Rhonchi

Summary for patients. Those Incentive Spirometry orders stand!

Preoperative Pulmonary Risk Stratification for Noncardiothoracic Surgery: Systematic Review for the American College of Physicians — Smetana et al. 144 (8): 581 — Annals of Internal Medicine
The authors found good evidence that the following patient factors increase the chances of pulmonary complications: older age, American Society of Anesthesiologists class II or higher, chronic obstructive pulmonary disease, dependence on others for help with daily activities, and congestive heart failure. The authors also found good evidence that pulmonary complications are most common with aortic aneurysm repair, thoracic surgery, abdominal surgery, neurosurgery, vascular surgery, head and neck surgery, surgery lasting for more than 3 hours, emergency surgery, and general anesthesia. The only laboratory test result that predicted pulmonary complications was low serum albumin level (blood test that indicates poor nutritional status). The authors found good evidence that strategies to expand the lungs after surgery, such as deep breathing exercises, reduce the risk for pulmonary complications. They found fair evidence that selective use of a nasogastric tube (a tube passed through the nose to the stomach) for nausea, vomiting, or abdominal distention only reduces pulmonary complications after abdominal surgery. They found insufficient evidence to draw firm conclusions about the effectiveness of other strategies to reduce pulmonary complications.

New York Daily News – Home – WTC air doomed ex-cop

An autopsy of a retired NYPD detective confirmed yesterday what his family and fellow cops long suspected – that James Zadroga’s death was “directly related” to the Ground Zero cleanup.

The stunning findings are believed to mark the first time the death of a cleanup worker has been officially tied to the aftermath of the terror attacks.

“It is felt with a reasonable degree of medical certainty that the cause of death in this case was directly related to the 9/11 incident,” Dr. Gerard Breton, a pathologist at the Ocean County, N.J., medical examiner’s office wrote in the Feb. 28 autopsy report.

Zadroga died on Jan. 5 of pulmonary disease and respiratory failure – and he had lung-tissue inflammation Breton attributed to “a history of exposure to toxic fumes and dust.”

…

Zadroga spent more than 450 hours at Ground Zero, digging through debris and inhaling the noxious gases that are believed to be related to death.

“On Sept. 11, 2001, James Zadroga was a 29-year-old healthy human being,” Palladino said.

But after his work at the 9/11 site, the nonsmoker’s health “began to deteriorate rapidly,” Palladino added.

Zadroga developed respiratory ailments, had difficulty breathing and was found to have fiberglass in his lungs, Palladino said.

The cop retired on a disability on Nov. 1, 2004. The 34-year-old widower died at his parents home in Little Egg Harbor, N.J., just over 14 months later.

In January, the Daily News revealed that 22 other men, most in their 30s and 40s, have died from causes their families say were accelerated by working at Ground Zero after the attacks.

Yesterday, Palladino said that nearly 400 NYPD detectives are suffering from symptoms believed to have been brought on by their work at the disaster site.

CurEvents.com – A Global Current Events Discussion Forum – Avian influenza (H5N1): implications for intensive care.
Abstract
Background As influenza A/H5N1 spreads around the globe the risk of an epidemic increases.
Discussion Review of the cases of influenza A/H5N1 reported to date demonstrates that it causes a severe illness, with a high proportion of patients (63%) requiring advanced organ support. Of these approx. 68% develop multiorgan failure, at least 54% develop acute respiratory distress syndrome, and 90% die. Disease progression is rapid, with a median time from presentation to hospital to requirement for advanced organ support of only 2 days.
Conclusion
The infectious nature, severity and clinical manifestations of the disease and its potential for pandemic spread have considerable implications for intensive care in terms of infection control, patient management, staff morale and intensive care expansion.

Complete list of plans for the Avian Flu, by state:

State Pandemic Plans | PandemicFlu.gov
Listed below are pandemic plans that are currently available on state Web sites. We will update this page as additional plans become available.

AARC Webcast Central:

Looks like a good service from the AARC. Live and archived webcasts for AARC members. The upcoming one about the issue of Mechanical Ventilation in Mass Casualty settings looks like an important one.

My buddy Hedgehog has a new group on MySpace called http://groups.myspace.com/HealthTravel for folks who are travelers in health care. If you’re an RT or other medical professional check it out.