Case Report of Serratus Plane Catheter for Pain Management in a Patient With Multiple Rib Fractures and an Inferior Scapular Fracture
We placed a superficial serratus anterior plane catheter in an elderly woman with dementia and elevated clotting times who presented with multiple rib fractures after a mechanical fall. She was not a surgical candidate, and treatment consisted of conservative management with physical therapy and pain control. She was not a candidate for a patient-controlled analgesia regimen because of her dementia. Given her elevated international normalized ratio, thoracic epidural and paravertebral analgesia was also contraindicated. We placed an ultrasound-guided serratus anterior plane catheter, allowing titratable continuous infusion in a trauma patient, resulting in excellent analgesia without adverse effects.
ConclusionOur baseline data highlights that education and change implementation needs to be tailored to the recipient site, recognising site-specific barriers to change. We will now use this data in our Work-based Learning intervention.
ConclusionWhilst some areas of Comprehensive Geriatric Assessment are achieved adequately, others are not. Our electronic assessment did not include a Geriatric Depression Score. Although pain was frequently assessed, again a score was not always used. Other areas for improvement include visual acuity, fractures and osteoporosis and advanced care planningThe results of this audit have been presented to the team, adjustments have been made to our electronic assessments so that we can record and capture this data better. There will be a reaudit in 6 month’s to evaluate improvement.
r M Abstract OBJECTIVE: Fast track concepts are used to reduce the risk of perioperative and postoperative complications after total knee arthroplasty. INDICATIONS: The described concepts are used for patients with indications for the implantation of a total knee prosthesis. CONTRAINDICATIONS: Contraindications for fast track concepts are aged patients, dementia, American Society of Anesthesiologists (ASA) grade IV and implantation of large revision or tumor prostheses. Contraindications for tranexamic acid are bleeding in the urinary tract, caution in cases of known epilepsy, individual risk assessment ...
ConclusionsObservation of PAIC items can be done reliably in healthcare settings. Observer agreement is quite promising already without extensive training.
Abstract The diagnostics of pain in older people with cognitive impairments should always consist of a subjective self-report of pain and a structured observation of pain behavior. It is important to note that the subjective self-report of pain becomes less valid with increasing cognitive decline (starting with a moderate degree of dementia). The external observation of pain behavior should include at least the three behavioral domains facial expressions, body movements and vocalization and should be performed during resting situations and during activities of daily living. Moreover, the patient should b...
Geriatric patients are at high risk of falls secondary to imbalance, weakness, higher prevalence of dementia, and medical co-morbidities frequently resulting in fracture. Mobility is critical to optimize healing and minimize loss of bone and muscle mass following fracture. However, the most common reason why many patients are unable to participate is poorly controlled pain . Geriatric patients are at high risk of developing post-operative delirium which is multifactorial in etiology, including anesthetic agents, poly-pharmacy, being in unfamiliar surroundings, and pain medications [2 –6].
Conclusions: POD patients were older and had more comorbidities. POD patients had lower QoR scores at T24 suggesting an adverse impact of delirium in postoperative quality of recovery. POD patients stayed for long in the PACU and at hospital.
ConclusionsThe final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed ‐on meta‐tool for Pain Assessment in Impaired Cognition, the PAIC‐15 scale.This article is protected by copyright. All rights reserved.
DiscussionThe number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.
The exacerbating of a clinical condition or the occurrence of negative symptoms after an inert substance dispensation or a sham treatment is known as “nocebo effect”. Nocebo is the psychobiological effect due to the negative psychosocial context that accompanies a therapy and it is a direct consequence of negative expectations by the patients and their own personal characteristics. Although the clinical relevance of the phenomenon is now recognised, a small number of studies has tried to ascertain its neural underpinnings (that it means nocebo responses). Moreover, there is no consensus on the brain networks ...