Case report: Traumatic lingual hematoma

We describe a case of traumatic lingual hematoma in a patient on dual antiplatelet therapy. After securing the airway, bilateral lingual artery embolization successfully halted expanding hematoma formation. Patient subsequently required tracheostomy for continued airway edema. Although patient course was wrought with postoperative complications, we review this case to illustrate how prompt hematoma evacuation and embolization can resolve significant vasovagal bradycardia and hypotension secondary to expansile lingual hematoma.

Parent Advocacy Group for Events of Resuscitation

BACKGROUND

The presence of patients' families during resuscitation has been an important practice issue. An American Association of Critical-Care Nurses (AACN) practice alert "Family Presence During Resuscitation and Invasive Procedures" supports family members of patients undergoing resuscitation being given the option of bedside presence. Parent Advocacy Group for Events of Resuscitation (PAGER) is an interdisciplinary collaborative in the pediatric intensive care unit.

OBJECTIVES

To ensure that patients' families are provided the option of being with their child during cardiopulmonary resuscitation.

METHODS

Resuscitation data were collected for 12 months by using the AACN practice alert audit tool. The Family Nurse Caring Belief Scale was administered to 150 pediatric intensive care unit nurses. PAGER nurses received crisis education.

RESULTS

Pediatric intensive care unit nurses were supportive of providing the option of family presence during resuscitation. Family Nurse Caring Belief Scale data revealed areas for improvement in family caring practices. PAGER was implemented with positive outcomes for 2 families.

CONCLUSIONS

PAGER has improved the care of families whose children experience cardiopulmonary resuscitation and should be implemented in pediatric critical care units. PAGER nurses are prepared to serve as role models in providing family-sensitive care during crisis.

Intra-accumbal administration of shRNAs against CART peptides cause increases in body weight and cocaine-induced locomotor activity in rats

In order to examine the effect of cocaine and amphetamine regulated transcript (CART) peptide depletion in adult rats, CART shRNAs or scrambled control shRNAs were administered bilaterally into the nucleus accumbens (NAc). There was an increase in body weight of the shRNA injected rats compared with the rats injected with the scrambled RNA. This is compatible with the data showing a role for the peptide in body weight and food intake. Also at this time, there was about a two-and-a-half fold increase in cocaine-mediated locomotion in the shRNA injected rats compared to the control rats. This finding is critical support for the hypothesis that endogenous CART peptides in the NAc inhibit the actions of cocaine and other psychostimulants. In immunohistochemical experiments on these same animals, there was a decrease in the staining density of CART peptide in the NAc of the shRNA injected rats. These data show that shRNA can reduce CART peptides in the NAc and that endogenous CART peptides influence body weight and cocaine-induced locomotor activity (LMA).

Management options in penetrating rectal injuries

A retrospective analysis of 54 patients (1976-1989) with penetrating rectal injuries was carried out to evaluate the options in management. The diagnosis was made on proctosigmoidoscopy in 39 patients and at laparotomy in 15. Three patients died within 24 hours from extensive associated trauma (Abdominal Trauma Index [ATI] 39.2). In the remaining 51 patients, rectal wound repair was performed in seven patients, four without proximal colostomy (mean ATI 16.5) and three with colostomy (mean ATI 24.8) without complications. Colostomy and presacral drainage with or without repair were employed in 43 patients. Twenty-one of these patients had rectal washout in addition. The other 22 patients did not have this procedure. The incidence of pelvic abscess in these two groups, who had comparable mean ATI, was identical (4.7% and 4.5%, respectively). One other patient with an extraperitoneal rectal injury had a colostomy alone without presacral drainage and subsequently developed pelvic abscess. The overall incidence of abscess was three of 51 patients or 5.8%. There were no late deaths from sepsis. It is concluded that colostomy (loop or end) and presacral drainage are the most important components of rectal injury management. Small and isolated rectal or rectosigmoid perforations may be repaired primarily without fecal diversion. The value of distal rectal irrigation remains to be proven, but it may be indicated in high-energy injuries of the rectum.