scholarly journals Patients With Traumatic Brain Injury Transported by Critical Care Air Transport Teams: The Influence of Altitude and Oxygenation during Transport

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1646-e1653
Author(s):  
Joseph K Maddry ◽  
Allyson A Araña ◽  
Lauren K Reeves ◽  
Alejandra G Mora ◽  
Xandria E Gutierrez ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Outcomes ◽  
Brain Injuries ◽  
Injury Severity ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Air Transport ◽  
Discharge Disposition ◽  
Regional Medical ◽  
Regional Medical Center

ABSTRACT Introduction Traumatic brain injuries (TBIs) are life-threatening, and air transport of patients with TBI requires additional considerations. To mitigate the risks of complications associated with altitude, some patients fly with a cabin altitude restriction (CAR) to limit the altitude at which an aircraft’s cabin is maintained. The goal of this study was to examine the effects of CARs on patients with TBI transported out of theater via Critical Care Air Transport Teams. Materials and Methods We conducted a retrospective chart review of patients with moderate-to-severe TBI evacuated out of combat theater to Landstuhl Regional Medical Center via Critical Care Air Transport Teams. We collected demographics, flight and injury information, procedures, oxygenation, and outcomes (discharge disposition and hospital/ICU/ventilator days). We categorized patients as having a CAR if they had a documented CAR or maximum cabin altitude of 5,000 feet or lower in their Critical Care Air Transport Teams record. We calculated descriptive statistics and constructed regression models to evaluate the association between CAR and clinical outcomes. Results We reviewed the charts of 435 patients, 31% of which had a documented CAR. Nineteen percent of the sample had a PaO2 lower than 80 mm Hg, and 3% of patients experienced a SpO2 lower than 93% while in flight. When comparing preflight and in-flight events, we found that the percentage of patients who had a SpO2 of 93% or lower increased for the No CAR group, whereas the CAR group did not experience a significant change. However, flying without a CAR was not associated with discharge disposition, mortality, or hospital/ICU/ventilator days. Further, having a CAR was not associated with these outcomes after adjusting for additional flights, injury severity, injury type, or preflight head surgery. Conclusions Patients with TBI who flew with a CAR did not differ in clinical outcomes from those without a CAR.

Critical care at Landstuhl Regional Medical Center

2008 ◽  
Vol 36 (Suppl) ◽  
pp. S383-S387 ◽  
Author(s):  
Raymond Fang ◽  
Valerie M. Pruitt ◽  
Gina R. Dorlac ◽  
Stephen V. Silvey ◽  
Erik C. Osborn ◽  
...  
Keyword(s):  
Critical Care ◽  
Medical Center ◽  
Regional Medical ◽  
Regional Medical Center

scholarly journals Impact of Critical Care Consultation Requests for Avoidable Central Venous Catheters on Medical-Surgical Units

2020 ◽  
Vol 41 (S1) ◽  
pp. s258-s258
Author(s):  
Madhuri Tirumandas ◽  
Theresa Madaline ◽  
Gregory David Weston ◽  
Ruchika Jain ◽  
Jamie Figueredo
Keyword(s):  
Critical Care ◽  
High Risk ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
High Risk Population ◽  
Central Venous

Background: Although central-line–associated bloodstream infections (CLABSI) in US hospitals have improved in the last decade, ~30,100 CLABSIs occur annually.1,2 Central venous catheters (CVC) carry a high risk of infections and should be limited to appropriate clinical indications.6,7 Montefiore Medical Center, a large, urban, academic medical center in the Bronx, serves a high-risk population with multiple comobidities.8–11 Despite this, the critical care medicine (CCM) team is often consulted to place a CVC when a peripheral intravenous line (PIV) cannot be obtained by nurses or primary providers. We evaluated the volume of CCM consultation requests for avoidable CVCs and related CLABSIs. Methods: Retrospective chart review was performed for patients with CCM consultation requests for CVC placement between July and October 2019. The indication for CVC, type of catheter inserted or recommended, and NHSN data were used to identify CLABSIs. CVCs were considered avoidable if a PIV was used for the stated indication and duration of therapy, with no anatomical contraindications to PIV in nonemergencies, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).6Results: Of 229 total CCM consults, 4 (18%) requests were for CVC placement; 21 consultations (9%) were requested for avoidable CVCs. Of 40 CVC requests, 18 (45%) resulted in CVC placement by the CCM team, 4 (10%) were deferred for nonurgent PICC by interventional radiology, and 18 (45%) were deferred in favor of PIV or no IV. Indications for CVC insertion included emergent chemotherapy (n = 8, 44%) and dialysis (n = 3, 16%), vasopressors (n = 3, 16%), antibiotics (n = 2, 11%) and blood transfusion (n = 2, 11%). Of 18 CVCs, 9 (50%) were potentially avoidable: 2 short-term antibiotics and rest for nonemergent indications; 2 blood transfusions, 1 dialysis, 2 chemotherapy and 2 vasopressors. Between July and October 2019, 6 CLABSIs occurred in CVCs placed by the CCM team; in 3 of 6 CLABSI events (50%), the CVC was avoidable. Conclusions: More than half of consultation requests to the CCM team for CVCs are avoidable, and they disproportionately contribute to CLABSI events. Alternatives for intravenous access could potentially avoid 9% of CCM consultations and 50% of CLABSIs in CCM-inserted CVCs on medical-surgical wards.Funding: NoneDisclosures: None

Rewards and Challenges of Nursing Wounded Warriors at Landstuhl Regional Medical Center, Germany

2010 ◽  
Vol 45 (2) ◽  
pp. 205-218 ◽  
Author(s):  
Nancy M. Steele ◽  
Ann Kobiela Ketz ◽  
Kathleen D. Martin ◽  
Dawn M. Garcia ◽  
Shannon Womble ◽  
...  
Keyword(s):  
Medical Center ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Wounded Warriors

scholarly journals An Examination of Individualism within Employee Help-Seeking Networks

2018 ◽  
Vol 8 (4) ◽  
pp. 1
Author(s):  
Randall P. Settoon ◽  
Sang H. Lee
Keyword(s):  
Help Seeking ◽  
Medical Center ◽  
Future Research ◽  
Dense Networks ◽  
Helping Others ◽  
Regional Medical ◽  
Regional Medical Center ◽  
The Impact ◽  
The Relationship

Prior research focusing on the impact of individualistic orientations on the performance of cooperative behaviors has produced mixed results. Researchers have concluded that the self-focused orientation of individualists will lead them to be less cooperative than others. On the other hand, some scholars have argued that helping others is core to individualists’ self-concept and that competently assuming the role of help-giver is a source of intrinsic satisfaction. In this study, we test this proposition by examining individualistic orientations within employee help-seeking networks. Results from a sample of 107 employees within a regional medical center indicate that the level of individualism in helping-seeking networks is positively associated with help-seekers’ perceptions of support. Further, the results suggest that the relationship is stronger in dense networks. Implications of this work and directions for future research are discussed.

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