Posts Tagged ‘aneurysms’

Week in Review (April 18 – 22, 2011) The Eye Opener Health and Law Blog

Saturday, April 23rd, 2011

From the Editor:

This past week, our blawgers (guess I’ll use this term now since we are legal bloggers) were busy on their keyboards once again. They covered a number of topics relating to law, medicine, health and patient safety. This week we posted a primer on aortic aneurysms and how they can present as back pain, a blog about “robot” anesthesiology, a disturbing post about how the recent threat of a federal government shutdown was averted but at a cost to those who are in dire need of healthcare, an interesting piece about laughing gas making its way back into the American medical scene for labor and delivery and finally, and a highly read piece on a not-to-often discussed topic but one of potential grave concern – shift switching by nurses and how this might impact patient safety.

Here’s our usual “quick summaries” for you to peruse, click on, read and comment:

Aneurysms – a deadly condition you need to know about!

Our in-house medical specialist, Theresa Neumann, wrote another highly educational and need-to-know piece about a condition that can present as back pain but which has deadly consequences for those who have this condition.

As Theresa’s research made us aware – “1 in every 50 males over the age of 55 have an abdominal aneurysm, this is a more common pathologic diagnosis than some others.  Men also corner the market at an 8-to-1 ratio as compared to women with abdominal aneurysms.”

As is the case with all of Theresa’s writings, we offer through her valuable information from someone who’s “been there” and “done that” in the clinical setting. Don’t miss her post entitled Aneurysms: A Potential Deadly Condition That May Present as Back Pain.

Who’s using remote control and a joy stick to put a breathing tube down your throat?

Mike Sanders brought to our attention a new practice of anesthesiologists – in Canada – that may soon be part of anesthesia management in the United States as well – using robotics to intubate patients. While you can certainly learn about the concept of intubation by reading Mike’s blog, basically, this is placing a small tube down a patient’s airway so that the anesthesiologist can control the airway and provide ventilation to a patient undergoing surgery.

Here’s an except -

Medical News Today is reporting that Dr. Thomas Hemmerling of McGill University and his team have developed a robotic system for intubation that can be operated via remote control.

For more on this fascinating new project by Dr. Hammerling and his team, read Mike’s post entitled Robot Anesthesiologists?

Government Shutdown Avoided – but who will pay the price for the “deals” that were cut?

The newest member of our blogging team, Jason Penn (fast approaching veteran blawger status) did a fascinating piece of the story-behind-the-story of the recent crisis our country faced when the federal government was on the verge of a shutdown. We all know about deals being cut in the back rooms of congress. We all know that the government avoided a shutdown this time around when the senate and house worked out a compromise that resulted in millions of dollars being earmarked for cuts in the budget.

Jason tells us what programs relating to healthcare will suffer as a result of these negotiated cuts. As some wise person once said, “why is it always those who are least represented who bear the burden of budget cuts?” Maybe it’s because they can’t afford lobbyists to protect them like those who need protection the least can.

Read Jason’s eye opening and no-punches-pulled report on just who will be the victims of the deals in his post of this past week Budget Crisis Avoided, But What About the Babies? Can They Live With $504 Million Less in Funding?

Will moms-to-be now be “laughing” their way through labor and delivery?

One of our seasoned blawgers, who every now and then is driven to report on the off-beat issues of law, medicine and healthcare, Jon Stefanuca, stepped up to the plate once again and took a swing at the return of an old-timer to the arsenal of pain relief for mothers-to-be undergoing labor and delivery – laughing gas!

As Jon’s piece in Eye Opener this past week tells us -

It appears that a number of hospitals are now considering making laughing gas available as a pain relief measure for women in labor. A hospital in San Francisco and another in Seattle have been using laughing gas in their labor and delivery units for a while. Hospitals like Dartmouth-Hitchcock Medical Center plan to offer laughing gas to laboring mothers in the immediate future.

For more about this return of laughing gas to our obstetrical units, read Jon’s piece Laughing Gas Making Its Way Back Into the Labor and Delivery Department.

Nursing and Sleep Deprivation: Is it a risk factor for patient safety?

I suspect somewhere along the line you have done “an all-nighter” – whether it was getting ready for a big test, a social event, or for some other reason. Remember how you felt as you made it through that night or the next day? Have you ever done it several nights in the same week? How about doing it a few times one week and then do the same thing the next week and the next…. Well you no doubt get the idea. You’ve been exhausted, right? Well what about nurses, who have to do this for a living?

Nurses have lives too. They have children, home responsibilities and obligations, and some form of social life. What happens when they swap shifts or are asked to do “a double”?

Sarah Keogh was back blogging this past week and wrote a fascinating (and concerning) post entitled Nurses Switching Shifts: Does a Lack of Sleep Put Patients at Risk? We invite you to read Sarah’s piece and share your comments. Are you a nurse who lives this lifestyle? What are your thoughts about nurses being allowed to work multiple shifts or back-to-back shifts in terms of patient safety? Should there be restrictions on nurses’ shifts just as there (finally) are work restrictions on doctors-in-training?

A “Sneak Peak” of the week ahead

As part of our continuing effort to “get the word out there” on issues relating to health, medicine, patient safety and the law, we post from time to time more extensive research pieces called White Papers. Well, the time has arrived for another White Paper to be posted on our website. Marian Hogan has completed her piece on a very important topic – Patient Controlled Analgesia in today’s hospital environment. She examines how some hospitals are now heavily marketing a spa-like environment so you choose them over the competition. Yet lurking in the shadows of these facilities which promote flat screen TV’s, valet parking, in-room safes and the like is a very dangerous practice: placing patients on patient-controlled-analgesia (for pain relief) without vital monitoring devices and patient safety practices. It’s at the “printer” now; we hope to have it online this week.

From our blawgers you can expect reports on a disturbing fight between manufacturers and child safety experts over – blinds! After decades of controversy, you’ll find out where the battle lines are now drawn, who’s winning and who the real losers are in this war. Wonder how healthcare safety is doing since the report To Err is Human was published by the Institute of Medicine over a decade ago? Jason Penn will be providing an updated report card, which you should not miss. Alcohol and surgery – not a good combination! Jon Stefanuca plans on posting a piece that looks deeper in the obvious problems with this potentially deadly combination.

This is just a taste of what’s to come. I better wrap-up now. I’m working on finishing the third installment on Medical Technology and Patient Safety. Oh yeah, if time permits, I might even get to post a piece I’ve been working on this past week – a lawyer’s rant about our modern day love affair with mediation practices and trends.

As always, don’t forget - subscribe to the Eye Opener and tell your friends about us too! …and… don’t forget to join our social networking communities on Facebook and Twitter.

Hope you have a great weekend!

Aneurysms – A Potentially Deadly Condition That May Present as Back Pain

Monday, April 18th, 2011

I have been writing a series of blogs devoted to common and not-so-common causes of back pain, some of which cause devastating and catastrophic injury.  Aneurysms of the aorta, either in the chest or abdominal cavity, can present as back pain, and these can often be fatal if not diagnosed or treated in a short period of time.

Considering that 1 in every 50 males over the age of 55 have an abdominal aneurysm, this is a more common pathologic diagnosis than some others.  Men also corner the market at an 8-to-1 ratio as compared to women with abdominal aneurysms. Thoracic aneurysms make up only 10% of the total number of aneurysms of the aorta, but these have a much poorer prognosis.

What is an aneurysm?

An aneurysm is a localized dilatation (i.e. the widening or stretching of an opening or a hollow structure in the body) of a blood vessel or even the heart, itself, due to some induced weakness in the wall of the vessel. The aorta is the largest blood vessel leaving the heart and transporting blood, oxygen and nutrition to every cell in the human body. It has the highest pressures and the thickest walls.

Should the weakness in the wall of the vessel rupture, blood will be released in such quantities and at such high pressures that the rapid blood loss causes a rapid death in most patients. There are a few exceptions, depending on which side of the blood vessel ruptures. If the rupture occurs on the side facing the abdominal cavity, the blood loss tends to be rapid since no opposing structures obstruct the flow. If the rupture occurs on the side facing the spinal column, structures in the near vicinity can actually slow the flow of blood allowing for a small time frame for diagnosis and intervention to occur. Sometimes, there is a slow “leak” of blood prior to a massive rupture, and this blood causes irritation and pain, allowing for a “window-of-opportunity” for a diagnosis to be made and intervention to occur.

I’ve provided a link at the end of this article to a well done video explaining aneurysms.

Real Case Scenario:

Patient M was a 62-year-old, moderately obese female, who came to the ER when I was working one day, complained of some vague low back pain and several episodes where she briefly lost consciousness that morning while trying to get up and move around. No injuries were sustained, but she felt very weak and light-headed. Her blood pressure was 109/68 while lying flat with a heart rate of 96. An attempt was made to obtain a blood pressure while sitting, but Patient M became near-syncopal and sweaty. A quick examination of her abdomen revealed a pulsatile aneurysm in her abdomen measuring 6cm (almost 2 1/2 inches wide). I was able to contact the vascular surgeon, have nurses place appropriate IV lines and obtain labs, and I notified the nursing supervisor regarding the need for an operating room. Patient M actually went for a CT scan on her way to the OR; the CT verified a “leaking” abdominal aortic aneurysm. Patient M was in the OR within 20 minutes of my evaluation. Upon opening the abdomen, the bleeding worsened, but the surgical team was prepared. They did have to resuscitate Patient M once, but a repair of the aorta was effective, and she went home within one week of her life-saving operation!

How is an aortic aneurysm diagnosed?

Most are actually diagnosed incidentally when patients undergo various diagnostic studies for other, unrelated complaints.These are the luckiest patients, because aneurysms can be detected early, monitored and then the patient can be offered elective intervention before an acute rupture occurs. It seems that 5cm (about 2 inches) is the “magic number” when it comes to an indication for repair since an aneurysm larger than that significantly increases the risk of rupture. Now, with endovascular (i.e. procedures in which a catheter is placed inside the blood vessel) repair options (“stenting procedures”), some of these aneurysm repairs can be done in a minimally invasive manner, offered even earlier, and have very good outcomes with only 2-to-3 day hospital stays.

Routine but thorough physical exams by a conscientious practitioner can ofter detect aneurysms in the abdomen simply by feeling the abdomen by hand. The chest cavity is more difficult for obvious reasons. Chest x-rays can sometimes suggest a problem if calcifications are present in the vessel wall (high-lighting the vessel contour) or if abnormalities are detected in the mid-line structures that overlap in this 2-dimensional picture. These patients can then undergo subsequent imaging studies to determine the existence and extent of the aneurysm.

When aneurysms go undetected, the acute presentation can also vary depending on the location of the aneurysm both in relation to the distance from the heart and the side of the vessel. Because of the position of the aorta anatomically (close to the spine), patients often experience back pain due to impingement of the spine and spinal nerves. If the aneurysm is in the chest cavity (thoracic), one often will feel upper to mid-back pain that can range from dull and aching to searing and excruciating; this may or may not accompany chest pain and other symptoms. If the aneurysm is in the abdomen (most often below the arteries that supply the kidneys), a patient will often complain of low back pain that could extend into the groin, and again, this pain can be dull and aching or sharp and excruciating.

What causes aortic aneurysms to occur?

The most common cause of aortic aneurysms is atherosclerotic vascular disease, commonly called cholesterol-plaqueing of the arteries. There are a multitude of other causes such as genetic conditions, fungal infections, bacterial infections, and other collagen-vascular diseases. Those individuals who have abnormal cholesterol panels, high blood pressure, perhaps a history of coronary artery disease or peripheral vascular disease, and diabetes are at risk for aortic aneurysms as they age.

Bottom line?

So, a person who is a little older with perhaps some of these notable risk factors who develops unusual back pain with no apparent precipitating cause (excessive physical activity/labor, fall, etc.) should be evaluated for a possible aneurysm. If present and detected, it is often a treatable condition; left untreated, it will ultimately lead to death, which is often sudden. Medical technology even offers minimally invasive procedures that are quite effective if treated early enough and located in an accessible region. Keep in mind that thoracic aneuryms do have a worse prognosis than abdominal aneurysms.

Here’s the link to the video explaining aneurysms.

Image from aorticstents.com