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https://www.readbyqxmd.com/read/29675258/livedo-reticularis-a-cutaneous-clue-to-an-underlying-endocrine-crisis
#1
Natasha Shrikrishnapalasuriyar, Mirena Noyvirt, Philip Evans, Bethan Gibson, Elin Foden, Atul Kalhan
A 54-year-old woman was admitted to hospital with a presumed allergic reaction to a single dose of amoxicillin given for a suspected upper respiratory tract infection. She complained of chest tightness although there was no wheeze or stridor. On examination, she was pyrexial, tachycardic, hypertensive and had a diffuse mottled rash on her lower limbs. Her initial investigations showed raised inflammatory markers. She was treated in the intensive care for a presumed anaphylactic reaction with an underlying sepsis...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29673293/systemic-thrombolytic-therapy-for-massive-and-submassive-pulmonary-embolism
#2
Lauren A Igneri, John M Hammer
OBJECTIVE: To critically evaluate the published literature assessing the safety and efficacy of thrombolytic therapy for massive and submassive pulmonary embolism (PE). METHODS: A search of human trials in the English-language (September 2017) was conducted through the MEDLINE database using the following terms: PE, tissue plasminogen activator, tenecteplase, and alteplase. 67 unique articles were identified, of which 24 clinical trials discussing clinical outcomes related to administration of either intravenous tenecteplase or alteplase were included...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29669237/current-practice-of-diagnosis-and-management-of-acute-kidney-injury-in-intensive-care-unit-in-resource-limited-settings
#3
Nattachai Srisawat, Nattaya Sintawichai, Win Kulvichit, Nuttha Lumlertgul, Patita Sitticharoenchai, Nicha Thamrongsat, Sadudee Peerapornratana
PURPOSE: In a resource limited settings, there is sparse information about the management of acute kidney injury (AKI) based on systemic data collection. This survey aimed to described the current management of AKI in intensive care units (ICUs) across Thailand. MATERIALS AND METHODS: Questionnaires were distributed to 160 physicians involved in the intensive care between January and December 2014 across Thailand. Distribution was done through an online survey platform or telephone interview...
April 11, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29668596/predictors-of-in-hospital-mortality-in-a-cohort-of-elderly-egyptian-patients-with-acute-upper-gastrointestinal-bleeding
#4
Mohamed A Elsebaey, Heba Elashry, Tamer A Elbedewy, Ahmed A Elhadidy, Noha E Esheba, Sherif Ezat, Manal Saad Negm, Yousry Esam-Eldin Abo-Amer, Mohamed El Abgeegy, Heba Fadl Elsergany, Loai Mansour, Sherief Abd-Elsalam
Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29664900/accuracy-and-precision-of-scvo2-measured-with-the-cevox-device-a-prospective-study-in-patients-with-a-wide-variation-of-scvo2-values
#5
Alexander Herner, Bernhard Haller, Ulrich Mayr, Sebastian Rasch, Lea Offman, Roland Schmid, Wolfgang Huber
INTRODUCTION: Central-venous oxygen saturation (ScvO2) is a key parameter of hemodynamic monitoring and has been suggested as therapeutic goal for resuscitation. Several devices offer continuous monitoring features. The CeVOX-device (Pulsion Medical Systems) uses a fibre-optic probe inserted through a conventional central-venous catheter (CVC) to obtain continuous ScvO2. OBJECTIVES: Since there is a lack of studies validating the CeVOX, we prospectively analyzed data from 24 patients with CeVOX-monitoring...
2018: PloS One
https://www.readbyqxmd.com/read/29663283/eeg-artifact-versus-subclinical-status-epilepticus-in-a-patient-following-cardiac-arrest
#6
Jean E Cibula, Daniel S Demos, Brenda G Fahy
BACKGROUND: A challenge in ICU EEG interpretation is identifying subclinical status epilepticus versus patterns on the ictal-interictal continuum versus other repetitive patterns. In the electrically noisy intensive care unit, identifying and eliminating interference and artifact allow accurate diagnoses from the EEG, avoiding unnecessary treatment or sedation. METHODS: We present a case during Impella (Abiomed Inc, Danvers, MA) continuous flow left ventricular assist device use where the EEG artifact was initially misinterpreted as seizure by the resident and treated as status epilepticus because of the "focal" sharply contoured repetitive pattern...
April 16, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29652271/prophylactic-preoperative-levosimendan-for-off-pump-coronary-artery-bypass-grafting-in-patients-with-left-ventricular-dysfunction-single-centered-randomized-prospective-study
#7
Pushkar Mahendra Desai, Manjula S Sarkar, Sanjeeta R Umbarkar
Background: Off-pump coronary artery bypass surgery (OPCAB) is often complicated by hemodynamic instability, especially in patients with prior left ventricular (LV) dysfunction and appropriate choice of inotrope plays a vital role in perioperative management of these patients. Aim and Objective: To study hemodynamic effects and immediate outcome of prophylactic infusion of levosimendan in patients with the LV dysfunction undergoing OPCAB surgery and whether this strategy helps in successful conduct of OPCAB surgery...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29651626/current-topics-in-the-management-of-acute-traumatic-spinal-cord-injury
#8
Christopher D Shank, Beverly C Walters, Mark N Hadley
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI...
April 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29650544/evaluation-and-management-of-right-sided-heart-failure-a-scientific-statement-from-the-american-heart-association
#9
REVIEW
Marvin A Konstam, Michael S Kiernan, Daniel Bernstein, Biykem Bozkurt, Miriam Jacob, Navin K Kapur, Robb D Kociol, Eldrin F Lewis, Mandeep R Mehra, Francis D Pagani, Amish N Raval, Carey Ward
BACKGROUND AND PURPOSE: The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality...
April 12, 2018: Circulation
https://www.readbyqxmd.com/read/29642696/periprocedural-and-perioperatory-management-of-patients-with-tricuspid-valve-disease
#10
Fabrizio Monaco, Ambra L DI Prima, Monica DE Luca, Gaia Barucco, Alberto Zangrillo
Tricuspid regurgitation (TR) is a common valvular lesion which may affect morbidity and mortality. It can be related to an intrinsic abnormality of the tricuspid valve leaflets (organic) or secondary to annular dilatation (functional). Often organic and functional TR coexist in the same patient. A long standing TR is associated with ascites, congestive hepatopathy, peripheral edema, renal failure, and abdominal fullness which significantly affect the outcome. In particular, the perioperative course may be complicated due to both the presence of comorbidities and the development of a severe postoperative right ventricle (RV) dysfunction...
April 11, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29628670/bilateral-hip-dislocation-an-indicator-for-emergent-full-body-computed-tomography-scan-in-polytraumatized-patients-a-case-report-and-review-of-the-literature
#11
Benjamin Rufer, Marius Johann Baptist Keel, Beat Schnüriger, Moritz Caspar Deml
We present a rare case of traumatic bilateral asymmetric hip dislocation with pelvic fractures and a traumatic diaphragmatic hernia. A 53-year-old machinist was transferred to our emergency department with the suspicion of a bilateral hip dislocation after he was trapped between an elevator and the roof. Immediate closed reduction of the hips was not performed because of the expected risk of increasing hemodynamic instability with muscular relaxation. An emergent full-body computed tomography (CT) scan was made to assess injuries with need for further operative treatment...
January 2018: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/29622331/postoperative-tonsillectomy-hemorrhage
#12
REVIEW
Jessica J Wall, Khoon-Yen Tay
Post-tonsillectomy hemorrhage represents a potentially life-threatening condition that occurs in up to 5% of pediatric patients. Minor bleeding often precedes severe hemorrhage. Patients with minor or self-resolving bleeding should be observed in the emergency department or admitted for monitoring. Patients with severe bleeding should be immediately assessed for airway and hemodynamic stability. Management of severe bleeding includes immediate surgical consultation or initiation of the transfer process to a center with surgical capabilities, direct pressure to the site of hemorrhage with or without the additional of a hemostatic agent, possible rapid sequence intubation, and management of hemodynamic instability with volume resuscitation...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29621529/severe-snakebite-envenomation-in-french-guiana-when-antivenom-is-not-available
#13
Hatem Kallel, Claire Mayence, Stéphanie Houcke, Cyrille Mathien, Hossein Mehdaoui, José María Gutiérrez, Bruno Megarbane, Didier Hommel, Dabor Resiere
In French Guiana, Bothrops atrox, Bothrops brazili, Bothrops bilineatus, Lachesis muta and Micrurus sp are responsible for most cases of snakebite envenomation. The clinical features in patients suffering from envenomations by viperid snakes involve local tissue damage and systemic manifestations, such as hemorrhage, coagulopathies and hemodynamic instability. We report a severe case of envenomation in a patient bitten by a large unidentified pit viper in French Guiana. Due to lack of antivenom, the patient only received symptomatic management...
April 2, 2018: Toxicon: Official Journal of the International Society on Toxinology
https://www.readbyqxmd.com/read/29619492/effects-of-ramadan-fasting-on-the-symptoms-of-chronic-heart-failure
#14
Rami M Abazid, Hassan H Khalaf, Haitham I Sakr, Nora A Altorbak, Habiba S Alenzi, Zaki M Awad, Osama A Smettei, Moataz A Elsanan, Adel M Widyan, Ahmed S Azazy, Hassan W Chamsi-Pasha
OBJECTIVES: To investigate the effect of Ramadan fasting on the symptoms of chronic heart failure with a reduced ejection fraction (HFrEF). Globally, more than one billion Muslims fast during Ramadan. Data regarding the effect of fasting in heart failure patients with a reduced ejection fraction are limited. METHODS: We prospectively studied 249 outpatients with HFrEF who undertook Ramadan fasting at tertiary care cardiac center in Saudi Arabia in 2017. We obtained information regarding the clinical assessment, diagnosis, emergency department visits, and hospitalization during and in the month preceding Ramadan...
April 2018: Saudi Medical Journal
https://www.readbyqxmd.com/read/29617508/the-role-of-heart-team-approach-in-penetrating-cardiac-trauma-case-report-and-review-of-the-literature
#15
Marzia Cottini, Amedeo Pergolini, Federico Ranocchi, Francesco Musumeci
Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively...
January 2018: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/29602861/relationship-between-stroke-recurrence-infarct-pattern-and-vascular-distribution-in-patients-with-symptomatic-intracranial-stenosis
#16
Karthikram Raghuram, Aditya Durgam, Jennifer Kohlnhofer, Ayush Singh
OBJECTIVE: In view of recent literature suggesting that stroke recurrence and risks related to intervention may be related to plaque physiology/instability, our study sought to discern the pattern of stroke and rates of stoke recurrence as they relate to the anatomy and presentation of the underlying stenosis. METHODS: Retrospective chart as well as CT and MR angiographic imaging review of patients in the institutional stroke database was performed, including identification of patient risk factors, medical therapeutic optimization, compliance, serum cholesterol (low density lipoprotein) levels, blood pressure, physical therapy referrals, follow-up clinical status (using the modified Rankin Scales), and rate of recurrent stroke...
March 30, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29602588/-transesophageal-echocardiography-in-perioperative-period-guiding-the-decision-making-during-hemodynamic-instability-due-to-atrial-fibrillation
#17
João Paulo Jordão Pontes, Aline Tonin Dos Santos, Marcello Fonseca Salgado Filho
BACKGROUND AND OBJECTIVE: Atrial fibrillation is the most common cardiac arrhythmia, which may occur during the perioperative period and lead to hemodynamic instability due to loss of atrial systolic function. During atrial fibrillation management, electrical cardioversion is one of the therapeutic options in the presence of hemodynamic instability; however, it exposes the patient to thromboembolic event risks. Transesophageal echocardiography is a diagnostic tool for thrombi in the left atrium and left atrial appendage with high sensitivity and specificity, allowing early and safe cardioversion...
March 27, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29602477/flow-instability-detected-in-ruptured-versus-unruptured-cerebral-aneurysms-at-the-internal-carotid-artery
#18
Lijian Xu, Fuyou Liang, Lixu Gu, Hao Liu
Flow instability has emerged as a new hemodynamic metric hypothesized to have potential value in assessing the rupture risk of cerebral aneurysms. However, diverse findings have been reported in the literature. In the present study, high-resolution hemodynamic simulations were performed retrospectively on 35 aneurysms (10 ruptured & 25 unruptured) located at the internal carotid artery (ICA). Simulated hemodynamic parameters were statistically compared between the ruptured and unruptured aneurysms, with emphasis on examining the correlation of flow instability with the status of aneurysm rupture...
March 15, 2018: Journal of Biomechanics
https://www.readbyqxmd.com/read/29601321/predicting-adverse-hemodynamic-events-in-critically-ill-patients
#19
Joo H Yoon, Michael R Pinsky
PURPOSE OF REVIEW: 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. RECENT FINDINGS: Data mining of large multidimensional clinical time-series databases using a variety of machine learning tools has led to our ability to identify alert artifact and filter it from bedside alarms, display real-time risk stratification at the bedside to aid in clinical decision-making and predict the subsequent development of cardiorespiratory insufficiency hours before these events occur...
March 29, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29597227/from-continuous-renal-replacement-therapies-to-multiple-organ-support-therapy
#20
Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco, Gaetano La Manna
The incidence of the multiple organ dysfunction syndrome (MODS) is rapidly increasing in intensive care units (ICU). It usually combines with sepsis and is the most frequent cause of death in the ICU patients. The nature of the ICU patients has changed in the last years. It includes a variety of patients with severe cases due to major surgical interventions, trauma, hemodynamic instability, sepsis, and so on but also older people than previous times. All these situations can easily lead to MODS. In the prior years, the only available and efficient therapy was renal replacement therapy (RRT) for treating acute renal failure, but the development of technology also gives us devices to support the other systems...
2018: Contributions to Nephrology
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