Post-traumatic pulmonary embolism (PE) poses diagnostic complexities, especially with underlying lung pathologies and delayed symptoms. We report a 43-year-old male who presented with cough, frothy sputum, and dyspnea following blunt chest trauma 2 weeks ago. Due to a history of asthma, an asthma exacerbation was suspected but he failed to respond to bronchodilator therapy. Doppler USG (ultrasonography) was negative for deep venous thrombi, however, elevated D-dimer levels prompted further investigation with computed tomography pulmonary angiography (CTPA), confirming the diagnosis of PE. Prompt initiation of anticoagulation and thrombolysis resulted in clinical improvement. This case underscores the need to rule out posttraumatic PE, irrespective of age, type of, or time since injury, and underlying lung disease, to ensure timely diagnosis and intervention.

2024-11-01·Journal of Allergy and Clinical Immunology: Global

Assessing sterility techniques in bronchodilator responsiveness testing by practicing allergists in North America

Article

作者: Singh, Neel ; Sharif, Naba ; Gupta, Dhruva ; Sekhsaria, Sudhir ; Chhabra, Kabir

BackgroundThe American Thoracic Society has published general guidelines for sterility when testing for bronchodilator responsiveness. However, the extent to which practicing allergists implement sterility measures is currently unknown.ObjectiveThis study aims to understand the adherence to the American Thoracic Society guidelines for sterility among practicing allergists.MethodsIn 2015, a questionnaire was approved and distributed by the American Academy of Allergy, Asthma & Immunology to all its members. The anonymous responses were recorded and tabulated after a 3-week period.ResultsOf the 6800 allergists who received surveys from the American Academy of Allergy, Asthma & Immunology members, 496 participated in the survey (response rate 7.3%). Using metered dose inhalers with a spacer and nebulizers were the most common bronchodilator administration techniques, as indicated by 59.35% and 58.52% of responses, respectively. Whereas 69.25% of the allergists considered their bronchodilator administration techniques to be sterile, 14.05% did not consider their administration technique to be sterile and 16.70% were unsure. For maintaining sterility, 38.75% of the respondents indicated using a new disposable attachment for reused inhalers, 18.71% indicated using a new inhaler for each patient, and 9.13% reported wiping inhalers with a cleaning agent.ConclusionsWhen asked about the sterility of the techniques used by them, nearly one-third of the allergists either stated that the measures used by them were unsterile or stated that they were were unsure. To increase adherence to sterility measures among North American allergists, promoting guideline awareness and proposing updated guidelines focused on the most common bronchodilator administration techniques is essential.

2024-10-17·Pediatric blood & cancer

Prevent Acute Chest Syndrome checklist (PACScheck): A quality improvement initiative to reduce acute chest syndrome.

Article

作者: Strumph, Kaitlin ; Kyon, Wen-Ling ; Abyazi, Miranda ; Schwartz, Leya ; Keenan, Janine ; Rinke, Michael L ; Cheng, Geoffrey ; Patel, Bhaumik B ; Chang, Susanna ; Reznik, Marina ; Ronca, Kristen ; Morrone, Kerry ; Zipper, Rachelle ; Manwani, Deepa ; Santos, Jennifer De Los ; Pisacano, Catherine ; Briggs, Jessica

BACKGROUNDAcute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). The Prevent Acute Chest Syndrome checklist (PACScheck) was created to drive appropriate ordering of opioids, incentive spirometry (IS), intravenous fluids (IVF), evaluation of oxygen desaturation, and bronchodilator use.OBJECTIVESDecrease the development of ACS by 5% in a hospitalized pediatric SCD population.METHODSA multidisciplinary team conducted a quality improvement (QI) project between April 2020 and August 2021 on an inpatient pediatric hematology unit. At-risk hospitalizations were patients with SCD who did not have ACS upon hospital admission. PACScheck was implemented and weekly run charts assessed documentation. Process control (p) charts, geometric control (g) charts, and chi-square tests assessed checklist process measures pre- and post-PACScheck. G chart assessed the number of encounters between ACS events.RESULTSA total of 483 at-risk hospitalizations were identified in the 12 months prior and 363 during the study period. A g chart demonstrated that fewer encounters developed ACS during PACScheck. A p chart demonstrated that IS documentation increased during PACScheck. A run chart of PACScheck documentation demonstrated a median of 100% documentation at least once per hospitalization during the last six months of the intervention.CONCLUSIONDevelopment of ACS can be reduced by implementing a best-practices checklist (PACScheck) on an inpatient pediatric hematology unit with a multidisciplinary team.

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