Experiences of Emergency Surgical Treatment for a COVID-19 Patient with Severe Traumatic Brain Injury at a Regional Trauma Center: A Case Report

Various medical scenarios have arisen with the prolonged coronavirus disease 2019 (COVID-19) pandemic. In particular, the increasing number of asymptomatic COVID-19 patients has prompted reports of emergency surgical experiences with these patients at regional trauma centers. In this report, we describe an example. A 25-yearold male was admitted to the emergency room after a traffic accident. The patient presented with stuporous mentality, and his vital signs were in the normal range. Lacerations were observed in the left eyebrow area and preauricular area, with hemotympanum in the right ear. Brain computed tomography showed a contusional hemorrhage in the right frontal area and an epidural hematoma in the right temporal area with a compound, comminuted fracture and depressed skull bone. Surgical treatment was planned, and the patient was intubated to prepare for surgery. A blood transfusion was prepared, and a central venous catheter was secured. The initial COVID-19 test administered upon presentation to the emergency room had a positive result, and a confirmatory polymerase chain reaction (PCR) test was administered. The PCR test confirmed a positive result. Emergency surgical treatment was performed because the patient’s consciousness gradually deteriorated. The risk of infection was high due to the open and unclean wounds in the skull and brain. We prepared and divided the COVID-19 surgical team, including the patient’s transportation team, anesthesia team, and surgical preparation team, for successful surgery without any transmission or morbidity. The patient recovered consciousness after the operation, received close monitoring, and did not show any deterioration due to COVID-19.

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Intracranial entrapment of a haemodialysis catheter guidewire

BMJ Case Reports ◽

10.1136/bcr-2019-232535 ◽

2020 ◽

Vol 13 (8) ◽

pp. e232535

Author(s):

Natasha Hemicke Langer ◽

Lars Hein ◽

Morten Heiberg Bestle

Keyword(s):

Vital Signs ◽

Jugular Foramen ◽

Seldinger Technique ◽

Chronic Obstructive ◽

Close Monitoring ◽

Obstructive Pulmonary Disease ◽

Haemodialysis Catheter ◽

The Wire ◽

Introducer Needle ◽

The Right

A 49-year-old man with chronic obstructive pulmonary disease was hospitalised due to pneumonia and pulmonary embolisms. After subsequently developing septic shock and acute renal failure, he required dialysis. A haemodialysis catheter was planned inserted into the right subclavian vein, the guidewire was introduced using the Seldinger technique. When the guidewire’s 20 cm marker entered the introducer needle, it suddenly encountered resistance. Repeated attempts to remove the guidewire failed. Vital signs and haemodynamic parameters remained unchanged throughout the procedure. CT angiography revealed cranial displacement of the wire into the right internal jugular vein, with the tip of the wire just cranial to the jugular foramen in the right sigmoid sinus. Interventional radiological removal attempts were unsuccessful. Thoracic and neurosurgical interventions were considered impossible and the guidewire was left in place. Due to the pulmonary embolism and the foreign object in the patient, life-long anticoagulation was considered, with close monitoring of compliance with the patient’s comorbidity and medication.

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Tisagenlecleucel Manufacturing Feasibility in Patients Less Than 3 Years of Age with Relapsed/Refractory Acute Lymphoblastic Leukemia

Blood ◽

10.1182/blood-2019-127346 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5066-5066 ◽

Cited By ~ 1

Author(s):

Lamis K. Eldjerou ◽

Christopher Acker ◽

Damien Howick ◽

Lee Clough ◽

Miriam Fuchs ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Vital Signs ◽

Venous Catheter ◽

Outcome Data ◽

Close Monitoring ◽

Acceptance Criteria ◽

T Cell Therapy ◽

Cell Counts ◽

Low Weight

The first and second authors contributed equally to this publication. Background: Tisagenlecleucel is a CD19-directed autologous chimeric antigen receptor (CAR)-T cell therapy approved for the treatment of patients (pts) up to 25 years of age with B-cell acute lymphoblastic leukemia (ALL) that is refractory or in ≥ 2nd relapse. However, pts < 3 years of age at screening were excluded from tisagenlecleucel clinical trials in relapsed/refractory (r/r) ALL (NCT02435849 [registrational ELIANA] and NCT02228096 [ENSIGN]). Here we present tisagenlecleucel manufacturing experience in pts < 3 years of age with r/r ALL in the commercial setting since regulatory approval. Methods: Eligible pts were < 3 years of age at time of the request for commercial tisagenlecleucel, with manufacturing data after August 30, 2017 (first FDA approval of tisagenlecleucel). Tisagenlecleucel was manufactured at Morris Plains, NJ, USA. Patient leukapheresis and manufacturing outcome data are presented for all patients and stratified by weight (< 10 kg and ≥ 10 kg). Results: Among 31 pts, the median age was 15 months (range, 3-35) and median body weight 10.2 kg (range, 6.0-15.6) at leukapheresis (14 pts < 10 kg and 17 pts ≥ 10 kg). Thirty-three leukaphereses were performed in 31 pts (Table 1; 2 pts underwent repeat leukapheresis for second manufacturing attempt), with a median of 1 leukapheresis day required to meet adequate cell counts (range, 1-6; Table 2). The acceptance criteria for tisagenlecleucel manufacture (total nucleated cells [TNC], CD3+ cells, CD3+% of TNC) were met in 29/33 leukapheresis materials; 2/3 that did not meet acceptance criteria were unsuccessful. Following the first manufacturing attempt in 30 pts (1 pt has not yet started manufacture), 26/30 (86.7%) were successful and 4/30 experienced manufacturing failure (2 pts < 10 kg and 2 pts ≥ 10 kg). Manufacturing success is defined as formulation of a final product (FP) within approved release specifications. Of the 4 manufacturing failures, 2 successfully underwent repeat leukapheresis and remanufacturing on second attempt and 2 did not undergo a second attempt. For 2 of the 4 manufacturing failures, the leukapheresis material did not meet acceptance criteria (pts were unable to undergo additional days of leukapheresis). The median manufactured cell dose in FP was 4.0x106 CAR+ viable T cells/kg (range, 0.37x106 -4.0x106), median % cell viability was 87.6% (range, 66.7%-95.7%), and median CAR+% expression was 10% (range, 2.7%-25.6%). Based on interaction with site personnel, measures to optimize leukapheresis in young pts with low weight, particularly < 10 kg, appeared to be essential, including raising hematocrit to 40% with blood transfusion, appropriate size central venous catheter, blood prime of the apheresis instrument, prevention of hypothermia during collection, close monitoring of vital signs and electrolytes, partial rinse back, and allowing > 1 day of leukapheresis to meet acceptance criteria. Conclusions: Leukapheresis and tisagenlecleucel manufacturing in pts with r/r ALL < 3 years of age and low weight (as low as 6 kg and as young as 3 months) are feasible and do not present manufacturability risk compared to Novartis clinical trial experience in patients ≥ 3 years of age. Table Disclosures Eldjerou: Novartis Pharmaceuticals Corporation: Employment. Acker:Novartis: Employment. Howick:Novartis: Employment. Clough:Novartis: Employment. Fuchs:Novartis: Employment. Salmon:Novartis: Employment. Willert:Novartis: Employment. Tiwari:Novartis: Employment. Pujols:Novartis: Employment. Robson:Novartis: Employment.

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UPAYA PENINGKATAN KINERJA PERAWAT GAWAT DARURAT MELALUI BERBAGAI GAYA KEPEMIMPINAN DI RSUD DAERAH ISTIMEWA YOGYAKARTA

Media Ilmu Kesehatan ◽

10.30989/mik.v6i3.248 ◽

2017 ◽

Vol 6 (3) ◽

pp. 186-194

Author(s):

Deby Zulkarnain Rahadian Syah ◽

Muhamat Nofiyanto

Keyword(s):

Emergency Room ◽

Leadership Style ◽

Quantitative Research ◽

Secondary Data ◽

Cross Sectional ◽

Organizational Goals ◽

Democratic Leadership ◽

The Right ◽

Research Type ◽

Special Region

Background: Nurses in charge of the Emergency Room are required to have more ability than nurses serving patients in other units. Emergency Room is an initial service in a hospital. One's leadership style will greatly affect the effectiveness of a leader. The selection of the right leadership style can lead to the achievement of individual or organizational goals. Objective: To know the various leadership style used by the head of room in improving the performance of nurses of Emergency Room RSUD in in Special Region of Yogyakarta. Method: This research includes quantitative research type, using cross sectional approach. The population of this study was the head of the treatment room. Secondary data of nurse's performance is taken from nursing care which is written in medical record file of Emergency Room of RSUD in Special Region of Yogyakarta. Results: The performance of nurses at Emergency Room RSUD A in the good category was 100%. The performance of nurses at Emergency Room RSUD B in the enough category was 45%. The performance of nurses at Emergency Room C in good category was 80%. The performance of nurses at Emergency Room RSUD D in good category was 55%. The performance of nurses at RSUD E in the good category was 95%. The result of cross tabulation between leadership style and nurse performance of RSUD in the whole DIY with good performance is leader who use democratic leadership style equal to 35%. Conclusion: Most of the nurse's good performance in Emergency Room is followed by democratic leadership style of head of space. Keyword: leadership style, head of space, performance of nurses

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A central venous catheter in the right vertebral vein.

American Journal of Roentgenology ◽

10.2214/ajr.161.4.8372795 ◽

1993 ◽

Vol 161 (4) ◽

pp. 908-908 ◽

Cited By ~ 2

Author(s):

M Kontrus ◽

M L Pretterklieber ◽

M T Farres

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

The Right

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Successful removal of a central venous catheter misplaced in the right subclavian artery using an intravascular stent: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00418-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Haruka Yoshida ◽

Shinichiro Ikemoto ◽

Yasuyuki Tokinaga ◽

Kanako Ejiri ◽

Tomoyuki Kawamata

Keyword(s):

Central Venous Catheter ◽

Subclavian Artery ◽

Axillary Artery ◽

Insertion Site ◽

Venous Catheter ◽

Central Venous ◽

Thrombotic Complications ◽

Successful Removal ◽

Intravascular Stent ◽

The Right

Abstract Background Cannulation of a central venous catheter is sometimes associated with serious complications. When arterial cannulation occurs, attention must be given to removal of a catheter. Case presentation A 62-year-old man was planned for emergency thoracic endovascular aortic repair. After the induction of anesthesia, a central venous catheter was unintentionally inserted into the right subclavian artery. We planned to remove the catheter. Since we considered that surgical repair would be highly invasive for the patient, we decided to remove it using a percutaneous intravascular stent. A stent was inserted through the right axillary artery. The stent was expanded immediately after the catheter was removed. Post-procedural angiography revealed no leakage from the catheter insertion site and no occlusion of the right subclavian and vertebral arteries. There were no obvious hematoma or thrombotic complications. Conclusions A catheter that has been misplaced into the right subclavian artery was safely removed using an intravascular stent.

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The value of real-time ultrasound-guidance for definite placement of a right supraclavicular subclavian central venous catheter

The Journal of Vascular Access ◽

10.1177/1129729821998531 ◽

2021 ◽

pp. 112972982199853

Author(s):

Jens M Poth ◽

Stefan F Ehrentraut ◽

Se-Chan Kim

Keyword(s):

Ultrasound Guidance ◽

Venous Catheter ◽

Needle Insertion ◽

Major Surgery ◽

Axillary Vein ◽

Central Venous ◽

Supraclavicular Fossa ◽

The Right ◽

High Index Of Suspicion ◽

Insertion Process

Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications. Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved. While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture. In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.

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Surgical treatment for common hepatic aneurysm. Original one-step technique

Open Medicine ◽

10.1515/med-2020-0104 ◽

2020 ◽

Vol 15 (1) ◽

pp. 898-904

Author(s):

Bruno Amato ◽

Renato Patrone ◽

Gennaro Quarto ◽

Rita Compagna ◽

Roberto Cirocchi ◽

...

Keyword(s):

Surgical Treatment ◽

Hepatic Artery ◽

Distal Part ◽

Intraoperative Ultrasound ◽

Section Area ◽

One Step ◽

A New Technique ◽

Open Surgical Treatment ◽

The Right ◽

Vascular Stapler

AbstractIntroductionHepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons.Materials and methodsA new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion is easily obtained, which allowed retrograde thrombosis. Liver blood supply is ensured to the right and left hepatic artery, through the gastroduodenal artery, and can be previously monitored, with temporary clamping of the section area, by visual control, enzyme evaluation and intraoperative ultrasound examination. We reported an open surgical treatment, with simultaneous removal of hepatic and adrenal metastases, secondary to colon cancer.ResultsThe duration of vascular surgery was 30 min and did not involve complications. Postoperative controls confirmed the efficacy of the procedure.DiscussionThis original technique can be added to the various open and endovascular techniques so far described for the treatment of a CHA aneurysm. It is advisable as open surgery, mostly in case of associated pathologies.ConclusionsThe authors believe that this “one shot” technique by vascular staple of the distal part of CHA is minimally invasive and effective to obtain the exclusion of the aneurysm.

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Task Shifting: The Use of Laypersons for Acquisition of Vital Signs Data for Clinical Decision Making in the Emergency Room Following Traumatic Injury

World Journal of Surgery ◽

10.1007/s00268-017-4121-5 ◽

2017 ◽

Vol 41 (12) ◽

pp. 3066-3073 ◽

Cited By ~ 6

Author(s):

Bryce E. Haac ◽

Jared R. Gallaher ◽

Charles Mabedi ◽

Andrew J. Geyer ◽

Anthony G. Charles

Keyword(s):

Decision Making ◽

Emergency Room ◽

Clinical Decision Making ◽

Traumatic Injury ◽

Vital Signs ◽

Clinical Decision ◽

Task Shifting

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Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: A longitudinal study

European Psychiatry ◽

10.1016/j.eurpsy.2008.11.004 ◽

2009 ◽

Vol 24 (5) ◽

pp. 275-281 ◽

Cited By ~ 11

Author(s):

Teresa Rodriguez-Cano ◽

Luis Beato-Fernandez ◽

Inmaculada Garcia-Vilches ◽

Ana Garcia-Vicente ◽

Victor Poblete-Garcia ◽

...

Keyword(s):

Body Image ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Body Dissatisfaction ◽

Regional Cerebral Blood Flow ◽

Whole Body ◽

Regional Cerebral Blood ◽

Temporal Area ◽

The Right

AbstractObjectiveThe aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up.MethodsThree single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated.ResultsFollowing the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up.DiscussionMore specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.

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