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Biomedical subjects

G F Sheldon

Publications and source records attributed to G F Sheldon.

At least 19 recordsLinked to original sources
PubMed1991

A comparison of intensive care unit care of surgical patients in teaching and nonteaching hospitals.

Three hundred forty-eight teaching (TH) and 282 nonteaching (NTH) hospitals were surveyed to determine how intensive care unit (ICU) care is delivered to surgical patients and current views on surgical critical care. Teaching hospitals were more likely than NTHs to have a separate surgical ICU (92% versus 37%), a dedicated ICU service/physician (37% versus 7%), and a surgeon as director of the ICU (67% versus 29%). All THs and 33% of NTHs provided 24 hour in-house coverage for the ICU. A majority of respondents preferred a surgeon as ICU director (TH, 85%; NTH, 67%) and felt that critical care was an essential part of surgery (THs, 87%; NTHs, 74%). Most (THs, 58%; NTHs, 56%) thought that a cooperative effort between the primary service and an ICU service provided better patient care, but only 37% of THs and 22% of NTHs provided care with such a system. Many (THs, 45%; NTHs, 33%) thought that surgeons are willingly relinquishing ICU care. Surgeons continue to desire responsibility for their patients in the ICU and most prefer ICU service involvement provided by surgeons. This discrepancy between what is practiced and what is desired, along with proposed changes in reimbursement for surgery and the recent definition of critical care as an essential part of surgery, may stimulate greater involvement of surgeons in critical care.

Attitude of Health Personnel↗
PubMed1991

Surgery in the aged.

Coincident with improvement in medical care and life-styles, the longevity of the population of the United States is increasing. As the population ages, more surgical procedures will be performed in elderly patients. The effects of the aging process on organ systems generally does not compromise function under normal conditions. However, the elderly patient may not be able to meet the metabolic demands of a hypermetabolic state. Operative outcome for the most part is related more to the urgency of the procedure than to the age of the patient. With the proper preoperative evaluation and postoperative care, the elderly patient at risk for perioperative morbidity and mortality can be identified and outcome approved. In most cases age in and of itself is not a contraindication to surgical intervention. Surgical problems in the aged patient can and should be safely managed with early elective management prior to the development of emergent situations.

Aged↗
PubMed1990

ABGs and arterial lines: the relationship to unnecessarily drawn arterial blood gas samples.

Arterial blood gas measurements (ABGs) are the most common tests ordered in an ICU. ABG utilization in a surgical ICU over a 1-year period (September 1, 1987-October 31, 1988) was evaluated to identify factors that might help reduce overutilization. A total of 842 admissions comprising 2,381 patient days were reviewed. ABGs were the most commonly ordered test (mean of 4.8/patient/day). Patients with arterial lines (A-lines) had more ABGs drawn than those who did not regardless of the value of PaO2 (p less than 0.01), PaCO2 (p less than 0.01 except for PaCO2 greater than 55), APACHE II score (p less than 0.01), use of ventilators (p less than 0.01), pulse oximeters (p less than 0.01), or a combination of the last two (p less than 0.01). Multivariate analysis demonstrated that the presence of an A-line was the most powerful predictor of the number of ABGs drawn per patient (p less than 0.0001) independent of all other measures of the patient's clinical status such as the use of ventilators, oximeters, and values of PaO2, PaCO2, or the APACHE II score. This suggests that ABGs are being drawn unnecessarily simply because of the presence of an A-line. To reduce the number of ABGs drawn, a policy for specific indications for placement of A-lines and ABG analysis should be adopted.

Blood Gas Analysis↗
PubMed1979

Role of parenteral nutrition in patients with short bowel syndrome.

More patients with extensive resection of the small bowel--secondary to regional enteritis, mesenteric infarction, cancer, etc.--are surviving perioperative treatment. To avoid nutrition-caused malabsorption and to maintain body composition, intravenous nutrition is initiated with a silastic atrial catheter in the immediate postoperative period. The patients are trained in "home hyperalimentation" procedures designed to allow normal nutrition to be maintained during the months required for bowel adaptation to occur. Because bowel adaptation to the absorption and transport of foodstuffs is in part dependent on the intraluminal presence of foodstuffs, elemental and regular diets are ingested during the period of intravenous support which may last for years. By using combined oral and intravenous nutrition, approximately 20 per cent of patients with short bowel syndrome eventually can take sufficient oral nutrients to sustain life.

Catheterization↗
PubMed1979

Septic phlebitis: a neglected disease.

A review of 100 patients with peripheral septic phlebitis revealed that 54 per cent of the cases were due to intravenous catheters and 46 per cent were secondary to drug abuse. Eighty per cent of the involved veins were in the arm or neck. Pain was the most common symptom (83 per cent), with erythema and edema the most common physical signs (63 per cent). Eighty per cent of the causative organisms were gram-positive bacteria, usually Staphylococcus aureus (41 per cent) or Group A streptococcus (20 per cent). Complications were more common if septic phlebitis was due to intravenous therapy than drug abuse. No deaths were directly attributed to septic phlebitis. However, hospital stay after development of septic phlebitis was 14 days with a 56 per cent complication rate. The initial treatment of septic phlebitis should include prompt removal of the intravenous device, antibiotics, heat, and elevation. Because serious complications occur in a significant number of patients, operative excision of the involved vein should be performed if clinical deterioration occurs or if septicemia persists after 24 hours despite conservative therapy.

Arm↗
PubMed1979

Acute acalculous cholecystitis: a complication of hyperalimentation.

In a 5 year period, eight patients in whom acute acalculous cholecystitis developed during intravenous hyperalimentation are reviewed with emphasis on factors contributing to pathogenesis. Gallbladder distention, biliary stasis, and bile inspissation, thought to be important in the pathogenesis of this disease, are enhanced with the use of hyperalimentation, and this potential complication is being seen with increasing frequency in seriously ill or injured patients who are being fed parenterally. In addition to hyperalimentation, sepsis, hypotension, multiple transfusions (more than 10 units), prolonged fasting, and ventilatory support were frequent common denominators. Typical findings of pain, tenderness, and a mass in the right upper abdominal quadrant are infrequent, and the diagnosis rests on a high index of suspicion and ultrasonography. This syndrome may be preventable by the stimulation of gallbladder emptying with intermittent fat ingestion or parenteral infusion of cholecystokinin.

Abdominal Injuries↗
PubMed1979

A comparison of essential and general amino acid infusions in protein-depleted patients receiving parenteral alimentation.

Six malnourished patients were studied during intravenous nutrition therapy to compare the efficiency of essential and general amino acids when given as the sole nitrogen source during intravenous nitrogen therapy. A cross-over design was used so that each patient received both essential amino acids plus arginine and histidine and a general amino acid solution in random order. Glucose provided the remainder of the energy and both infusions contained 2 g of amino acid per 100 kcal. Each patient's daily urea nitrogen production was greater during infusion of the general amino acid solution. Consequently, nitrogen intake minus urea nitrogen production was significantly greater when the essential amino acid solution was infused. Plasma amino acid levels were determined on each patient during both essential and general amino acid infusion. Abnormalities tend to reflect the composition of the amino acid solutions as well as their administration directly into the systemic circulation bypassing the portal circulation.

Adult↗
PubMed1979

Management of portal vein injuries.

Injuries to the portal vein are associated with a high mortality because of a high incidence of concomitant injury to surrounding structures and refractory shock. Repair of the portal vein injury is often difficult or impossible because of massive hemorrhage. The key to successful management of a portal vein injury is rapid blood volume resuscitation and obtaining rapid and adequate exposure. The optimal exposure for repair consists of reflection of the hepatic flexure of the colon with mobilization of the root of the mesentery, pancreas, and duodenum. Lateral venorrhaphy is the preferred method of management, but in hemodynamically unstable patients, ligation of the portal vein is an acceptable method of treatment.

Arteriovenous Shunt, Surgical↗
PubMed1979

Morbidity of a negative finding at laparotomy in abdominal trauma.

Although it is undesirable to perform an unneeded laparotomy in patients with abdominal trauma, it is more serious to delay exploration and incur morbidity or mortality. Because a negative finding at laparotomy has a low incidence of complications, early exploration is justified in instances in which intra-abdominal injury is suspected. Although peritoneal lavage for blunt trauma and selective exploration for some stab wounds may reduce the incidence of unnecessary laparotomies, the high incidence of major injury associated with gunshot wounds precludes use of selective exploration as a reasonable policy.

Abdominal Injuries↗
PubMed1978

Hepatic dysfunction during hyperalimentation.

Liver biopsy specimens were studied in 26 patients in whom liver function abnormalities developed during intravenous hyperalimentation (IVH). The clinical manifestations and duration of IVH were evaluated in relation to the morphological changes seen in the liver. Early hepatic changes consisted of fatty metamorphosis, and progressive intrahepatic cholestasis developed as IVH was continued. Essential fatty acid deficiency, amino acid imbalance, caloric excess, and toxic manifestations of certain amino acids are postulated as causative factors. The hepatic steatosis secondary to IVH may be treated by lowering the dextrose concentration of the infusion or by administering dextrose-free amino acid solutions. The clinical importance of this common complication of IVH is the difficulty in distinguishing it from other causes of cholestasis in seriously ill patients.

Adult↗
PubMed1978

Metabolism, oxygen transport, and erythropoietin synthesis in the anemia of thermal injury.

The relationship between metabolism, oxygen transport, and anemia was assessed in burn patients. A significant negative correlation was found between erythrocyte 2,3 DPG, the major modulator of oxygen transport, and erythropoietin synthesis. Simultaneous bioassay and radioimmunoassay for erythropoietin revealed elevated values in the anemic burn patients. Elevated 2,3 DPG values during convalescence from thermal injury may remove the "anemic hypoxia" stimulus to erythropoieitn production, resulting in persistence of the anemia.

Adult↗