez Fernández-Llamazares C, Calvo Macías C. [Materials for the paediatric resuscitation trolley or backpack: Expert recommendations]. An Pediatr (Barc) 2017; 88:173.e1-173.e7. [PMID: 28688610 DOI: 10.1016/j.anpedi.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 11/25/2022] Open
Abstract
Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR.
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Affiliation(s)
- Jesús López-Herce Cid
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Facultad de Medicina. Universidad Complutense de Madrid. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022.
| | - Antonio Rodríguez Núñez
- Área de Pediatría, Servicio de Críticos, Intermedios y Urgencias Pediátricas. Hospital Clínico Universitario de Santiago de Compostela. Departamento de Radiología, Psiquiatría, Salud Pública, Enfermería y Medicina de la Universidad de Santiago de Compostela (USC). Grupos de Investigación CLINURSID (USC) y Soporte Vital y Simulación (Instituto de Investigación de Santiago). Instituto de Investigación de Santiago (IDIS). Red de Salud Maternoinfantil (SAMID II). RETICS financiada por el PN 2018-2011, el ISCIII- Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) ref: RD16/0022
| | - Ángel Carrillo Álvarez
- Servicio de Cuidados Intensivos Pediátricos. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Facultad de Medicina. Universidad Complutense de Madrid. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022
| | - Gonzalo Zeballos Sarrato
- Servicio de Neonatología. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
| | - Cecilia Martínez Fernández-Llamazares
- Servicio de Farmacia. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022
| | - Custodio Calvo Macías
- Emérito SAS. Asociado a UGC Críticos y Urgencias Pediátricas. Hospital Regional Universitario de Málaga. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
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Rodríguez-Núñez A, López-Herce Cid J, Calvo-Macías C, Carrillo-Alvarez A. Do we need guidelines for pediatric resuscitation carts/trolleys/backpacks content and management? Resuscitation 2017; 114:e19-e20. [PMID: 28263790 DOI: 10.1016/j.resuscitation.2017.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Rodríguez-Núñez
- Spanish Pediatric and Neonatal Resuscitation Working Group, Spanish Resuscitation Council, Spain; SAMID-II Network, Madrid, Spain; CLINURSID Research Group, School of Nursing, University of Santiago de Compostela, and Life Support and Simulation Research Group, Institute of Research of Santiago (IDIS), Santiago de Compostela, Spain; Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela, Spain.
| | - Jesús López-Herce Cid
- Spanish Pediatric and Neonatal Resuscitation Working Group, Spanish Resuscitation Council, Spain; SAMID-II Network, Madrid, Spain; Institute of Investigation, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Pediatric Critical Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain
| | - Custodio Calvo-Macías
- Spanish Pediatric and Neonatal Resuscitation Working Group, Spanish Resuscitation Council, Spain; Andalusian Public Health System (SAS), Spain
| | - Angel Carrillo-Alvarez
- Spanish Pediatric and Neonatal Resuscitation Working Group, Spanish Resuscitation Council, Spain; SAMID-II Network, Madrid, Spain; Institute of Investigation, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Pediatric Critical Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain
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