Tag: thrombosis

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This clinical casebook provides a comprehensive yet concise state-of-the-art review of adult critical care medicine. Presented in a case-based format, each case focuses on a scenario commonly encountered with an adult patient in the ICU. Case scenarios include management of seizures and acute intracranial hypertension, sepsis, liver failure, brain death, bleeding and thrombosis, and treating hospital acquired infections (HAI) in the ICU. Written by experts... Read More | Comment
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By incorporating algorithms into the electronic health record (EHR), UPMC was able to realize a “dramatic” 72% reduction in missed doses, from 4,331 missed doses in 2014 to 1,193 in 2015, Dr. Neal told attendees in a session focused on hot topics in surgical patient safety. That decrease in missed doses has translated into a decreased rate of VTE, from an already relatively low rate... Read More | Comment
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As the use of chest CT-angiograms in emergency departments and medical wards has risen by more than tenfold, so has the discovery of small pulmonary emboli of unclear clinical significance. These PEs are often isolated to distal (subsegmental) branches of the pulmonary artery, without concurrent deep venous thrombosis (DVT). Small distal PEs may be incidentally found in an asymptomatic patient; more often, these PEs are... Read More | Comment
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Working with cells that line the innermost layer of the blood vessels, Johns Hopkins investigators say they have made a leap forward in understanding the underlying biology behind pulmonary hypertension, a dangerous type of high blood pressure in lungs that ultimately leads to right heart failure and death. By conducting experiments in endothelial cells, they discovered that a protein called KLF15 (Kruppel-like factor 15) protects... Read More | Comment
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Does use of the pulmonary embolism rule-out criteria (PERC) in emergency department patients with low clinical probability of pulmonary embolism (PE) safely exclude the diagnosis of PE? Among very low-risk patients with suspected PE, randomization to a PERC strategy vs conventional strategy did not result in an inferior rate of thromboembolic events over 3 months. These findings support the safety of PERC for very low-risk... Read More | Comment
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ICU patients are high risk of developing thrombotic complications such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Indeed, due to the hypercoagulative state typical for many forms of critical illness associated with risk factors as prolonged immobilization or the use of intravascular devices, ICU patients are at higher risk for thrombotic complications. Read More | Comment
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The FDA approved angiotensin-II (Giapreza) as a new intravenous vasopressor for septic shock and other forms of distributive shock. The first new FDA-approved vasopressor in decades, angiotensin-II could significantly change the management of severe septic shock. FDA based its expedited approval (under priority review) on the ATHOS-3 trial enrolling 321 patients with shock refractory to catecholamines like norepinephrine or epinephrine. Read More | Comment
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Determining appropriateness for vascular access devices limits the risk of complications in critically ill patients. Michigan Appropriateness Guide to Intravenous Catheters (MAGIC) establishes evidence-based indications as summarised in this paper. Safe and reliable venous access is the foundation for medication administration in critical and intensive care unit (ICU) patients. Several important issues surround vascular access in the ICU setting, including the need for multiple multi-lumen... Read More | Comment
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Liver involvement in chronic heart failure has long been recognized and reflects the systemic hemodynamic changes that occur during the evolution of heart failure syndrome. Apart from venous congestion and backward failure, other fundamental mechanisms also exist such as decreased hepatic blood flow, decreased arterial saturation, and sinusoidal thrombosis. Read More | Comment
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The trimethylamine/TMAO pathway likely represents only one of many microbe-dependent pathways that will ultimately be linked to cardiovascular disease pathogenesis, and proven to be an important diagnostic and therapeutic target for cardiovascular diseases. Key to the discovery of this pathway were untargeted metabolomics studies in large patient cohorts to demonstrate reproducibility of associations and then, more important, performance of animal model studies to test for... Read More | Comment
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When a patient has an aortic valve that requires replacement because the native valve is diseased, 2 types of valves can be used – mechanical valves or bioprosthetic valves, also known as tissue valves. Bioprosthetic valves are less durable than mechanical values but generally do not require the long-term use of anticoagulation; they are often recommended in older patients. Mechanical valves require therapeutic anticoagulation because... Read More | Comment
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The internal jugular vein (IJV) and subclavian vein (SCV) are the two most commonly used insertion sites for central venous catheterization (CVC). A multicenter clinical trial compared commonly used insertion sites and found that SCV use is associated with a lower incidence of bloodstream infection and deep vein thrombosis than IJV use. Read More | Comment