Tag: hemodynamics

Upvote Story 6
Oxygen desaturation was more commonly observed during tracheal intubation in children with cyanotic versus noncyanotic heart disease. However, hemodynamic tracheal intubation associated event rates were similar. In both groups, oxygen desaturation greater than or equal to 30% was significantly associated with increased occurrence of hemodynamic tracheal intubation associated events. Our exposure of interest was oxygen desaturation measured by a fall in pulse oximetry from baseline... Read More | Comment
Upvote Story 9
Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation. Yet few words together strike greater fear in the minds of savvy resuscitationists. Not because we cannot deftly manage shock, or because we are anything but hardy intubators, but because the swiftest way to transform a living patient into a dying patient or... Read More | Comment
Upvote Story 4
A Novel and Simultaneous Analysis of the Guyton and Rahn Diagrams. Graphical models of physiology are heuristically appealing as they facilitate qualitative conclusions at the bedside of the critically ill. Historically, the Rahn diagram has portrayed the physiology of the lungs, chest wall and respiratory system, while the Guyton diagram has illustrated cardiovascular physiology. As contemporary methods of haemodynamic monitoring, and their predecessors, are inexorably... Read More | Comment
Upvote Story 9
The art of predicting future hemodynamic instability in the critically ill has rapidly become a science with the advent of advanced analytical processed based on computer-driven machine learning techniques. How these methods have progressed beyond severity scoring systems to interface with decision-support is summarized. Using advanced analytic tools to glean knowledge from clinical data streams is rapidly becoming a reality whose clinical impact potential is... Read More | Comment
Upvote Story 6
Only half of patients who are hemodynamically unstable will respond to a fluid bolus. There are no historical or physical examination findings that can help us decide whether a patient is a fluid responder, but we must treat hypotension, as we do know that a mean arterial pressure (MAP) less than 60 mmHg increases the risk of death and acute kidney injury (AKI). Empirical fluid... Read More | Comment
Upvote Story 10
Angiotensin II has been studied for many years and has consistently shown to increase MAP. This medication adds a new mechanism of action to the vasopressor arsenal that is already used for septic shock. Angiotensin II should be reserved for patients in septic shock who do not respond to high doses of catecholamines and vasopressin. The only drug interactions with angiotensin II known to date... Read More | Comment
Upvote Story 8
Praised by nursing students for its straightforward language and readability, this interdisciplinary reference on bedside hemodynamic monitoring covers the technical aspects of clinical monitoring, including diagnostic and management principles for fluid-filled systems, intracranial hemodynamics, open-heart surgery patients, pediatric patients, and more! Well illustrated chapters detail exactly how to insert and manipulate catheters safely, read monitors properly, and interpret readings accurately. Precise illustrations deliver crucial details... Read More | Comment
Upvote Story 7
This case report shows that junctional rhythm can cause deterioration of SAM, LVOTO, and MR, and can lead to unstable hemodynamics in a patient with right ventricular failure after MVR. Atrial pacing can resolve SAM, LVOTO, and MR and can improve hemodynamics in a patient with unstable normal sinus rhythm. TEE in the ICU can play a pivotal role in clinical decision-making. Given that there... Read More | Comment
Upvote Story 4
In this article, we review physiologic principles of global oxygen delivery, and discuss the bedside approach to assessing the adequacy of oxygen delivery in critically ill patients. Although there have been technological advances in the assessment of oxygen delivery, we revisit and emphasize the importance of a ‘tried and true’ method – the physical examination. Also potentially important in the evaluation of oxygen delivery is... Read More | Comment
Upvote Story 5
Multi-system organ failure is ubiquitous but treatable with adequate hemodynamic support. Neurologic recovery was prolonged requiring delayed prognostication. Immediate 24/7 availability of surgical and medical specialty expertise was required to achieve 48% functionally intact survival. Of 100 appropriately transported patients, 83 achieved CICU admission. 40/83 (48%) discharged functionally intact. Multi-system organ failure occurred in all patients. Cardiac, pulmonary, renal, and liver injury improved within 3-4... Read More | Comment
Upvote Story 13
Recently released, Abdominal Sepsis examines in detail the topic of sepsis, with a focus on intra-abdominal sepsis. Particular attention is devoted to source control in the management of the infection, antimicrobial therapy and sepsis support, which represent the cornerstones of treating patients with this problem. The importance of a multidisciplinary approach is highlighted not only by the instructive and informative sections on the acute manifestations... Read More | Comment
Upvote Story 6
Sepsis resuscitation generally focuses on hemodynamics. Rivers of ink have been spilled writing about oxygen delivery and fluid responsiveness. This is clearly important, but it's possible that our focus on easily observable phenomena has led us to ignore something of equal importance: metabolic resuscitation. We can deliver all the oxygen we want to the tissues, but if the mitochondria are failing it won't work. Clinical... Read More | Comment
Upvote Story 8
Less than 7 cm H2O positive end-expiratory pressure reduced atelectrauma encountered at zero end-expiratory pressure. Above a defined power threshold, sustained positive end-expiratory pressure contributed to potentially lethal lung damage and hemodynamic impairment. Lung mechanical power was similar at 0 (8.8 ± 3.8 J/min), 4 (8.9 ± 4.4 J/min), and 7 (9.6 ± 4.3 J/min) cm H2O positive end-expiratory pressure, and it linearly increased thereafter... Read More | Comment
Upvote Story 7
Despite timely intervention, there exists a small subgroup of patients with septic shock who develop progressive multi-organ failure. Seemingly refractory to conventional therapy, they exhibit a very high mortality. Such patients are often poorly represented in large clinical trials. The management of refractory septic shock remains extremely challenging. We believe that where established conventional interventions fail to deliver improvements, a different approach using pragmatic strategies... Read More | Comment
Upvote Story 7
Pericardial tamponade occurs when fluid within the pericardial sac impairs filling of the right-sided chambers, leading to a decrease in cardiac output and hemodynamic compromise. It is neither a clinical nor an echocardiographic diagnosis alone. Bedside echocardiography can help diagnose pericardial tamponade when there is already a degree of clinical suspicion. The core findings include: a pericardial effusion, diastolic RV collapse (high specificity), systolic RA... Read More | Comment