American journal of hospital medicine, volume 4, issue 4 (2020 October-December)
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Item Early identification of the difficult airway from orbital deformity(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-10) Marshall, Julie M.; Timko, Noah J."We report an adult patient presenting for surgery with hidden marked orbital exenteration (Figures 1, 2). The patient had history of resected left orbital neoplasm that remained concealed under an eye patch during preoperative physical examination and presentation to the operating room. Face mask ventilation proved impossible after anesthetic induction. Removal of the eye patch revealed a large facial orbital floor defect from exenteration of the orbit floor and the patient immediately underwent endotracheal intubation. Following the procedure, postoperative respiratory insufficiency required additional airway support. Emergent placement of a laryngeal mask airway provided adequate ventilation."--CaseItem Evaluation of Bivalirudin in Percutaneous Coronary Intervention(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-10) Vitale, Lia; Stringberg, Alexandria; Trivedi, NamritaThe aim of this study was to analyze the appropriateness of bivalirudin utilization indicated for percutaneous coronary interventions (PCI). A total of 218 patients who were admitted to University of Missouri Health Care that underwent a PCI were included in this retrospective study. Analysis was conducted for appropriate utilization of bivalirudin in patients with a history of heparin induced thrombocytopenia (HIT) over unfractionalized heparin. Bivalirudin use was found to be inappropriate in 170 of the 218 patients evaluated (78[percent]). By using, none experienced minimal bleeding, 15 experienced minor bleeding, three experienced major bleeding per the thrombolysis in myocardial infarction (TIMI) bleeding criteria, and none died as a result of bleeding complications.