Tag: shock

Upvote Story 5
Shock has potentially reversible causes of morbidity and mortality if appropriately diagnosed and managed. Older methods of invasive monitoring have significant limitations but are still critical for managing shock in certain patients and settings. Newer methods are easier to employ, but further validation is needed. Multiple modalities along with careful clinical assessment are often useful in distinguishing shock subtypes. Best practice standards for monitoring should... Read More | Comment
Upvote Story 14
Delirium is a confused mental state that includes changes in awareness, thinking, judgment, sleeping patterns, and behavior. It can affect patients of any age but is more common among older adults who experience major illness or have a major surgery. More than half of patients who are given mechanical ventilation in the intensive care unit (ICU) experience delirium. Antipsychotic medications have been used to treat... Read More | Comment
Upvote Story 11
If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, “kids are not just small adults”, and so I won’t say it again. Well, I guess I just did, but at least I wont stop at this quote, but attempt to explain how kids are not small adults, and how this may impact their... Read More | Comment
Upvote Story 10
Supported by numerous x-rays, CT scans, plus informative tables throughout, this trusted reference begins with an informative look at kinematics and the mechanisms of trauma injury. Subsequent chapters provide useful background information on the epidemiology of trauma; injury prevention; the basics of trauma systems, triage, and transport; and much more. The next section meticulously reviews generalized approaches to the trauma patient, from pre-hospital care and... Read More | Comment
Upvote Story 24
In Shock is a riveting first-hand account from a young critical care physician, who in the passage of a moment is transfigured into a dying patient. This transposition, coincidentally timed at the end of her medical training, instantly lays bare the vast chasm between the conventional practice of medicine and the stark reality of the prostrate patient. Hauntingly perceptive and beautifully written, it allows the... Read More | Comment
Upvote Story 17
After ketamine induction, high shock index patients exhibited blunted hypertensive responses and more frequent hypotension, whereas low shock index patients had sustained increases in pulse rate and SBP. One hundred twelve patients were enrolled (81 low shock index, 31 high shock index). Low shock index patients had increased SBP after induction (16 mm Hg; 95% confidence interval [CI] 11 to 21 mm Hg), whereas high... Read More | Comment
Upvote Story 6
Resuscitative TEE in the diagnosis of massive PE in the ED. We have multiple tools in the ed that allow us to assess patients rapidly. But of course, you must use the right tool for the patient. transthoracic echo (TTE) can be useful to assess a patient in shock and is our go-to tool when we approach a patient with hemodynamic decompensation or shock. But... Read More | Comment
Upvote Story 9
Subsyndromal delirium occurred in most critically ill patients, and its duration was an independent predictor of institutionalization. Routine monitoring of all delirium symptoms may enable detection of full and subsyndromal forms of delirium. Subsyndromal delirium, lasting a median of 3 days, developed in 702 of 821 patients (86%). After adjusting for covariates, duration of subsyndromal delirium was an independent predictor of increased odds of institutionalization... Read More | Comment
Upvote Story 18
Acute kidney injury (AKI) requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of angiotensin II on the outcomes of acute kidney injury requiring renal replacement therapy. In patients with acute kidney injury requiring renal replacement therapy at study drug... Read More | Comment
Upvote Story 19
Vasopressors and inotropes are cornerstones in the management of shock syndromes. Understanding vasopressors’ receptor activity and resultant pharmacological response enables clinicians to select the ideal vasopressor(s) for a patient suffering from shock. The following table outlines common vasopressors/inotropes and their general receptor activity profiles. Clinical efficacy is demonstrated primarily via targeted hemodynamic variables, while application to clinical practice remains variable and driven by expert opinion,... Read More | Comment
Upvote Story 6
Sepsis presents with similar profiles in adult and pediatric patients, characterized by enhanced inflammatory hormonal response and by repressed innate immunity, metabolism, and myocardial contractility. These features early distinguish sepsis from systemic inflammatory response syndrome (SIRS) across all age groups. Flow cytometry determined mean fluorescence intensity for monocyte or neutrophil heat shock protein expression. Resistin, adiponectin, and extracellular heat shock proteins were measured using enzyme-linked... Read More | Comment
Upvote Story 5
In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition. After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended... Read More | Comment
Upvote Story 4
Adding angiotensin II to available vasopressor therapies correlated with significantly improved arterial pressure in patients with catecholamine-resistant vasodilatory shock and less adverse effects, according to a study presented at the recent international conference of the American Thoracic Society. In a double blind, controlled, phase III study, 70% of 163 patients given angiotensin II reached arterial pressure of at least 75 mm HG or improved by... Read More | Comment