Complications classification of local cold injury

The OBJECTIVE of this work was to develop a classification of complications of local cold injury.METHODS AND MATERIALS. The study is based on the results and analysis of the treatment of 132 patients with local cold injury of the II–IV degree of the lower extremities. The victims were hospitalized in the regional center for thermal trauma on the basis of the «City Clinical Hospital № 1» in the period from 2018 to 2019. Post-traumatic complications were detected in 54 patients (40.1 %), of which 32 developed early and 22 patients developed late complications. The remaining 78 patients after discharge from the hospital did not seek medical help again and were under the supervision of a polyclinic surgeon.RESULTS. In the course of the study, it was found that in 32 out of 132 patients in the early period of local cold injury of the lower extremities, sensitivity disorders, muscle weakness, convulsions, impaired coordination of movements, graft rejection, wound suppuration and suture failure, stump necrosis were detected in the affected segments of the extremities. 22 victims developed late complications of local cold injury: trophic ulcers of the stumps of the feet, osteomyelitis with the formation of sequesters, gangrene of the stumps of both feet. As a result of the study and pathogenetic interpretation of the consequences of cryoinjury, a new classification of complications of local cold injury was formed and the criteria for the forms of «cold extremity» were identified.CONCLUSION. Post-traumatic complications were detected in almost half of the victims with local cold injury (54 patients, 40.1 %). Thus, in the early stages of cryoinjury, 32 patients were found to have impaired sensitivity of the affected limb, muscle weakness, convulsions, and impaired coordination of movements; 4 (12.5 %) had treatment complicated by graft rejection; 5 (15.5 %) had wound suppuration and suture failure; 2 (6.25 %) had stump necrosis. In the late period, complications of local cold injury were registered in 22 patients. Of these, 12 (55 %) patients were found to have trophic disorders; osteomyelitis was detected in 8 (36 %) patients; in 2 (9 %) — gangrene of the distal segment of the affected limb.

Exertional Heatstroke, Asesmen Cepat Dan Penatalaksanaan Tepat: Laporan Kasus

Heatstroke is the most severe heat illness which homeostatic thermoregulatory mechanism is failed, characterized by an elevation of the core body temperature above 40 oC, central nervous system dysfunction, and possible multi-organ failure. Heatstroke is the third leading cause of death among athletes. Exertional heatstroke (EHS) is exercise-induced; usually affects young healthy people during strenuous physical activity and have not acclimatized to environmental heat stress. Frequently encountered complications include encephalopathy, acute respiratory distress syndrome, myocardial injury, acute kidney injury, hypoglycemia, intestinal ishemia or infarction, pancreatic injury, rhabdomyolysis, disseminated intravascular coagulation (DIC), hypocalcemia, lactic acidosis, and hepatic failure. Immediate cooling is the cornerstone of treatment which evaporative cooling is preferred. Aspiration and seizure are common; airway management, oxygenation, and ventilation have to be adequately maintained. Crystalloid-fluid resuscitation is essential, averaging 1200 mL in first 4 hours. Systemic complications of heatstroke should be well-managed to prevent worse outcome. A case of 32-years-old man with no significant medical history was brought to emergency department after collapsing while running into the 20-kilometres marathon. He was unresponsive (GCS E1V2M1), had serial generalized seizure and hematemesis-melena. On primary survey, the patient was shocked (BP 67/24 mmHg, HR 165 bpm, cold extremity), tachypnea (41/min), hyperthermia (40.5oC rectally), SpO2 95% on simple mask 10 L/min. His laboratory results showed full-blown complications of heatstroke. Immediate rehydration therapy using saline solution and colloid solution intravenously was started, followed with blood or blood component transfusion. Tracheal intubation and mechanical ventilation were performed. During the intensive treatment, he became fully conscious and was extubated on hospital day 7. He was hemodynamically stable without any support, but developed multi-organ failure. Unfortunately, on twentieth day, he was cardiac arrest during hemodialysis and died four days later.

Death predicictive factor in terminal cancer patients

18627 Background: One of the most important role of a end-of-life care is to control physical symptoms of patients and help them to face comfortable end. In terminally ill cancer patients, accurate prediction of survival is necessary for clinical and ethical reasons, especially in helping to avoid harm, discomfort and inappropriate therapies and in planning specific care strategies. The aim of the study was to investigate prognostic factor of death for the patients with terminal cancer. Methods: We enrolled 121 patients with the terminal cancer of Kangnam St. Mary’s Hospital from September 2004 until their death. We observed symptoms shown in dying patients and assess 17 common symptoms shown in terminally ill cancer patients, performance status, pain and analgesic use. The common symptoms were measured in a score of 0-none, 1-mild, 2-moderate, 3-severe or 4-severe by objective criteria. Results: Mean period from enrollment to death was 34.7days. The most important prognostic factor is performance status (KPS), average KPS at enrollment is 52.2% and at last 48hours is 29.8%. Physical symptoms that have significant prognostic importance are weakness, anorexia, dry mouth, dysphagia, dyspnea. VAS and analgesic use dose not impact on the prognosis. But cognitive impairment and delirium are the reliable prognostic factor. Especially weakness, dry mouth, poor oral intake, drowsiness, edema, dyspnea, ascites, icterua gradually worsened with significance. Dying patients showed markedly decreased blood pressure, cyanosis, cold extremity, death rattle, abnormal respiration frequently at 48hours before death. Conclusions: Terminally ill cancer patients have various prognostic factor and the most important factor is performance status. The death predictive symptoms such as markedly decreased pressure, cyanosis, cold extremity, death rattle, abnormal respiration appeared at last 48hours. If we assess the symptoms more carefully, we can predict the more accurate prognosis. The communication about the prognostic information will influence the personal therapeutic decision and specific care planning. No significant financial relationships to disclose.