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Emmanuel Ademola Anigilaje
The survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug. While the old principles proposed by Holliday and Segar, and Finberg have stood the test of time, recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids...
2018: Frontiers in Pediatrics
G Mulkerrin, N M Hogan, M Sheehan, M R Joyce
INTRODUCTION: Gastrointestinal Stromal Tumors (GISTs) are a rare slow growing malignancy, accounting for less than 1% of all gastrointestinal (GI) tract tumors. These tumors are usually discovered incidentally by endoscopy, surgery or radiology. However on occasions they may present with significant symptoms including GI blood loss. This case report discusses an atypical presentation of a GIST in a 57-year-old female. CASE PRESENTATION: A 57-year-old woman presented to the emergency department following one episode of melena...
March 1, 2018: International Journal of Surgery Case Reports
Åsa Lidén, Tine Veronika Karlsen, Bengt Guss, Rolf K Reed, Kristofer Rubin
NEW FINDINGS: What is the central question of this study? Collagen-binding β1 -integrins function physiologically in cellular control of dermal interstitial fluid pressure (PIF ) in vivo and thereby participate in control of extravascular fluid volume. During anaphylaxis, simulated by injection of Compound 48/80 integrin αV β3 takes over this physiological function. Here we addressed the question whether integrin αV β3 can replace collagen-binding β1 -integrin to maintain a long-term homeostatic PIF ...
March 10, 2018: Experimental Physiology
Scott E Rudkin, Craig L Anderson, Tristan R Grogan, David A Elashoff, Richard M Treger
BACKGROUND AND OBJECTIVES: In severe circulatory failure agreement between arterial and mixed venous or central venous values is poor; venous values are more reflective of tissue acid-base imbalance. No prior study has examined the relationship between peripheral venous blood gas (VBG) values and arterial blood gas (ABG) values in hemodynamic compromise. The objective of this study was to examine the correlation between hemodynamic parameters, specifically systolic blood pressure (SBP) and the arterial-peripheral venous (A-PV) difference for all commonly used acid-base parameters (pH, Pco2 , and bicarbonate)...
January 1, 2018: Journal of Intensive Care Medicine
Zhi-Gang Zhang, Xin-Min Liu
RATIONALE: Tolvaptan (TLV) is a new vasopressin type 2 receptor antagonist effective in patients with heart failure (HF). Accumulating evidences have revealed that treatment with TLV does not alter the blood pressure significantly. PATIENT CONCERNS: An 84-year-old man was diagnosed with acute exacerbation of chronic HF due to ischemic cardiomyopathy, arrhythmia, mitral and aortic regurgitation. Treatment with TLV increased the urine volume and improved the dyspnea...
January 2018: Medicine (Baltimore)
Adriana M Pedraza Bermeo, Ana María Ortiz Zableh, Mariangel Castillo, Jaime Francisco Pérez Niño
INTRODUCTION: Postobstructive diuresis (POD) is a polyuric state in which large quantities of salt and water are eliminated after solving a urinary tract obstruction. These patients are at increased risk of severe dehydration, electrolytic disturbances, hypovolemic shock, and death. Ureteropelvic junction obstruction (UPJO) is the most common etiology of collecting system dilatation in the fetal kidney, and a significant number of patients require pyeloplasty. There are limited data regarding prognostic risk factors for POD in this scenario...
February 20, 2018: Journal of Pediatric Urology
Stefano Guarino, Mario Diplomatico, Rosaria Marotta, Anna Pecoraro, Daniela Furlan, Lorenzo Cerrone, Emanuele Miraglia Del Giudice, Cesare Polito, Angela La Manna, Pierluigi Marzuillo
Patients affected by nephrogenic diabetes insipidus (NDI) can present with hypernatremic dehydration, and first-line rehydration schemes are completely different from those largely applied in usual conditions determining a mild to severe hypovolemic dehydration/shock. In reporting the case of a patient affected by NDI and presenting with severe dehydration triggered by acute pharyngotonsillitis and vomiting, we want to underline the difficulties in managing this condition. Restoring the free-water plasma amount in patients affected by NDI may not be easy, but some key points can help in the first line management of these patients: (1) hypernatremic dehydration should always be suspected; (2) even in presence of severe dehydration, skin turgor may be normal and therefore the skinfold recoll should not be considered in the dehydration assessment; (3) decreased thirst is an important red flag for dehydration; (4) if an incontinent patient with NDI appears to be dehydrated, it is important to place the urethral catheter to accurately measure urine output and to be guided in parenteral fluid administration; (5) if the intravenous route is necessary, the more appropriate fluid replenishment is 5% dextrose in water with an infusion rate that should slightly exceed the urine output; (6) the 0...
February 28, 2018: Pediatric Emergency Care
Evan Tsiklidis, Carrie Sims, Talid Sinno, Scott L Diamond
Trauma with hypovolemic shock is an extreme pathological state that challenges the body to maintain blood pressure and oxygenation in the face of hemorrhagic blood loss. In conjunction with surgical actions and transfusion therapy, survival requires the patient's blood to maintain hemostasis to stop bleeding. The physics of the problem are multiscale: (a) the systemic circulation sets the global blood pressure in response to blood loss and resuscitation therapy, (b) local tissue perfusion is altered by localized vasoregulatory mechanisms and bleeding, and (c) altered blood and vessel biology resulting from the trauma as well as local hemodynamics control the assembly of clotting components at the site of injury...
February 27, 2018: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
M H Møller, A Granholm, E Junttila, M Haney, A Oscarsson-Tibblin, A Haavind, J H Laake, E Wilkman, K Ö Sverrisson, A Perner
BACKGROUND: Adult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient-important treatment recommendations on this topic. METHODS: This guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock...
February 25, 2018: Acta Anaesthesiologica Scandinavica
Michael S Enslow, Stephen R Preece, Benjamin Wildman-Tobriner, Ryan A Enslow, Maciej Mazurowski, Rendon C Nelson
OBJECTIVE: The objective of the article is to assess changes in splenic volume in the setting of hypovolemic shock; splenic enhancement in hypovolemic shock is also assessed. MATERIALS/METHODS: 71 consecutive adult patients with the hypovolemic shock complex on computed tomography (CT) were identified. Spleen volume and enhancement were compared to a baseline CT scan (without shock) or to height- and sex-corrected normal values and a control population when a comparison CT was unavailable...
February 19, 2018: Abdominal Radiology
Kapil Bhalla, Deepali Garg, Mahima Rajan, Jaya Shankar Kaushik, Geeta Gathwala
Nephrotic syndrome is a prothrombotic state with predisposition to venous sinus thrombosis and arterial vascular stroke. Watershed infarcts in junction of arterial territory develop in hypotensive hypovolemic state. These border zone infarcts are usually bilateral in the absence of unilateral arterial stenosis or microembolism. We report a 6-year-girl of frequently relapsing nephrotic syndrome who developed sudden onset hemiparesis with aphasia. Magnetic resonance (MR) imaging brain revealed unilateral watershed infarct in territory between the major cerebral arterial vessels with evidence of restricted diffusion and normal vessel anatomy on MR angiography...
January 2018: Journal of Natural Science, Biology, and Medicine
Paula Ferrada, Rachael A Callcut, David J Skarupa, Therese M Duane, Alberto Garcia, Kenji Inaba, Desmond Khor, Vincent Anto, Jason Sperry, David Turay, Rachel M Nygaard, Martin A Schreiber, Toby Enniss, Michelle McNutt, Herb Phelan, Kira Smith, Forrest O Moore, Irene Tabas, Joseph Dubose
Background: The traditional sequence of trauma care: Airway, Breathing, Circulation (ABC) has been practiced for many years. It became the standard of care despite the lack of scientific evidence. We hypothesized that patients in hypovolemic shock would have comparable outcomes with initiation of bleeding treatment (transfusion) prior to intubation (CAB), compared to those patients treated with the traditional ABC sequence. Methods: This study was sponsored by the American Association for the Surgery of Trauma multicenter trials committee...
2018: World Journal of Emergency Surgery: WJES
Sofia Morão, Rita S Ferreira, Nelson Camacho, Vanda Pratas Vital, J Pascoal, M Emília Ferreira, L Mota Capitão, Frederico B Gonçalves
INTRODUCTION: Traumatic non-iatrogenic vascular injuries in children are rare and rarely discussed in literature. Paediatric vascular injuries pose a set of challenges mainly because of continued growth and development in a child or adolescent. The purpose of the study is to characterize management strategies and outcomes in these cases. PATIENTS AND METHODS: Single-centre retrospective review of patients less than age 18 years (paediatric age) with acute, non-iatrogenic traumatic vascular injuries between January 2009 and December 2015...
February 8, 2018: Annals of Vascular Surgery
Wendy Dendas, Jean-Christophe Schobbens, Greet Mestdagh, Liesbeth Meylaerts, Geert Verswijvel, Caroline Van Holsbeke
Objective: To report a case of heterotopic interstitial pregnancy after in vitro fertilization-embryo transfer (IVF-ET), presenting with a second trimester uterine rupture. To review the clinical presentations, risk factors, treatment options, and outcome of heterotopic interstitial pregnancies. Methods: We describe the clinical presentation, management, and outcome of a patient with a heterotopic interstitial pregnancy, diagnosed following second trimester rupture of the interstitial pregnancy...
August 2017: Ultrasound: Journal of the British Medical Ultrasound Society
H Lier, M Bernhard, B Hossfeld
The term "shock" refers to a life-threatening circulatory failure caused by an imbalance between the supply and demand of cellular oxygen. Hypovolemic shock is characterized by a reduction of intravascular volume and a subsequent reduction in preload. The body compensates the loss of volume by increasing the stroke volume, heart frequency, oxygen extraction rate, and later by an increased concentration of 2,3-diphosphoglycerate with a rightward shift of the oxygen dissociation curve. Hypovolemic hemorrhagic shock impairs the macrocirculation and microcirculation and therefore affects many organ systems (e...
February 5, 2018: Der Anaesthesist
Joung Taek Kim, Young Sam Kim, Yong Han Yoon, Helen Ki Shin, Keun Myoung Park, Wan Ki Baek
BACKGROUND:  The recently developed thoracic endovascular repair (TEVAR) technique seems to offer a good alternative for treating acute traumatic transection of the thoracic aorta (TTA). We reviewed our experience of TEVAR in cases of acute traumatic transection and analyzed the subsequent remodeling changes. METHODS:  The medical records of 17 patients who underwent TEVAR for TTA were reviewed. The trauma mechanisms, anatomical characteristics of the transected aortas, technical details of TEVAR, and postprocedural results were reviewed...
February 2, 2018: Thoracic and Cardiovascular Surgeon
Astrid Van den Broecke, Laura Van Coile, Alexander Decruyenaere, Kirsten Colpaert, Dominique Benoit, Hans Van Vlierberghe, Johan Decruyenaere
BACKGROUND: Hypoxic hepatitis (HH) is a type of acute hepatic injury that is histologically characterized by centrilobular liver cell necrosis and that is caused by insufficient oxygen delivery to the hepatocytes. Typical for HH is the sudden and significant increase of aspartate aminotransferase (AST) in response to cardiac, circulatory or respiratory failure. The aim of this study is to investigate its epidemiology, causes, evolution and outcome. METHODS: The screened population consisted of all adults admitted to the intensive care unit (ICU) at the Ghent University Hospital between January 1, 2007 and September 21, 2015...
January 30, 2018: Annals of Intensive Care
Bethany M Biron, Chun-Shiang Chung, Yaping Chen, Zachary Wilson, Eleanor A Fallon, Jonathan S Reichner, Alfred Ayala
Indirect acute respiratory distress syndrome (iARDS) is caused by a nonpulmonary inflammatory process resulting from insults such as nonpulmonary sepsis. Neutrophils are thought to play a significant role in mediating ARDS, with the development of iARDS being characterized by dysregulation and recruitment of activated neutrophils into the lung. Recently, a novel mechanism of microbial killing by neutrophils was identified through the formation of neutrophil extracellular traps (NETs). NETs are composed of large webs of decondensed chromatin released from activated neutrophils into the extracellular space; they are regulated by the enzyme peptidylarginine deiminase 4 (PAD4) through mediation of chromatin decondensation via citrullination of target histones...
January 26, 2018: Journal of Immunology: Official Journal of the American Association of Immunologists
M Taboada Muñiz, A Tubio Pose, E Ferreiroa Mosquera, A Calvo Rey, J M Martínez Cereijo, J Alvarez Escudero
We report a case of a 35-years-old man who presented a massive haemothorax and hypovolemic shock following cardiac surgery, from spontaneous rupture of a phrenic artery. A quick diagnosis and immediate intervention is crucial to manage the patient.
January 19, 2018: Revista Española de Anestesiología y Reanimación
Christine L Gremillion, Mason Savage, Eli B Cohen
Colonic torsion is a life-threatening condition in dogs and radiographic findings for this condition have not been well described. The purpose of this retrospective case series was to describe radiographic findings and clinical signs in a group of dogs with colonic torsion. Inclusion criteria were dogs presenting during the period of 2006 and 2016, and that had abdominal radiography and a surgically confirmed or presumed diagnosis of colonic torsion. For each dog, clinical data were recorded from medical records and imaging findings were recorded from retrieved plain radiographs and positive contrast radiographs in which barium enema was performed...
January 23, 2018: Veterinary Radiology & Ultrasound
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