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5 results

  • 29 - Abdominal Aortic Aneurysms

  • from Section 6 - Gastrointestinal Emergencies
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 270-278

  • Summary

    Abdominal aortic aneurysm (AAA) refers to aortic dilatations of > 3 cm. True AAA is a localized dilatation of the aorta caused by weakening of the aorta wall involving all three layers (intima, media and adventitia). False aneurysms or pseudoaneurysms typically occur at sites of vessel injury that allow blood to leak out from the arterial lumen while remaining enclosed by adventitia or surrounding soft tissue.

  • The devil is in the details: Factors influencing hand hygiene adherence and contamination with antibiotic-resistant organisms among healthcare providers in nursing facilities

  • John P. Mills, Ziwei Zhu, Julia Mantey, Savannah Hatt, Payal Patel, Keith S. Kaye, Kristen Gibson, Marco Cassone, Bonnie Lansing, Lona Mody
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 40 / Issue 12 / December 2019
    Published online by Cambridge University Press:
    24 October 2019, pp. 1394-1399
    Print publication:
    December 2019
  • Background:

    Antibiotic-resistant organism (ARO) colonization rates in skilled nursing facilities (NFs) are high; hand hygiene is crucial to interrupt transmission. We aimed to determine factors associated with hand hygiene adherence in NFs and to assess rates of ARO acquisition among healthcare personnel (HCP).

    Methods:

    HCP were observed during routine care at 6 NFs. We recorded hand hygiene adherence, glove use, activities, and time in room. HCP hands were cultured before and after patient care; patients and high-touch surfaces were cultured. HCP activities were categorized as high-versus low-risk for self-contamination. Multivariable regression was performed to identify predictors of hand hygiene adherence.

    Results:

    We recorded 385 HCP observations and paired them with cultures performed before and after patient care. Hand hygiene adherence occurred in 96 of 352 observations (27.3%) before patient care and 165 of 358 observations (46.1%) after patient care. Gloves were worn in 169 of 376 observations (44.9%). Higher adherence was associated with glove use before patient care (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.44–4.54) and after patient care (OR, 3.11; 95% CI, 1.77–5.48). Compared with nurses, certified nurse assistants had lower hand hygiene adherence (OR, 0.31; 95% CI, 0.15–0.67) before patient care and physical/occupational therapists (OR, 0.22; 95% CI, 0.11–0.44) after patient care. Hand hygiene varied by activity performed and time in the room. HCP hands were contaminated with AROs in 35 of 385 cultures of hands before patient care (0.9%) and 22 of 350 cultures of hands after patient care (6.3%).

    Conclusions:

    Hand hygiene adherence in NFs remain low; it is influenced by job title, type of care activity, and glove use. Hand hygiene programs should incorporate these unique care and staffing factors to reduce ARO transmission.

  • 36 - Abdominal aortic aneurysms

  • from Section 6 - Gastrointestinal emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 237-244

  • Summary

    This chapter talks about the management of post-cardiac arrest care. It discusses the special circumstances in which adequate hemodynamic stability cannot be achieved during post-cardiac arrest care. An immediate assessment of a patient after the return of spontaneous circulation should include a focused history (usually obtained from bystanders or emergency medical services personnel), physical examination, diagnostic testing, and imaging studies. The physical examination should follow the ABCs, checking the airway for appropriate endotracheal tube (ETT) placement, the presence of bilateral breath sounds, circulatory status and blood pressure, heart rate and rhythm, disability with neurological response and Glasgow coma scale, and exposure to fully expose the patient and complete the examination. The extent of brain injury and cardiovascular instability are the major determinants of mortality after cardiac arrest. Brain injury is responsible for mortality in 68% of out-of-hospital arrests and 23% of in-hospital arrests.