Incomplete spinal cord injuries--nursing diagnoses

Patients with incomplete spinal cord injuries may face physiologic instability and functional uncertainty during the acute phase. Although the injury is incomplete, critical care nurses are challenged to accurately assess and rapidly develop interventions for these patients. Developing potential and actual nursing diagnoses assists the critical care nurse in preventing and reducing complications.     

Incomplete dabigatran reversal with idarucizumab

Context: With increasing use of direct oral anticoagulants (DOACs), urgent reversal of these agents becomes a growing concern. Idarucizumab is a humanized monoclonal antibody fragment that specifically binds to dabigatran with higher affinity than thrombin, rapidly neutralizing its anticoagulant effect without increased risk of thrombosis.

Case details: We describe two cases in which the recommended dose of idarucizumab was unsuccessful in completely reversing the anticoagulant effects of dabigatran. Both of these patients were noted to have supratherapeutic international normalized ratios (INRs) and high dabigatran concentrations. In the first case, an 86-year-old male underwent an emergent procedure and experienced excessive hemorrhaging refractory to blood product repletion, idarucizumab, and factor eight inhibitor bypass activity (FEIBA). In the second case, a 62-year-old female in shock was found to have elevated dabigatran concentrations despite two doses of idarucizumab, continuous renal replacement therapy (CRRT), blood product repletion, and FEIBA. Both patients ultimately expired from their coagulopathies.

Discussion: These cases illustrate the potential for incomplete reversal of dabigatran with the recommended 5?g of idarucizumab and emphasize the importance of early detection of dabigatran toxicity. While direct dabigatran serum concentrations are not readily available, the INR may be a useful surrogate marker for supratherapeutic dabigatran concentrations.     

小儿肠套叠水压灌肠复位不全的超声表现

目的 探讨超声引导下小儿肠套叠水压灌肠复位不全的超声声像图表现.方法 复习15例小儿肠套叠水压罐肠复位"成功"(最后诊断为复位不全)后24 h内又复套患儿,对其灌肠时超声图像表现、灌肠时间长短、最大水压力、进水量、肠系膜淋巴结肿大情况以及患儿发病时间长短的异同进行回顾性分析,对比短期内无复套的患儿,寻找短时间内(24 h内,下同)复套患儿的不同超声声像图表现.结果 短时间内复套患儿在套叠部位、水压力大小、操作时间长短以及淋巴结肿大方面均无明显差别,而其回盲瓣开放后无闭合动作,以及小肠进水时不彻底即复位不全是其共同点.结论 小儿肠套叠短时间内复套主要是水压灌肠复位不全引起的,回盲瓣开放后无闭合动作,小肠进水时部分小肠没有疏通是水压灌肠复位不全的特征性声像图表现.识别其复位不全的特征性超声表现可以避免短时间内再次水压灌肠或手术治疗.     

米索前列醇在药物流产不全中的应用

米索前列醇是一种前列腺素E1的类似物，对子宫有较强、较频的作用，与米非司酮配伍终止早孕完全流产率达90％以上，由于此方法简单方便，痛苦小，已普遍开展，广泛应用，但由于药流以后易造成残留，出血刮宫等，一直是临床探讨的问题，本文就米索前列醇在药流过程中的应用进行了观察。     

Incomplete pretransfusion testing leads to surgical delays

BACKGROUND: The Joint Commission has highlighted the importance of having appropriate and complete pretransfusion testing before surgery begins. The maximum surgical blood ordering schedule (MSBOS) indicates which patients require preoperative transfusion testing. We determined the number of times surgical delays were caused due to the lack of completed pretransfusion testing. STUDY DESIGN AND METHODS: All transfusion events reported through the common medical event reporting system of eight networked hospitals over a 12‐month period were evaluated to determine how often patients experienced surgical delays due to not having complete pretransfusion testing. RESULTS: During this 12‐month period 12 patients were identified who were either in or en route to the operating room with incomplete pretransfusion testing leading to a delay in providing crossmatched red blood cells (RBCs). In 6 of 12 cases a new antibody was discovered, which required extra time for the provision of crossmatched RBCs, while in 4 of 12 patients the samples were not sent or were lost on the way to the blood bank. In the remaining two patients other parts of the pretransfusion testing process were not followed according to hospital policy. The median surgery start time delay was approximately 12 hours (range, 1‐168 hr) in 11 of 12 cases. One patient's case was not aborted when it was discovered that crossmatched RBCs were not immediately available due to newly detected alloantibodies. CONCLUSIONS: We identified three mechanisms by which delays in completing pretransfusion testing in surgical patients occurred. Adherence to the MSBOS and sample collection policies should reduce delays.     

Behavior of Incomplete Antibodies in Quantitative Hemagglutination Reactions

The increase in agglutinating activity of group O sera following centrifugation has been related to incomplete, cross-reactive antibodies in these sera. The effect is thought to be due to steric interference of smaller 7S, cross-reactive molecules by the larger 19S agglutinins rather than to any lack of equilibrium in the agglutinating system.
An increase in activity was also demonstrated with anti-Rh sera containing saline agglutinins and incomplete antibodies following centrifugation. With anti-Rh sera, centrifugation at 17,750 × g for 7.5 minutes was required to produce the same effect apparent with group O sera centrifuged at 100 × g for two minutes.
High speed centrifugation produced saline agglutination with incomplete anti-Rh antibodies equivalent to that produced in 20 per cent bovine albumin.     

Incomplete Relaxation between Beats after Myocardial Hypoxia and Ischemia

Recovery from hypoxia has been shown to prolong cardiac muscle contraction, particularly the relaxation phase. The present studies were designed to examine whether incomplete relaxation between beats can result from this prolongation of contraction and relaxation in isolated muscle after hypoxia and in the canine heart after both hypoxia and acute ischemia. The relationship between heart rate and the extent of incomplete relaxation is emphasized in view of the known enhancement of the velocity of contraction caused by increasing heart rate.The extent of incomplete relaxation during 10-s periods of pacing at increasing rates was examined before and after hypoxia in isometric cat right ventricular papillary muscle (12-120 beats/min) and in the canine isovolumic left ventricle (120-180 beats/min). Incomplete relaxation was quantified by measuring the difference between the lowest diastolic tension or pressure during pacing and the true resting tension or pressure determined by interruption of pacing at each rate. In eight cat papillary muscles (29 degrees C), there was significantly greater incomplete relaxation 5 min after hypoxia at rates of 96 and 120 beats/min (P < 0.02 vs. before hypoxia). In seven canine isovolumic left ventricles, recovery from hypoxia and higher heart rates also resulted in incomplete relaxation. Incomplete relaxation before hypoxia at a rate of 180 beats/min was 0.8+/-0.5 cm H(2)O and at 5 min of recovery from hypoxia was 12.6+/-3.5 cm H(2)O (P < 0.01). 12 hearts were subjected to a 1.5-3-min period of acute ischemia and fibrillation. There was significant incomplete relaxation at a rate of 140 beats/min for 5 min after defibrillation and reperfusion.These data indicate that incomplete relaxation is an important determinant of diastolic hemodynamics during recovery from ischemia or hypoxia. The extent of incomplete relaxation appears to be a function of the rate of normalization of the velocity of relaxation and tension development after ischemia or hypoxia, the heart rate, and the magnitude of developed tension or pressure.     

雌-孕激素联合生化汤加减治疗不完全流产

目的观察雌-孕激素联合生化汤对不完全流产患者的临床治疗效果。方法将90例不完全流产患者按简单随机方法分为雌-孕激素组48例和雌-孕激素联合生化汤组42例。雌孕激素组给予补佳乐2mg bid+黄体酮胶囊50mg bid口服,共10d;雌-孕激素联合生化汤组在雌孕激素组给药基础上给予生化汤(当归15g,川芎15g,桃仁12g,益母草12g,川断12g,泡姜15g和炙甘草9g),1剂·d-1,煎服,连服10d,气虚者加黄芪和桂枝。观察2组宫腔组织物排出情况及月经恢复情况,并进行疗效评定。结果雌-孕激素组中有效12例,显效10例,无效26例,总有效22例,总有效率为45.8%;雌-孕激素联合生化汤组中有效32例,显效8例,无效2例,总有效40例,总有效率为95.2%。2组总有效率差异有统计学意义(P<0.05)。结论对于不完全流产患者可以选择雌-孕激素联合生化汤治疗,既避免了二次清宫术,减少清宫术并发症的发生,并可达到治愈目的。更多还原     

思他宁对老年人不完全性肠梗阻的临床研究

目的:探讨思他宁对老年人不完全性肠梗阻的疗效及可能机制.方法:将60例老年人不完全性肠梗阻患者随机分为实验组(n=33)和对照组(n=27).对照组给与常规治疗,实验组在常规治疗基础上加用思他宁6 mg加入生理盐水500 mL中静脉滴注,维持24 h.比较治疗前后两组疗效.结果:实验组腹痛腹胀的缓解率93.9%和恢复排便排气的比率90.3%均明显高于对照组的66.7%和65.4%,P均<0.05.结论:老年人不完全性肠梗阻在常规治疗的基础上加用思他宁可取得较好疗效.