Stable Vital Signs Research Articles

Delivering Telerehabilitation to COVID-19 Inpatients:A Retrospective Chart Review Suggests It Is a Viable Option

BackgroundGuidelines for physical therapy management of patients hospitalized with COVID-19 recommend limiting physical therapists’ contact with patients when possible. Telehealth has been viewed as “electronic personal protective equipment” during the COVID-19 pandemic; although telerehabilitation has been shown to be effective with outpatients, it is unknown whether it is a viable option for hospitalized patients.PurposeOur facility developed an algorithm for the use of a physical therapy telerehabilitation program for inpatients with COVID-19. We sought to investigate the safety and viability of the program.MethodsWe conducted a retrospective chart review of patients admitted with a diagnosis of COVID-19 who received either telerehabilitation only or a combination of telerehabilitation and in-person rehabilitation. Based on the algorithm, COVID-19 inpatients were selected to receive telerehabilitation if they could ambulate independently, could use technology, had stable vital signs, required minimal supplemental oxygen, and were cognitively intact. We analyzed data of inpatients who received telerehabilitation only, which included patient education, therapeutic exercises, and breathing techniques.ResultsOf 33 COVID-19 inpatients who received telerehabilitation, in-person rehabilitation, or a combination of the two, 12 patients received telerehabilitation only (age range, 33 to 65 years; all but one male). They demonstrated independence with their individualized home exercise programs in one to two sessions, did not require an in-person rehabilitation consultation, did not require increased oxygen, experienced no exacerbation of symptoms, and were discharged home.ConclusionsInpatient telerehabilitation appears to be a viable option for selected hospitalized patients with COVID-19 and may be a safe way of delivering inpatient rehabilitation to isolated or at-risk populations. At our hospital, the use of inpatient telerehabilitation reduced staff exposure while providing important education and services to patients. To our knowledge, no studies have investigated the use of telerehabilitation for hospitalized patients, including those with COVID-19. Our findings suggest that this innovative approach warrants further study.

The interactive effect of preoperative consultation and operating room admission by a counselor on anxiety level and vital signs in patients undergoing Coronary Artery Bypass Grafting surgery. A clinical trial study.

Objective. The purpose of this study was to provide appropriate preoperative supportive conditions to improve anxiety and vital signs for patients undergoing Coronary Artery Bypass Grafting -CABG- surgery. Methods. This clinical trial study was performed on 90 patients undergoing CABG surgery in Farshchian Hospital of Hamadan, Iran in 2019. Sample was selected by convenience and were randomly divided into three groups: control (n=30), intervention1 (n=30), and intervention2 (n=30). The control group received only the routine preoperative counseling of ward and admitted to the operating room as usual; the intervention1 and intervention2 groups in addition received another two counseling sessions, then the intervention1 group was admitted in the operating room as usual, but the intervention2 group was admitted by the counselor in the operating room. Data were collected using a three-part questionnaire including demographic characteristics, vital signs chart, and the Spielberger's State-Trait Anxiety Inventory. Results. The results showed that there was a significant difference in the mean anxiety of the three groups after admission in the operating room (intervention2 was lower than intervention1 and control groups, p<0.001; and intervention 1 group was lower than control group, p<0.001) and also there was a significant difference between the mean systolic blood pressure, heart rate and respiratory rate of the three groups (p<0.001) but the mean of the variables of temperature and diastolic blood pressure in the three groups were not significantly different (p=0.59 and p=0.225, respectively). Conclusion. Our results revealed preoperative consultation and admission in the operating room by the consultant can reduce the level of anxiety and stability of vital signs of patients undergoing CABG.

Successful Treatment of Covid-19 Associated Cytokine Release Syndrome with Colchicine. A Case Report and Review of Literature

ABSTRACT We describe the case of a 42 year old, healthy patient with Covid-19 who despite improvement in his respiratory symptoms developed a mild to moderate cytokine release syndrome (CRS) and an associated monoarticular gout flare. Since the patient refused admission to the hospital and had stable vital signs, we chose to treat him with a safe anti-inflammatory and non-immunosuppressive therapy. To hit two birds with one stone, we considered colchicine, as it has systemic anti-inflammatory effects and is also effective in gout flare. Unexpectedly, 48 hours after treatment, not only did his ongoing fever and toe pain disappear, he also had significant improvements in his general state of health and all his inflammatory markers including fibrinogen, ferritin, D-dimer, and IL-6 levels normalized. To our knowledge, the use of colchicine in Covid-19 and CRS has not been reported. This observation merits the consideration of colchicine as a safe, inexpensive and oral medication for the treatment of mild to moderate CRS in Covid-19 patients. More importantly, in Covid-19 patients with early lung involvement colchicine may be an appropriate candidate to prevent CRS in adjunction with routine antiviral agents. Indeed, multicenter, randomized controlled studies are required to evaluate the benefits of this therapy.

Rare Knee Injury In A Hurdler

HISTORY: 18-year-old female with history of asthma presented to the ED with injury to knee. About 20 minutes prior to arrival she tripped over a hurdle and landed awkwardly. Immediately felt pain to the left knee and left hip and had an obvious left knee deformity. The high school trainer was able to palpate distal pulses. EMS was called and patient was placed in an air splint and transferred to the ED. PHYSICAL EXAM: In the ED Patient had stable vital signs. She had notable deformity to the left knee, left lower limb notably shorter than right and externally rotated with dimpling at the medial knee. Unable to flex at the left knee joint. Tenderness at the left knee joint, no erythema, no swelling. Able to wiggle toes, dorsiflex and plantarflex. L3-S1 Sensation intact. Dorsalis pedis and posterior tibialis pulses 1+ on the left, weaker than the right. Brisk cap refill. DIFFERENTIAL DIAGNOSES: 1. Anterior Knee Dislocation with multiple ligamentous damage with vascular compromise. 2. Anterior Knee Dislocation with multiple ligamentous damage without vascular compromise. 3. Anterior Knee Dislocation with minimal ligamentous injury. 4. Hip Fracture/dislocation TESTS AND RESULTS: 1. XR KNEE LT 2V IMPRESSION: Complete dislocation at the left knee joint. Distal femur displaced posteriorly with respect to proximal tibia. No fractures noted. No radiopaque foreign body. 2. XR PELVIS 1V IMPRESSION: Normal Xray, no fracture, dislocations or deformities noted. 3. XR KNEE LT 2V Post Reduction IMPRESSION: Relocation of previously seen dislocation. Normal alignment noted. No fractures. FINAL WORKING DIAGNOSIS: Anterior Knee Dislocation with multiple ligamentous damage and vascular compromise. TREATMENT AND OUTCOME: 1. Pt underwent a closed reduction in the ED with sedation by ortho and ED physicians. 2. Distal pulses improved and patient was placed in an immobilizer. 3. Vascular surgery was consulted, and a CTA of the lower extremity was done which showed no vascular injury. 4. Pt had external fixation procedure with fluoroscopy for knee stabilization. 5. Pt was followed up with outpatient Ortho. External fixation was removed 2-3 months after the surgery. 6. Pt was placed in an immobilizer and was started with physical therapy. Further management pending orthopedic evaluation and patient progression.

Combination of Polyethylene Terephthalate Nesting and Prone Position at the Standard Box Care to the Vital Signs and Length of Stay on the Low Birth Weight Babies

Background: The use of nesting and prone position conditioned Low Birth Weight (LBW) babies as the mother's womb that helped in the development of physiological functions and achieve physiological function stability. This study aims to test the effectiveness of designed nesting with polyethylene terephthalate materials and the position of prone with standard care using a box of baby warmers for the length of stay which is observed from the achievement of the stability of vital signs on LBW. Methods: This is a quasi-experimental design study with non-equivalent control group design. The study population was all LBW treated in the Perinatal room with a sample of 36 LBW selected consecutively from newborns at RSUD RAA Soewondo Pa􀦞 and RSUD Dr. R. Soetrasno Rembang. Results: The combination of nesting polyethylene group with position prone achieved faster vital signs stability and shorter duration of treatment compared to the control group with p = 0.001 for temperature, respiration and oxygen saturation. Conclusion: The combination of polyethylene terephthalate nesting and prone position is effective to reduce the duration of treatment and achieving the stability of vital signs of low birth weight infants. This intervention can be used as LBW care during hospital and home care. Keywords: nesting, position prone, polyethylene tread, length of stay, baby vital signs Received: 25 August 2018 Reviewed: 10 September 2018 Revised: 28 June 2020 Accepted: 28 June 2020 DOI: 10.35898/ghmj-41579

SAT-LB311 Inoperable, Metastatic Pheochromocytoma &amp; Paraganglioma Tumor Size Reduction After Lu-177-dotatate (Lutathera®) Treatment Trial: The Role of Nursing

Tumor Size Reduction after Lu-177-DOTATATE (Lutathera®) Treatment in Patients with Inoperable Metastatic Pheochromocytoma and Paraganglioma: The Role of NursingAssumpta Ude, Frank I. Lin, Karel Pacak, Ejigayehu Demissie. Clinical Center Nursing Department, Molecular Imaging Program NCI, Endocrine Service Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development. Background: Nursing management of patients with metastatic pheochromocytoma (PCC) and paraganglioma (PGL) undergoing treatment trial with radiopharmaceutical medication has unpredictable clinical outcomes. Clinical Case: A 52-year old woman with inoperable metastatic PCC/PGL was admitted into protocol 17-C-0087 after poor response to various chemotherapies. Patient was treated in the endocrine nursing unit with 200 mCi of Lu-177-DOTATATE (Lutathera®) intravenous infusion given by a radionuclide specialist every eight weeks for a total of four doses. Prior to admission, various members of the endocrine clinical nursing leadership team reviewed protocol with the medical and radiation safety team and a clinical research nurse (CRN) to ensure CRNs understand their roles and expectations to ensure patient safety during procedures and treatment. The patient was admitted on the day preceding the treatment and monitored for 48 hours afterwards. The CRN obtained comprehensive diet and medication history to determine if there is anything that may falsely elevate plasma/urinary catecholamines/metanephrines. The CRN ensured correct placement of intravenous (IV) line and proper collection of blood from IV line to increase the reliability of results. The CRN ensured that IV amino acid (Clinisol 15 %) infusion was administered 30 minutes prior to dosing to diminish renal issues. This patient had minimal side effects and no adverse events to therapy. The research team followed up the patient in clinic every month while she was on treatment, then every 3 months in the follow-up period. Recent evaluation showed this patient had stable vital signs, impalpable supraclavicular lymph node, returned to baseline physical activity with significant decrease in the size of the PCC/PGL, and reduction in serum catecholamine/metanephrine levels. Conclusion: The endocrine CRN team is critical in the assessment, monitoring, observation and education of patients and families regarding expectations during therapy which played a significant role in minimizing the patient’s side effects to therapy. Working collaboratively with other members of the multidisciplinary research team also contributed to patient’s favorable outcome.

SAT-685 Euglycemic Diabetic Ketoacidosis in T1d: The Era of SGLT-2 Inhibitors and Keto-Diet

Introduction Euglycemic diabetic ketoacidosis (DKA) is a challenging diagnosis since near normal blood sugar levels can be misleading. In the present case, we describe a patient with Type 1 Diabetes (T1D) on SGLT2 who underwent a strict low carb diet. Case Report A 70-year-old female with past medical history of unspecified diabetes mellitus and primary hypothyroidism presented to emergency room complaining of nausea and dizziness of four days with decreased oral intake. She was alert and oriented, normal weight (52 kg, BMI 20 kg/m2) with stable vital signs, except for mild tachypnea (22/min). Initial labs showed serum glucose 136 mg/dL, bicarbonate 10 mmol/L (normal 20-31), anion gap of 27, venous blood gas pH 7.1, B-hydroxybutyrate 8.8 mmol/L (normal 0.02-0.27), glucosuria > 500 mg/dL, and moderate ketonuria. Screening for ethyl alcohol and ethylene glycol was negative. Lactic acid, cardiac enzymes, renal and liver function tests were normal. She was diagnosed with diabetes mellitus at age 37, on insulin since then. No alcohol use. Her new primary care physician found an A1C of 9.0% for which metformin 1000mg oral twice a day and empagliflozin 12.5 mg oral daily were added and aspart insulin was discontinued. Daily glargine remained at 20 units daily. She was advised to lose weight for which she started a keto-diet 4 weeks prior to this presentation. She had lost 15 pounds since then accompanied by polyuria and polydipsia. Upon admission, she received IV insulin and IV fluids. An endocrinology consultation was requested for euglycemic DKA secondary to SGLT2 complicated by starvation ketosis. Antibodies against glutamic acid decarboxylase were positive at 250 IU/mL (normal < 5). She was discharged on glargine, aspart insulins and oral medications were discontinued. Conclusion This case shows the importance of identifying the specific type of diabetes for appropriate individualization of therapy. Following a keto-diet in unrecognized T1D can trigger ketoacidosis in the setting of SGLT2 inhibitors leading to euglycemic diabetes ketoacidosis.

Application of vacuum stretcher combined with feeding in cranial magnetic resonance imaging examination for neonates: a prospective randomized controlled study

To study the effect and safety of vacuum stretcher combined with feeding in cranial magnetic resonance imaging (MRI) examination for neonates. A prospective study was performed for the neonates with hyperbilirubinemia, with a gestational age of >34 weeks and stable vital signs, who needed cranial MRI examination and did not need oxygen inhalation hospitalized in the Department of Neonatology, Children's Hospital of Zhejiang University School of Medicine, from September to November, 2019. The neonates were randomly divided into a vacuum stretcher combined with feeding group and a conventional sedation group. Vital signs were monitored before, during, and after MRI examination. The success rate of MRI procedure was recorded. A total of 80 neonates were enrolled in the study, with 40 neonates in the vacuum stretcher combined with feeding group and 40 in the conventional sedation group. The vacuum stretcher combined with feeding group had a significantly higher success rate of MRI procedure than the conventional sedation group (P<0.05). As for the neonates who underwent successful MRI examination, the fastest heart rate after examination in the vacuum stretcher combined with feeding group was significantly lower than that in the conventional sedation group (P<0.05), while there were no significant differences between the two groups in transcutaneous oxygen saturation, respiratory rate, and body temperature before and after MRI examination (P>0.05). No complications, such as apnea, acute allergic reactions, and malignant fever, were observed. Vacuum stretcher combined with feeding can improve the success rate of MRI procedure and reduce the use of sedatives, and meanwhile, it does not increase related risks.

Non-invasive respiratory support for patients with novel coronavirus pneumonia: clinical efficacy and reduction in risk of infection transmission.

Non-invasive respiratory support for patients with novel coronavirus pneumonia: clinical efficacy and reduction in risk of infection transmission.

Thoracoscopic delivery of therapeutics in the swine sympathetic chain: Implications for future neuromodulation

The thoracic sympathetic chain is implicated in several disease processes including palmar hyperhidrosis and complex regional pain syndrome. These diseases are often medically refractory and require surgical treatments including sympathectomies and ganglion blocks. The use of chemogenetic or optogenetic technologies to modulate sympathetic chain activity may be a potential treatment for these diseases. However, there is no established thoracoscopic surgical approach to deliver viral vectors into the thoracic sympathetic chain and ganglia. Our objective was to evaluate the feasibility of thoracoscopic injection of the swine sympathetic chain. Two Landrace farm pigs underwent a novel procedure for thoracoscopic sympathetic chain injections. One was non-survival and one was a five-day survival surgery. Both procedures successfully delivered methylene blue in the thoracic sympathetic chain. Over the five-day postoperative period, the animal displayed stable vital signs. Thoracoscopic targeted injections of the sympathetic chain is a feasible approach to deliver therapeutics in swine. Future studies should investigate the use of transgene expression as a potential means to control sympathetic output for the development of novel therapies for palmar or axillary hyperhidrosis, thoracic neuropathic pain syndromes and select peripheral vascular diseases.

Patient-controlled Sedation During Flexible Bronchoscopy

Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB). This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol). The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (P<0.0001). Between PCS groups, 96% of the PCS-G group patients were ready for discharge compared with 65% in the PCS-MS group (P=0.0002) at 2 hours. Bronchoscopists' and patients' satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups. PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.

Evidence for Gastrointestinal Infection of SARS-CoV-2

No abstract available Keywords: ACE2; Gastrointestinal Infection; Oral-Fecal Transmission; SARS-CoV-2.

Asymptomatic COVID-19 infection in pregnant woman in the third trimester: a case report/ 中华围产医学杂志

We report a case of asymptomatic COVID-19 infection in a pregnant woman in the third trimester with good maternal and infant outcomes. The patient was admitted to the Second People's Hospital of Hefei on February 11, 2020, because of a novel coronavirus nucleic acid test result for one at 38 weeks of gestation. No abnormality was observed during her previous regular prenatal examinations. A throat swab sample was obtained from the patient four days before admission due to the diagnosis of COVID-19 infection in her husband and sister on the 14th and 7th day before her admission, and the new coronavirus nucleic acid test showed positive. The patient reported no discomfort before admission. Chest CT on the 3rd after admission showed a small amount of bilateral pleural effusion. Irregular contractions occurred three days after admission and labor was considered to be imminent. An emergency cesarean section was performed and the patient delivered a live baby girl. No tests were performed on amniotic fluid, cord blood or placenta for new coronavirus nuclei acid. The patient was isolated from the infant without breastfeeding after surgery. All medical staff involved in the cesarean section were isolated after surgery. Neonatal peripheral blood and nasopharyngeal swabs were collected for the new coronavirus nucleic acid tests on the day of birth and one day of age respectively, and nasopharyngeal swabs and anal suabs were taken at nine days after birth. All test results were negative. The patient recovered well after surgery with stable vital signs. Chest CT on the 8th after operation showed a small amount of bilateral pleural effusion, while the new coronavirus nucleic acid test results of the pharyngeal swabs were positive on the 11th and 12th day after operation. The throat swabs of all medical staff involved in the operation were negative 14 days after the operation. The mother and baby were discharged 14 days after the Cesarean section.

The Epidemiological Study of the Children Committing Suicide with Toxic Substances Admitted to the Emergency and Pediatric Wards in Iran (2013-2016)

Introduction: Poisoning is the most common method of non-fatal suicide. In recent years, poisoning caused by the use of medications and chemicals has increased. The present study aimed to investigate the rate of suicide using toxic compounds in Iranian children.Methods: This retrospective study was conducted using the data of 83 children aged 5-16 years who attempted suicide using toxic substances and were admitted to the pediatric and toxicology departments of Imam Reza Hospital in Mashhad, Iran. Results: Among 500 suicide cases, 83 committed suicide using toxic substances, and 8.4% of the suicides were committed by children aged 5-7 years. In addition, 60% of the suicide cases were aged 14-16 years. In total, 45.5% of the children committed suicide with prior planning (statistically significant). The peak time of referral to the emergency department was between 6-12 PM, and more than 90% of the patients were admitted with stable vital signs. The most commonly used toxic substance was organophosphate. During admission, psychiatric counseling was not provided to 36.1% of the patients, and the clinical outcomes also showed the use of non-lethal doses. Conclusion: According to the results, it is of utmost importance to assess the underlying causes of suicide attempts in early childhood (e.g., prior planning and antisocial behaviors), especially with the increased age of children to 14-16 years in such incidents.

Case Study: Daily Review of Telemonitoring Data by a Critical Care Nurse Improves Outcomes in a Patient with Class IV, Stage D Heart Failure with Reduced Ejection Fraction Receiving Home Intravenous Dobutamine for Palliation.

Purpose The purpose of this case study is to demonstrate how a robust telemonitoring program, which includes daily critical care nurse review of heart failure symptoms, vital signs, oxygen saturation, weight, and blood glucose levels, prompts clinical interventions that result in overall improved symptom management and decreased hospital readmissions for a patient requiring home inotrope infusion. Objectives 1. To summarize particular telemonitoring data that triggered nursing telephonic outreach for further patient evaluation 2. To summarize clinical interventions resulting from data and nursing telephonic outreach 3. To report patient outcomes (symptom improvement and avoidance of hospitalizations) Methods A retrospective review of this patient's medical record was performed, which consisted of telemonitoring data, physician order changes, and clinical assessments performed by critical care nurses. Results This 50-year-old male with Class IV, Stage D heart failure with reduced ejection fraction was admitted to this home infusion provider on 03/26/2015 to receive palliative treatment with continuous intravenous dobutamine 2.5 mcg/kg/min and daily telemonitoring. He was not a candidate for advanced heart failure therapies, such as left ventricular assist device or heart transplant, due to prior noncompliance with his treatment plan. The first telemonitoring data was transmitted on 03/28/2015. The patient was largely compliant with daily data transmissions throughout the course of care, which ended 06/03/2015 when the patient's insurance changed and the payor mandated transfer of care to another home infusion provider. A telephonic assessment performed by a critical care nurse occurred each day the transmitted data triggered an alert. A total of 25 alerts were received and are summarized as follows: 1 increased lower extremity edema, 5 weight increased more than 2 pounds in 24 hours, 7 heart rate and blood pressure elevations, 2 blood glucose elevations, 1 increased orthopnea, 1 significant weight loss in 24 hours, and 8 missing daily data transmissions. These alerts and resulting telephonic assessments prompted 61 clinical interventions, which included: 32 nursing visits for IV furosemide administration, 7 patient education sessions, 1 additional dose of oral furosemide, 7 rechecks of blood pressure and heart rate, 6 physician contacts, and 8 patient contacts requesting health check/data transmission. Conclusions Daily critical care nurse telemonitoring resulted in nearly daily interventions with gradual stabilization of weight and vital signs, no decline in respiratory status, and no hospitalizations throughout 69 days of service. Of particular significance is the fact that telemonitoring improved the patient's compliance to his treatment plan, which resulted in an evaluation for a left ventricular assist device placement. Results

Efficacy of Bronchoalveolar Lavage as Adjunct Therapy in the Treatment of Neonatal Severe Pneumonia: A Prospective Case-Control Study.

The aim of this study was to investigate the efficacy and safety of bronchoalveolar lavage (BAL) in the treatment of neonatal severe pneumonia (NSP). One hundred patients with severe pneumonia were randomly divided into two groups, the BAL and control groups, with 50 patients in each group. In the BAL group, normal saline was instilled into the endotracheal tube for BAL. Before and after lavage, lung ultrasound (LUS) monitoring was performed to observe the lung pathological changes. Conventional treatment was administered in the control group. The need for and duration of invasive mechanical ventilation, the complication rate, the duration and cost of hospitalization and the mortality rate were compared between the two groups. The results of this study showed that there were 35 (70%) patients who meet the indications of the invasive mechanical ventilation (IMV) at admission in the BAL group, while there were only 15 (30%) patients still requiring IMV after BAL therapy. The duration of IMV was 41.7 ± 7.5 vs. 97.7 ± 12.9 h in BAL and controls, the incidence rate of complications was 8.0% vs. 20.0% in both groups, the length of hospital stay was 9.2 ± 1.9 vs. 14.1 ± 2.1 days in both groups, and the expense of hospital cost was 12557 ± 832 vs. 19121 ± 929 Chinese Yuan in both groups. All patients had stable vital signs during lavage, and no significant adverse side effects were observed. BAL was significantly beneficial for NSP with no significant adverse side effects; LUS is a useful tool for the timely detection of BAL effects.

Nerve Block for Septorhinoplasty: A Retrospective Observational Study of Postoperative Complications in 24 Hours.

Septorhinoplasty is a surgical procedure that provides functional improvements and esthetic adjustments to the appearance of the nose. Pain is a common postoperative complication, and pain management is known to decrease postoperative complications and total cost. Local anesthetics can cost-effectively decrease postoperative pain scores and reduce analgesic requirements.The primary objective of this study was to assess the effect of bilateral facial nerve blocks given with general anesthesia on pain scores and the use of postoperative analgesia. The secondary objective was to compare the vital signs stability between a group given bilateral facial nerve blocks with general anesthesia and a group given general anesthesia only.We conducted a retrospective observational study among 40 patients who were divided into two groups, each containing 20 patients. The patients in the nerve block (NB) group received general anesthesia and bilateral facial blocks of the infraorbital and infratrochlear nerves via 5 ml of 0.25% levobupivacaine with 5 ml of diluted adrenaline 1:100,000. Patients in the Control group received general anesthesia only. Both groups received the same local injection of a mixture of 5 ml of 1% lidocaine and 5 ml of 1:100,000 epinephrine at the surgical site, along with the standard general anesthesia. A numerical rating scale, the visual analog scale (VAS), was used to evaluate postoperative pain at 15, 30, and 45 minutes postoperatively, and the stability of the vital signs was also assessed.The results showed that using bilateral infraorbital and infratrochlear nerve block injection with 0.25% levobupivacaine for patients who underwent septorhinoplasty under general anesthesia provided greater stability of vital signs but had no effect on the pain score or analgesia need. Further assessment should be performed in a larger number of patients to either confirm or refute these results. Additional studies could be conducted in several hospitals within the Kingdom to determine how broadly applicable nerve blockade is in reducing pain sensation.

Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

BackgroundPneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology.Case presentationWe herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months.ConclusionIn the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

Retrospective analysis of medical emergencies in an oral emergency department.

To retrospectively analyze the rescue of medical emergencies and critical patients in the oral emergency department in a hospital during the past 14 years; analyze the general condition of patients, their diagnosis, etiological factors, and outcomes of the disease, so as to improve the ability of oral medical staff to deal with emergencies; and optimize the emergency procedures and resource allocation in such departments. Data and related information of critical patient emergency rescue from the Emergency Department of the Hospital of Stomatology, Peking University from January 2006 to December 2019, were analyzed. A total of 53 critical patients were rescued in the oral emergency department in the past 14 years, which is an average of four cases per year, with an incidence rate of 0.00506%. The main type of emergency included hemorrhagic shock and active hemorrhage, with the highest incidence being in the age group of 19-40 years old. Among these cases, 67.92% (36/53) developed emergency and critical diseases before visiting the oral emergency department and 41.51% (22/53) had systemic diseases. After rescue, a total of 48 patients (90.57%) had stable vital signs and 5 (9.43%) died. Oral doctors and other medical staff should be able to rapidly identify medical emergencies in oral emergency departments and commence emergency treatment. The department should be equipped with relevant first-aid drugs and devices, and medical staff should be regularly trained in practical first-aid skills. Patients with oral and maxillofacial trauma, massive hemorrhage and systemic diseases should be evaluated and treated according to their conditions and systemic organ function to prevent and reduce medical emergencies.

1094 Exercise syncope as initial symptom of constrictive pericarditis in a young patient

Abstract Introduction Constrictive pericarditis is a form of diastolic heart failure that arises because an inelastic pericardium inhibits cardiac filling. Syncope is a rare initial symptom of constrictive pericarditis. Clinical case A 22-year-old man with previous medical history of viral meningitis when he was 3 months-old but without any family history of cardiac disease or sudden cardiac death, was admitted to the Emergency Department for syncope. During the last year, he had suffered several episodes of intense exercise-related syncope. The patient denied having prodromes, chest pain, palpitations or any other symptoms. The physical exam of the patient was normal with stable vital signs. Normal S1 and S2 heart sounds were present, no murmurs or gallop. There were no signs of heart failure, only a minimal jugular ingurgitation. An electrocardiogram (ECG) revealed sinus rhythm, signs of bi-atrial enlargement (prominent P-wave with P mitral morphology in DI-II leads, with enhanced negative deflection in V1), and negative asymmetric T-waves in inferior (DII-III-aVF) and V6 leads. Chest X-ray showed minimal calcium density in the inferior pericardial silhouette. The patient was admitted in the Cardiology Department for aetiological study. A transthoracic echocardiogram revealed a marked protodiastolic cleft in the interventricular septum, with 40% variations of the transmitral flow with the respiratory changes and dilation of the cava vein, with absent respiratory collapse. A marked thickening and calcification of the inferoposterior pericardium was also seen. Considering these results, the diagnosis of constrictive pericarditis was suggested (Fig. A, B, C). Blood tests for autoimmune disease screening, as well as infectious diseases, including Quantiferon test, HIV, HVC, HVB and other viral serologies were done, with negative results. A cardiac magnetic resonance was requested, which confirmed the echocardiographic findings, with bi-atrial enlargement and markedly thickened pericardium with loss of signal, suggestive of calcification. Left and right ventricle had normal dimensions and contractility. The CT coronary angiography revealed normal coronary anatomy. Extensive calcification and pericardial thickening were shown, with myocardial infiltration in the lateral-basal area (Fig D). It was considered important to rule out any additional arrhythmic aetiology of the exercise syncope. Therefore, a stress test and, an electrophysiologic study were done, both with normal results. The patient remained asymptomatic and a pericardiectomy was indicated given the severe thickening and calcification of the pericardium and frequent syncopal episodes that our patient suffered. Conclusions Syncope as the initial symptom in the absence of significant right heart failure signs is a very unusual form of presentation of idiopathic constrictive pericarditis given the severe thickening and calcification of the pericardium of our patient. Abstract 1094 Figure.