Tag: diagnosis

Upvote Story 6
PET-CT precisely detected the deep foci of infection about 48 hours prior to the diagnosis of sepsis. The cases reports suggested the use of this image technique in ICU for patients with sepsis of unknown origin. We admitted two critically ill patients for suspected sepsis and altered mental state. As all bacteriological samples were initially sterile, diagnostic workups in both patients led us to suspect... Read More | Comment
Upvote Story 10
Pediatric critical care nephrology is a complex and highly specialized field, presenting challenges and management strategies that are often quite distinct from those seen in adult practice. Therefore, it is high time to address all the topics in the field of critical care nephrology in children in a unique book which is the first of its kind. This book covers the basics as well as... Read More | Comment
Upvote Story 4
Shared decision making occurs when patients and clinicians reach a formulation about the presenting problem and discuss how to manage it. If there are several reasonable alternatives, the alternatives should be explicitly compared, using evidence about relevant harms and benefits. Such decisions should be informed by knowledge about the patients’ condition, about the evidence applicable to it, and the patient’s goals and preferences. Eliciting patients’... Read More | Comment
Upvote Story 8
Dr. Larry Komer and Joan Chandler Komer offer new hope to those with brain injuries. Millions of people of all ages experience concussions. Many others have a more serious event known as a traumatic brain injury. Battlefield injuries often include concussions or a TBI. These brain injuries can lead to a complex condition known as PTSD that can alter a person’s life, family and community.... Read More | Comment
Upvote Story 4
Implementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time. Sixty-one consecutive patients with ARDS were enrolled. Esophageal pressure was measured in 53 patients (86.9%). In 41 patients (67.2%), ventilator settings were changed after the measurements, often by reducing positive end-expiratory pressure or by... Read More | Comment
Upvote Story 4
Emergency department (ED) visit rates in the United States have been rising over the past 2 decades, outpacing population growth.1 These visits are portrayed in the lay press as unnecessary visits that must be reduced or avoided. Yet a growing body of evidence indicates that most ED visits are medically necessary and that EDs serve as a critical source of care for high-risk patients, including... Read More | Comment
Upvote Story 6
Intensive care is an interesting specialty. From all the early excitement in the 1970s, passing through two decades of intensive physiological use at the bedside, intensive care landed on the rough ground of modern randomized controlled trials (RCTs) in the late 1990s and early 2000s. The increasing number of critically ill patients coupled with new monitoring devices and important funding both from governmental and private... Read More | Comment
Upvote Story 5
Critical care transesophageal echocardiography is feasible, safe, and has clinical utility. It can be safely and effectively performed by fellows within the context of their critical care training with faculty supervision. Pulmonary critical care fellowship training programs should consider introducing critical care transesophageal echocardiography as a useful clinical tool. The examination was feasible in all patients in whom it was attempted, and there were no... Read More | Comment
Upvote Story 5
When obtaining intracompartmental pressures, place the catheter within 5cm of the fracture level, with the transducer secured at the level of the measured compartment. Make sure to keep the catheter tip outside of the actual fracture site. If placed within the fracture, levels will be falsely high. Failure to place the transducer at the same height of the catheter tip will cause a falsely high... Read More | Comment
Upvote Story 7
Troponin assays are integral to the diagnosis of acute myocardial infarction (AMI), but there is concern that testing is over utilized and may not conform to published guidelines. We reviewed all testing performed at 14 hospitals over 12 months and associated troponin values with the primary and secondary diagnoses for each visit. Troponin was determined to be negative, indeterminate or elevated based on reference ranges.... Read More | Comment
Upvote Story 7
This book provides clinical and electrovectorcardiographic evidence of the existence of left septal fascicular blocks and demonstrates the clinical importance of these blocks in the clinical scenario of acute coronary syndrome. There are currently no standard criteria for detecting conduction defects involving the third left fascicle, the septal or median fascicle, and the very existence of such defects is still a matter of controversy. This... Read More | Comment
Upvote Story 13
Sepsis is medicine’s last remaining preserve for unrestrained antibiotic prescribing. The Surviving Sepsis Campaign guidelines recommend empirical broad-spectrum therapy within one hour of triage for both sepsis and septic shock. This recommendation, and mandates that compel it, encourage clinicians to adopt an approach of “treat first, ask questions later” for patients with any possibility of serious infection. This approach fails to account for the difficulties... Read More | Comment
Upvote Story 5
Using the right word or phrase to describe a specific pathologic process/patient diagnosis and/or status is important, not only within the intensive care unit team, but also when we communicate with external consultants. This is not just a question of semantics. Using incorrect terms can lead to misunderstanding and even to incorrect therapeutic decisions. For example, it is not uncommon to see clinicians examining an... Read More | Comment
Upvote Story 8
When compared with the reference standard — prospective clinical diagnosis — ANZICS CORE database criteria significantly underestimate the incidence of sepsis and overestimate the incidence of septic shock, and also result in lower estimated hospital mortality rates for each condition. Of 864 patients admitted to the ICU, 146 (16.9%) were diagnosed with sepsis by clinical criteria and 98 (11%) according to the database definition. Diagnoses... Read More | Comment
Upvote Story 7
Writing in the MJA, researchers have reported the findings of a prospective cohort study comparing estimates of the incidence and mortality of sepsis using clinical diagnosis or the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) database methodology. The researchers found that when compared with clinical diagnosis, the ANZICS CORE database criteria significantly underestimated the incidence of sepsis... Read More | Comment