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https://www.readbyqxmd.com/read/29333494/ensuring-adequate-vascular-access-in-patients-with-major-trauma-a-quality-improvement-initiative
#1
Kevin Verhoeff, Rachelle Saybel, Pamela Mathura, Bonnie Tsang, Vanessa Fawcett, Sandy Widder
Ensuring adequate vascular access in major trauma patients prior to decompensative physiological processes is crucial to patient outcomes. Most protocols suggest achieving two 18-gauge or larger intravenous lines immediately in patients with major trauma. We discuss a quality improvement approach to ensure that >90% of patients with major trauma (as defined by an injury severity score ≥12) at a level one trauma centre receive timely and adequate fluid access. Applying Donabedian principles for process improvement, we used the Alberta Trauma Registry to perform a 4-month chart audit on patients with major trauma at the University of Alberta Hospital...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29331270/severe-beta-blocker-and-calcium-channel-blocker-overdose-role-of-high-dose-insulin
#2
Karan Seegobin, Satish Maharaj, Ansuya Deosaran, Pramod Reddy
A 54-year-old female presented after taking an overdose of an unknown amount of hydrochlorothiazide, doxazocin, atenolol and amlodipine. She was initially refractory to treatment with conventional therapy (intravenous fluids, activated charcoal, glucagon 5 mg followed with glucagon drip, calcium gluconate 10%, and atropine). Furthermore, insulin at 4 U/kg was not effective in improving her hemodynamics. Shortly after high dose insulin was achieved with 10 U/kg, there was dramatic improvement in hemodynamics resulting in three of five vasopressors being weaned off in 8 h...
January 10, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29329518/the-use-of-eculizumab-in-gemcitabine-induced-thrombotic-microangiopathy
#3
Vinod Krishnappa, Mohit Gupta, Haikoo Shah, Abhijit Das, Natthavat Tanphaichitr, Robert Novak, Rupesh Raina
BACKGROUND: Thrombotic microangiopathy (TMA) secondary to gemcitabine therapy (GiTMA) is a very rare pathology that carries a poor prognosis, with nearly half of the cases progressing to end stage renal disease. GiTMA is most commonly associated with adenocarcinomas, most notably pancreatic cancers. The mainstay of management is withdrawal of the offending drug and supportive care. Plasmapheresis has a limited role and hemodialysis may help in the management of fluid overload secondary to renal failure...
January 12, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29329358/modulating-role-of-ang1-7-in-control-of-blood-pressure-and-renal-function-in-angii-infused-hypertensive-rats
#4
Marta Kuczeriszka, Elzbieta Kompanowska-Jezierska, Janusz Sadowski, Minolfa Prieto, L Gabriel Navar
Background: Indirect evidence suggests that angiotensin 1-7 (Ang1-7) may counterbalance prohypertensive actions of angiotensin II (AngII), via activation of vascular and/or renal tubular receptors to cause vasodilation and natriuresis/diuresis. We examined if Ang1-7 would attenuate the development of hypertension, renal vasoconstriction and decreased natriuresis in AngII-infused rats and evaluated the mechanisms involved. Methods: AngII, alone or with Ang1-7, was infused to conscious Sprague-Dawley rats for 13 days and systolic blood pressure (SBP) and renal excretion were repeatedly determined...
January 10, 2018: American Journal of Hypertension
https://www.readbyqxmd.com/read/29326825/staphylococcal-scalded-skin-syndrome-a-pediatric-dermatology-case-report
#5
Girish Gulab Meshram, Neeraj Kaur, Kanwaljeet Singh Hura
Staphylococcal scalded skin syndrome is a condition which predominantly affects children and causes a spectrum of skin lesions. We present a case of a 2-month-old infant with complaints of fever and fragile blisters over the body. The mucosal areas were spared. The diagnosis of staphylococcal scalded skin syndrome was reached on clinical grounds and culture report. The patient responded well to the treatment, which included an antibiotic (cloxacillin), an analgesic (paracetamol), and hydration with intravenous fluids...
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29321112/the-evaluation-and-management-of-urolithiasis-in-the-emergency-department-a-review-of-the-literature
#6
REVIEW
Michael Gottlieb, Brit Long, Alex Koyfman
BACKGROUND: Urolithiasis is a common condition in the U.S. Patients frequently present to the emergency department (ED) for care, including analgesia and treatments to facilitate stone passage. OBJECTIVE: With the new evidence concerning the evaluation and treatment of urolithiasis, this review summarizes current literature regarding the ED management of urolithiasis. DISCUSSION: Urolithiasis occurs primarily through supersaturation of urine and commonly presents with flank pain, hematuria, and nausea/vomiting...
January 5, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29319648/resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-hemorrhage-control-in-trauma-patients-an-evidence-based-review
#7
Molly Sambor
Traditionally, resuscitative efforts for uncontrolled noncompressible torso hemorrhage are achieved by cross-clamping the proximal aorta via thoracotomy to deliver temporary hemodynamic stability during injury repair. A less commonly used method of promoting early resuscitation and hemorrhagic control in trauma patients is resuscitative endovascular balloon occlusion of the aorta (REBOA). The focus of this literature review is to examine the effectiveness of REBOA in the management of noncompressible pelvic hemorrhage when compared with traditional methods of hemorrhage control in trauma patients...
January 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29318860/-effect-of-transcutaneous-acupoint-electrical-stimulation-on-hemodynamic-fluctuation-caused-by-loosing-tourniquet-in-elderly-patients-undergoing-knee-joint-replacement
#8
Han-Sheng Liang, Yi Feng
OBJECTIVE: To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on hemodynamic fluctuation caused by loosing tourniquet in the elderly patients undergoing knee joint replacement. METHODS: A total of 60 ASA (America Society Anesthesiologist) I or II elderly patients for elective knee joint replacement surgery were randomly divided into control group (30 cases) and TAES group (30 cases). Patients of both groups were treated by intravenous anesthesia, and monitored with bispectral index (BIS, between 45-60) for anesthesia depth, stroke volume variation (SVV) for fluid management, mean arterial pressure (MAP) and cardiac index (CI) for hemodynamic fluctuation evaluation, and with analgesia nociception index (ANI, between 50-70) for remifentanil dosage adjustment...
December 25, 2017: Zhen Ci Yan Jiu, Acupuncture Research
https://www.readbyqxmd.com/read/29318796/recurrent-guillain-barr%C3%A3-syndrome-following-urinary-tract-infection-by-escherichia-coli
#9
Yoon Sik Jo, Jin Yong Choi, Hong Chung, Yuseok Kim, Sang Jun Na
Recurrent Guillain-Barré syndrome (GBS) is a rare, immune-mediated disease of the peripheral nervous system. It has been reported to occur at intervals ranging from four months to 10 years; published case studies suggest that 1%-6% of patients who have had GBS will experience recurrent attacks. The most commonly identified infections coinciding with GBS are Campylobacter jejuni, Haemophilus influenzae, Mycoplasma pneumonia, and cytomegalovirus, while an antecedent infection with Escherichia coli is very uncommon...
January 22, 2018: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/29318355/an-enhanced-recovery-after-surgery-eras-protocol-for-ambulatory-anorectal-surgery-reduced-postoperative-pain-and-unplanned-returns-to-care-after-discharge
#10
Aaron B Parrish, Sean M O'Neill, Steven R Crain, Tara A Russell, Deepak K Sonthalia, Vu T Nguyen, Armen Aboulian
BACKGROUND: Ambulatory surgery for anorectal procedures has been proven to be safe and effective. Specific perioperative pathways combining multiple interventions have been shown to optimize recovery and outcomes associated with inpatient colorectal surgery. However, there are no major studies describing and evaluating a standardized protocol for ambulatory anorectal surgery. The purpose of this study was to evaluate the outcomes of a modified enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery...
January 9, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29317968/b-type-natriuretic-peptide-a-predictor-for-mortality-intensive-care-unit-length-of-stay-and-hospital-length-of-stay-in-patients-with-resolving-sepsis
#11
Harsimar Singh, Daryl Ramai, Harshil Patel, Marina Iskandir, Sarina Sachdev, Rabjot Rai, Jay Patolia, Getaw Worku Hassen
Background: B-type natriuretic peptide (BNP) is a hormone secreted by cardiomyocytes in response to myocardial ischemia, increased ventricular wall tension, and overload. BNP is utilized as a diagnostic and prognostic marker in congested heart failure (CHF). Its prognostic value in sepsis is unknown. The aim of this study is to determine if BNP correlates with increased in-hospital mortality for septic patients. Methods: This was a retrospective study of 505 patients admitted for sepsis or severe sepsis or septic shock during the period of January 2013 and August 2014...
December 2017: Cardiology Research
https://www.readbyqxmd.com/read/29316834/delayed-administration-of-bq788-an-etb-antagonist-after-experimental-traumatic-brain-injury-promotes-recovery-of-blood-brain-barrier-function-and-reduction-of-cerebral-edema-in-mice
#12
Shotaro Michinaga, Akimasa Kimura, Shunichi Hatanaka, Shizuho Minami, Arisa Asano, Yuki Ikushima, Shingo Matsui, Yoshiya Toriyama, Manami Fujii, Yutaka Koyama
Traumatic brain injury (TBI) is induced by immediate physical disruption of brain tissue, and causes death and disability. Studies on experimental TBI animal models show that disruption of the blood-brain barrier (BBB) underlies brain edema and neuroinflammation during the delayed phase of TBI. In neurological disorders, endothelin-1 (ET-1) is involved in BBB dysfunction and brain edema. In this study, the effect of ET antagonists on BBB dysfunction and brain edema were examined in a mouse focal TBI model using lateral fluid percussion injury (FPI)...
January 9, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29315142/enteroviral-encephalitis-in-a-child-with-cns-relapse-of-burkitt-leukemia-treated-with-rituximab
#13
Najma Shaheen, Francis Mussai
A boy with central nervous system relapse of Burkitt leukemia developed fever and neurological symptoms and cognitive impairment. He had received multi-drug chemotherapy including rituximab. Enterovirus (EV) was detected in cerebrospinal fluid by polymerase chain reaction, and magnetic resonance imaging findings were consistent with viral infection. The patient was treated with intravenous immunoglobulin and within 1 month cleared his EV. Rituximab can cause a profound B-cell deficiency predisposing patients to infections including EV encephalitis...
January 8, 2018: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/29310984/comparison-of-sonographic-inferior-vena-cava-and-aorta-indexes-during-fluid-administered-in-children
#14
Yun Ang Choi, Hyuksool Kwon, Jin Hee Lee, Jae Yun Jung, Yoo Jin Choi
OBJECTIVES: This prospective, observational study evaluated changes in ultrasound measurements of the inferior vena caval index (IVCI), the aorta diameter/IVC diameter index (Ao/IVCD), and the aorta area/IVC area index (Ao/IVCA) during fluid administration in children requiring intravenous fluid administration. METHODS: Children who presented to the pediatric emergency department with symptoms of dehydration were enrolled between May 2015 and February 2016. The maximum diameter of the aorta, from inner wall to inner wall, and the long and short axis diameters of IVC were measured using a convex array transducer in the transverse view...
January 4, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29310343/cerebrospinal-fluid-real-time-quaking-induced-conversion-test-for-sporadic-creutzfeldt-jakob-disease-in-an-18-year-old-woman-a-case-report
#15
Yuan Yao, Xiaoping Dong, Hongzhi Guan, Qiang Lu
RATIONALE: Sporadic Creutzfeldt-Jakob disease (sCJD) mainly occurs in the elderly, with the peak age of onset ranging from 55 to 75 years. The symptoms of sCJD are not unique, and laboratory tests such as magnetic resonance imaging (MRI), electroencephalogram (EEG) and cerebrospinal fluid (CSF)14-3-3 protein have low sensitivity or specificity. Therefore, excluding treatable diseases and establishing a diagnosis could be difficult in young patients with suspected sCJD. Recently, real-time quaking-induced conversion (RT-QuIC) has been used in the diagnosis of sCJD, with more than 95% sensitivity and 100% specificity...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29307101/aciclovir-induced-acute-kidney-injury-in-patients-with-suspected-viral-encephalitis-encountered-on-a-liaison-neurology-service
#16
Petya Bogdanova-Mihaylova, David Burke, John P O'Dwyer, David Bradley, Jennifer A Williams, Simon J Cronin, Shane Smyth, Raymond P Murphy, Sinead M Murphy, Catherine Wall, Dominick J H McCabe
BACKGROUND: Patients with 'suspected viral encephalitis' are frequently empirically treated with intravenous aciclovir. Increasing urea and creatinine are 'common', but rapidly progressive renal failure is reported to be 'very rare'. AIMS: To describe the clinical course and outcome of cases of aciclovir-induced acute kidney injury (AKI) encountered by the Liaison Neurology Service at AMNCH and to highlight the importance of surveillance and urgent treatment of this iatrogenic complication...
January 6, 2018: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/29306858/guillain-barr%C3%A3-syndrome-with-exaggerated-pleocytosis-and-anti-gm1-ganglioside-antibodies
#17
Gabriel T Doctor, Sian K Alexander, Aleksandar Radunovic
An 81-year-old man presented with fever, confusion and rapidly-progressive flaccid tetraparesis. Clinical presentation and neurophysiology were consistent with a severe axonal polyneuropathy. Anti-GM1 and Campylobacter serology were both positive, consistent with postinfectious axonal-variant Guillain-Barré syndrome (GBS). GBS is characterised by albuminocytological dissociation, where an elevated protein and acellular cerebrospinal fluid are typical. However, in this case, CSF analysis revealed an exaggerated pleocytosis (72 white blood cells (WBC)/mm3)...
January 6, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29297830/successful-treatment-of-a-clinical-elephant-endotheliotropic-herpesvirus-infection-the-dynamics-of-viral-load-genotype-analysis-and-treatment-with-acyclovir
#18
Supaphen Sripiboon, Taweepoke Angkawanish, Khajohnpat Boonprasert, Petthisak Sombutputorn, Warangkhana Langkaphin, William Ditcham, Kristin Warren
This article describes the treatment of clinical elephant endotheliotropic herpesvirus (EEHV) infection in a male Asian elephant ( Elephas maximus; approximately 3 yr old), the dynamics of viral load during the active infection, and genetic analysis of the virus. Treatment included injectable acyclovir (12 mg/kg iv, bid), antibiotic, vitamin, and fluids. Quantitative polymerase chain reaction was used to measure the viral levels in blood, which decreased continuously after initiation of intravenous acyclovir...
December 2017: Journal of Zoo and Wildlife Medicine: Official Publication of the American Association of Zoo Veterinarians
https://www.readbyqxmd.com/read/29297387/personalised-fluid-resuscitation-in-the-icu-still-a-fluid-concept
#19
REVIEW
Frank van Haren
The administration of intravenous fluid to critically ill patients is one of the most common, but also one of the most fiercely debated, interventions in intensive care medicine. Even though many thousands of patients have been enrolled in large trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Critically ill patients are significantly heterogeneous, making a one size fits all approach unlikely to be successful.New data from basic, animal, and clinical research suggest that fluid resuscitation could be associated with significant harm...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29290890/intravenous-fluid-selection-rationales-in-acute-clinical-management
#20
Wing Yan Shirley Cheung, Wai Kwan Cheung, Chun Ho Lam, Yeuk Wai Chan, Hau Ching Chow, Ka Lok Cheng, Yau Hang Wong, Chak Wah Kam
BACKGROUND: Intravenous fluid (IVF) is commonly used in acute clinical management. This study aimed to review the choice and primary considerations in IVF prescriptions and to evaluate the adequacy of guidelines and trainings on it in the New Territories West Cluster (NTWC) of Hong Kong. METHODS: This is a descriptive study based on data collected from an online survey. Data were processed by SPSS for statistical analysis. This study focused on a general description and doctor-nurse between group comparison...
2018: World Journal of Emergency Medicine
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