Brian L Erstad

PMID: 11329113;Abstract:

A retrospective investigation was conducted to determine if acute ethanol (EtOH) ingestion before injury leads to hematologic impairment as noted by coagulation and transfusion parameters. Patients older than 18 years of age were grouped according to the presence or absence of detectable EtOH concentrations in the blood, with further subdivision based on an Injury Severity Score of 8 or less or 9 or more. The following direct and indirect indicators of hematologic function were studied: volume of resuscitation fluids administered (including blood products), prothrombin time, partial thromboplastin time, and hematocrit. Of the 304 patients who were evaluated, 152 had detectable EtOH concentrations and 136 had undetectable EtOH concentrations; 16 patients had not been tested for blood EtOH concentrations and were excluded from the analysis. There were no significant differences between groups with regard to blood or fluid requirements or coagulation parameters. Detectable blood EtOH concentrations in trauma patients are not associated with significant changes in transfusion requirements or coagulation parameters compared to patients without detectable EtOH concentrations.

PMID: 12495169;Abstract:

Compilations of key articles and guidelines in a particular clinical practice area are useful not only to clinicians who practice in that area, but to all clinicians. We compiled pertinent articles and guidelines pertaining to drug therapy in the intensive care unit setting from the perspective of an actively practicing critical care pharmacist. This document also may serve to stimulate other experienced clinicians to undertake a similar endeavor in their practice areas.

Abstract:

Purpose: To examine the rate of compliance with National Surgical Infection Prevention Project performance measures and compliance with American Society of Health-System Pharmacists guidelines for procedures not covered by these measures and to evaluate noncompliance for explanatory factors. Methods: A retrospective review of all patients receiving prophylactic antibiotics for Class I (clean) or Class II (clean-contaminated) surgical procedures. Information collected included antibiotic ordered, antibiotic given, dose of antibiotic, time of administration, time of incision, time of closure, duration of procedure, need for re-dosing during the procedure, documentation of re-dosing administered, and antibiotic discontinuation. Results: Choice of antibiotic for prophylaxis was appropriate in 99% of the 568 procedures. Antibiotic was administered too early in 94 of 527 (17.8%) patients. Prophylactic antibiotics were inappropriately continued for more than 24 hours in 43 of 216 (20%) patients undergoing noncardiothoracic procedures and for more than 48 hours in 4 of 10 (40%) in patients undergoing cardiothoracic surgery. Conclusion: Although improvements in key performance measures related to prophylactic antibiotic agent selection, timing of administration, and discontinuation have been made compared to data collected in a larger multicenter study conducted at the beginning of this century, there remains considerable room for improvement. © 2006 Sage Publications.