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Biomedical subjects

C R Nunn

Publications and source records attributed to C R Nunn.

9 recordsLinked to original sources
PubMed1998

The futility of chest roentgenograms following routine central venous line changes.

OBJECTIVE: To demonstrate chest roentgenograms after central venous line changes over a guidewire delay the use of the central lines and increases charges with no change of morbidity or the rate of complication. METHODS: Retrospective study using the Surgical Intensive Care database followed by a nonrandomized, prospective study of central venous line changes. The total time from the catheter change until chest radiograph confirmation and an analysis of charges was done. RESULTS: The retrospective study of 1,201 central line changes demonstrated no pneumothorax and two central lines malpositioned. The prospective study of 100 patients demonstrated no pneumothorax and one catheter malpositioned. The average time from completion of the central line change until the radiographic confirmation was 60.2 minutes. The charge for the chest x-ray film was $156. CONCLUSIONS: The combined studies composed of 1,301 patients demonstrated no pneumothorax and three malpositioned catheters. This study demonstrates that radiographic confirmation of central venous line placement after routine line change is of no benefit as the malpositioned catheters caused no morbidity, produces significant delays and increases medical charges to the patient. Extrapolation predicts an annual reduction of $46,800 in the Vanderbilt Surgical Intensive Care Unit.

Catheterization, Central Venous↗
PubMed1998

Hypothermia in critically ill trauma patients.

OBJECTIVE: To determine the incidence and mortality of hypothermia in trauma patients. METHODS: Retrospective review of patients admitted to the Surgical Intensive Care Unit (SICU) over 4 1/2 years. Hypothermia was defined as a temperature < 35 degrees C. RESULTS: There were 7045 admissions to the SICU, of which 661 (9.4%) had a recorded temperature of < 35 degrees C. Over half (395) were trauma patients, with a mortality of 52.7%. The temperature ranged from 27.1 to 34.9 degrees C, with a mean for survivors of 34.0 degrees C and 33.1 degrees C for those that died. There was a significant difference in Apache II scores (16.6 vs 25.4) and Injury Severity Scores (26.1 vs 33.4) between survivors and non-survivors. CONCLUSIONS: The incidence of hypothermia in trauma patients is significant and is independent of the month of admission. Mortality is high but there is no threshold below which mortality is assured. Unlike historical data, 13 patients survived temperatures < 32 degrees C.

APACHE↗
PubMed1998

Elective bedside surgery in critically injured patients is safe and cost-effective.

OBJECTIVE: The success of elective minimally invasive surgery suggested that this concept could be adapted to the intensive care unit. We hypothesized that minimally invasive surgery could be done safely and cost-effectively at the bedside in critically injured patients. SUMMARY BACKGROUND DATA: This case series, conducted between October 1991 and June 1997 at a Level I trauma center, examined bedside dilatational tracheostomy (BDT), percutaneous endoscopic gastrostomy (PEG), and inferior vena cava (IVC) filter placement. All procedures had been performed in the operating room (OR) before initiation of this study. METHODS: All BDTs and PEGs were performed with intravenous general anesthesia (fentanyl, diazepam, and pancuronium) administered by the surgical team. IVC filters were placed using local anesthesia and conscious sedation. BDTs were done using a Ciaglia set, PEGs were done using a 20 Fr Flexiflow Inverta-PEG kit, and IVC filters were placed percutaneously under ultrasound guidance. Cost difference (delta cost) was defined as the difference in hospital cost and physician charges incurred in the OR as compared to the bedside. RESULTS: Of 16,417 trauma admissions, 379 patients (2%) underwent 472 minimally invasive procedures (272 BDTs, 129 PEGs, 71 IVC filters). There were four major complications (0.8%). Two patients had loss of airway requiring reintubation. Two patients had an intraperitoneal leak from the gastrostomy requiring operative repair. No patient had a major complication after IVC filter placement. Total delta cost was $611,994. When examined independently, the cost was $324,224 for BDT, $164,088 for PEG, and $123,682 for IVC filter. OR use was reduced by 506 hours. CONCLUSIONS: These bedside procedures have minimal complications, eliminate the risk associated with patient transport, reduce cost, improve OR utilization, and should be considered for routine use in the general surgery population.

Adult↗
PubMed1997

Cost-effective method for bedside insertion of vena caval filters in trauma patients.

BACKGROUND: The need for patient transport for inferior vena cava (IVC) filter placement impacts patient safety, comfort, charges, and nursing care. Bedside, ultrasound-guided IVC filter placement may offer an acceptable, cost-effective alternative. METHODS: Prospective cohort study of 55 consecutive trauma patients requiring IVC filter placement. During a 13-month period (August of 1995-September of 1996), patients meeting criteria for IVC filter were evaluated. Complications were recorded, and the potential financial savings were determined. RESULTS: Of 3,172 trauma admissions, 55 patients met IVC filter criteria and 49 patients had IVC filters placed under ultrasound guidance. In six patients (10.9%), ultrasound guided filter placement failed. There were four complications in four patients (8.2%). Over 13 months, charges were reduced by $69,800 when compared with radiology suite placement and $118,300 when compared with operative placement. CONCLUSIONS: Ultrasound guided, bedside placement of IVC filters is a safe, cost-effective method of pulmonary embolism prophylaxis in select trauma patients.

Adolescent↗
PubMed1997

Traumatic asphyxia syndrome.

Although the craniofacial changes associated with TAS are usually not life threatening, the syndrome is not benign. The mechanism of injury needed to create TAS is sufficient to warrant extreme caution in the approach to these patients. It is vital for the physician to recognize the pathophysiology of the injury pattern and to remain cognizant of the high likelihood of potentially lethal associated injuries. Aggressive and directed management of the cardiopulmonary systems coupled with prompt recognition and treatment of associated injuries is essential for optimal patient outcome.

Adult↗
PubMed1997

Hypothermia: impact on the trauma victim.

Secondary hypothermia may present the clinician with an extraordinary set of challenging problems. Rapid rewarming using both passive and active techniques is essential to correct the many reversible changes associated with hypothermia. Despite aggressive management, secondary hypothermia continues to exact a large toll in terms of the mortality of trauma victims.

Adult↗
PubMed1994

Lobular carcinoma of the male breast.

BACKGROUND: A case of lobular carcinoma in a male breast is described. Lobular carcinoma is a very uncommon histopathologic form of male breast cancer because of the absence of lobules in the normal male breast. The cytoarchitecture of the normal male breast can be deranged in conditions such as Klinefelter's syndrome or as a result of estrogen exposure. Lobular carcinoma of the male breast has been described in such instances where cytoarchitectural changes are likely to have occurred. METHODS AND RESULTS: After the pathologic diagnosis was made, a fibroblast karyotype was performed to confirm a male genotype. The patient had received no hormonal therapy. The English language literature was reviewed. CONCLUSIONS: This case represents the first report of lobular carcinoma in a proven genotypic male patient receiving no exogenous estrogens.

Antineoplastic Combined Chemotherapy Protocols↗