The Journal of Medicine, Law & Public Health

Evacuating Patients with Ongoing Dialysis

2023-09-14T04:56:06-07:00

Introduction:

Efficient planning is crucial for the safe evacuation of dialysis patients during a disaster. The lack of evidence-based approaches for evacuating these patients highlights the need to explore the associated challenges and develop a comprehensive plan to address the unique vulnerabilities of this cohort.

Methods:

Information was gathered using three methods: First, a thorough literature search was conducted. Secondly, a focus group was established, comprising experts in nephrology, biomedical engineering and safety engineering, as well as senior dialysis nurses. Finally, the research team visited a dialysis centre to examine the dialysis machines and engage in discussions regarding evacuation plans.

Results:

Three procedures were identified to promptly release patients from a dialysis machine: the ‘clamp and cut’ method, the ‘clamp and cap’ method, and the hand crank method. Factors such as the size and weight of the dialysis machine, battery life, and potential blood loss resulting from immediate interruption of the dialysis process were noted as important considerations.

Conclusion:

It is essential that dialysis patients be recognized as a vulnerable group, and that time and effort be invested in the design of an evacuation plan specific to their needs.

Utility of Previous Culture Results for Guiding Empirical Treatment of Sepsis in The Emergency Department

2023-07-16T07:25:59-07:00

Background: Sepsis is a serious medical condition and a major cause of morbidity and mortality, and poses challenges in terms of recognition and management. Although studies have investigated the early identification of sepsis and early use of broad-spectrum antibiotics, no clear criteria exist to identify those patients needing additional coverage for resistant organisms.

Aims: This study aims to evaluate the utility of previous positive blood or urine culture results in predicting the presence of resistant organisms in septic patients in the emergency department (ED).

Methods: This retrospective observational study was conducted at King Fahad Medical City (KFMC), a tertiary care centre in Riyadh, Saudi Arabia, between March and August 2021. Patients aged 18 years or older, who visited the ED at KFMC during the study period, were included if they had a positive blood or urine culture and met the sepsis definition.

Result: A total of 133 patients were enrolled (mean age 61.6 [18.3] years), of whom approximately half were male (67, 50.4%). We found that previous colonisation with resistant organisms was more likely in patients with resistant organisms at the time of the enrolled visit (n = 17, 77.3%) than in patients with non-resistant organisms (n = 22, 19.8%, p < .05). Therefore, one statically significant predictor of a current resistant organism is a prior colonisation with a resistant organism (OR = 13.8; 95% CIs 3.6, 51.9; p < .05).

Conclusion: Previous cultures, from within the last 12 months, are useful predictors of current resistant organisms, and are therefore essential in guiding empirical antibiotic treatment in septic patients in the ED. Further more extensive and prospective cohort studies on this subject are now needed to mitigate the burden of sepsis on healthcare systems worldwide.

Ketamine For Sickle Cell Priapism: A Case Report & Literature Review

2023-07-22T12:30:30-07:00

Priapism is a urological emergency that requires swift intervention to prevent complications. Here, we present a case in which ketamine effectively induced detumescence in an adult patient suffering from priapism secondary to sickle cell disease. Our review explores the efficacy of ketamine for priapism from diverse causes beyond sickle cell disease, as well as its use in paediatric populations, while also assessing its safety profile. Based on the evidence, we recommend the use of ketamine for priapism in acute care settings. The valuable insights provided by our study encourage additional investigation and educated clinical judgement to improve patient outcomes in the treatment of this condition.

Exploring Gerota’s Fascia: Revealing a Gross Image through Cadaver Dissection

2023-07-16T08:02:10-07:00