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https://www.readbyqxmd.com/read/28625299/managing-major-obstetric-haemorrhage-pharmacotherapy-and-transfusion
#1
REVIEW
Rachel Collis, Emilia Guasch
Major obstetric haemorrhage is a leading cause of maternal mortality. A prescriptive approach to early recognition and management is critical to improving outcomes. Uterine atony is the primary cause of post-partum haemorrhage. First-line prevention and treatment include the administration of uterine tonic agents; other conservative measures include uterine cavity tamponade and uterine compression sutures. Interventional radiology procedures have been used for both prophylaxis and treatment, but a hysterectomy may be necessary if conservative measures fail...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28625244/-establishment-of-porcine-model-of-prolonged-cardiac-arrest-and-cardiopulmonary-resuscitation-electrically-induced-by-ventricular-fibrillation
#2
Cai Wen, Heng Li, Xiaozhu Zhai, Youde Ding, Huatao Zhou, Zhiming Ouyang, Zhengfei Yang, Longyuan Jiang, Wanchun Tang, Tao Yu
OBJECTIVE: To investigate the optimal injury time point of cardiac arrest (CA) induced electrically, and establish a reproducible prolonged CA and cardiopulmonary resuscitation (CPR) model in pigs. METHODS: Forty healthy domestic male pigs were randomly divided into four groups, which were ventricular fibrillation (VF) 8, 10, 11, and 12 minutes groups, each group for 10 animals. In these groups, VF was induced by alternating current delivered to right ventricular endocardium and untreated for 8, 10, 11, and 12 minutes, respectively, followed by 6 minutes of CPR procedure...
June 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28616160/cardiopulmonary-arrest-in-primary-care-clinics-more-holes-than-cheese-a-survey-of-the-knowledge-and-attitudes-of-primary-care-physicians-regarding-resuscitation
#3
Sharon Einav, Oren Wacht, Nechama Kaufman, Eliezer Alkalay
BACKGROUND: Patients experiencing pre-arrest symptoms may first refer to their primary care physician. The study's aim was to determine the likelihood that a patient undergoing out-of-hospital cardiac arrest will receive appropriate resuscitation efforts in a primary care clinic in a country with a directive that clinics maintain resuscitation equipment and physicians undergo periodic resuscitation training. METHODS: An anonymous, 23-question online cross-sectional survey was created and administered to primary care physicians working in community clinics (10/1/2015-5/3/2015)...
2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/28604999/percutaneous-cardiac-support-during-myocardial-infarction-drastically-reduces-mortality-perspectives-from-a-swine-model
#4
Maria Giovanna Trivella, Alessandra Piersigilli, Fabio Bernini, Gualtiero Pelosi, Silvia Burchielli, Stefano Puzzuoli, Claudia Kusmic, Antonio L'Abbate
BACKGROUND/AIMS: Acute myocardial infarction (AMI) with cardiogenic shock (CS) remains the leading cause of in-hospital death in acute coronary syndromes. In the AMI-CS pig model we tested the efficacy of temporary percutaneous cardiorespiratory assist device (PCRA) in rescuing the failing heart and reducing early mortality. METHODS: In open-chest pigs we induced AMI by proximal left anterior descending coronary artery (LAD) ligation. Eight animals without PCRA (C group) were compared with 12 animals otherwise treated with PCRA (T group), starting approximately at 60 minutes post-occlusion and lasting 120-180 minutes...
June 6, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28601310/hemoglobin-based-oxygen-carriers-promote-systemic-hyperfibrinolysis-that-is-both-dependent-and-independent-of-plasmin
#5
Alexander P Morton, Ernest E Moore, Hunter B Moore, Eduardo Gonzalez, Michael P Chapman, Erik Peltz, Anirban Banerjee, Christopher Silliman
BACKGROUND: Hyperfibrinolysis plays an integral role in the genesis of trauma-induced coagulopathy. Recent data demonstrate that red blood cell lysis promotes fibrinolysis; however, the mechanism is unclear. Hemoglobin-based oxygen carriers (HBOCs) have been developed for resuscitation and have been associated with coagulopathy. We hypothesize that replacement of whole blood (WB) using an HBOC results in a coagulopathy because of the presence of free hemoglobin. MATERIALS AND METHODS: WB was sampled from healthy donors (n = 6)...
June 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28601273/potential-impact-of-the-2016-consensus-definitions-of-sepsis-and-septic-shock-on-future-sepsis-research
#6
Sandra L Peake, Anthony Delaney, Michael Bailey, Rinaldo Bellomo
STUDY OBJECTIVE: The influence of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) on the conduct of future sepsis research is unknown. We seek to examine the potential effect of the new definitions on the identification and outcomes of patients enrolled in a sepsis trial. METHODS: This was a post hoc analysis of the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial of early goal-directed therapy that recruited 1,591 adult patients presenting to the emergency department (ED) with early septic shock diagnosed by greater than or equal to 2 systemic inflammatory response syndrome criteria and either refractory hypotension or hyperlactatemia...
June 7, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28596476/rnase-alleviates-neurological-dysfunction-in-mice-undergoing-cardiac-arrest-and-cardiopulmonary-resuscitation
#7
Ye Ma, Chan Chen, Shu Zhang, Qiao Wang, Hai Chen, Yuanlin Dong, Zheng Zhang, Yan Li, Zhendong Niu, Tao Zhu, Hai Yu, Bin Liu
Cardiac arrest (CA) is one of the leading lethal factors. Despite cardiopulmonary resuscitation (CPR) procedure has been consecutively improved and lots of new strategies have been developed, neurological outcome of the patients experienced CPR is still disappointing. Ribonuclease (RNase) has been demonstrated to have neuroprotective effects in acute stroke and postoperative cognitive impairment, possibly through acting against endogenous RNA that released from damaged tissue. However, the role of RNase in post-cardiac arrest cerebral injury is unknown...
May 23, 2017: Oncotarget
https://www.readbyqxmd.com/read/28591008/plasma-resuscitation-improved-survival-in-a-cecal-ligation-and-puncture-rat-model-of-sepsis
#8
Ronald Chang, John B Holcomb, Par I Johansson, Shibani Pati, Martin A Schreiber, Charles E Wade
BACKGROUND: The paradigm shift from crystalloid to plasma resuscitation of traumatic hemorrhagic shock has improved patient outcomes due in part to plasma-mediated reversal of catecholamine and inflammation-induced endothelial injury, decreasing vascular permeability and attenuating organ injury. Since sepsis induces a similar endothelial injury as seen in hemorrhage, we hypothesized that plasma resuscitation would increase 48-hour survival in a rat sepsis model. METHODS: Adult male Sprague-Dawley rats (375-425 g) were subjected to 35% cecal ligation and puncture (CLP) (t = 0 h)...
June 6, 2017: Shock
https://www.readbyqxmd.com/read/28590357/rotem-significantly-optimizes-transfusion-practices-for-damage-control-resuscitation-in-combat-casualties
#9
Nicolas J Prat, Andrew D Meyer, Nichole K Ingalls, Julie Trichereau, Joseph J DuBose, Andrew P Cap
BACKGROUND: Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood (WB) by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused...
June 6, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28590349/outcomes-following-concomitant-traumatic-brain-injury-and-hemorrhagic-shock-a-secondary-analysis-from-the-proppr-trial
#10
Samuel M Galvagno, Erin E Fox, Savitri N Appana, Sarah Baraniuk, Patrick L Bosarge, Eileen M Bulger, Rachel A Callcut, Bryan A Cotton, Michael Goodman, Kenji Inaba, Terence O'Keeffe, Martin A Schreiber, Charles E Wade, Thomas M Scalea, John B Holcomb, Deborah M Stein
BACKGROUND: Often the clinician is faced with a diagnostic and therapeutic dilemma in patients with concomitant traumatic brain injury (TBI) and hemorrhagic shock (HS), as rapid deterioration from either can be fatal. Knowledge about outcomes following concomitant TBI and HS may help prioritize the emergent management of these patients. We hypothesized that patients with concomitant TBI and HS (TBI+HS) had worse outcomes and required more intensive care compared to patients with only one of these injuries...
June 6, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28583154/a-cohort-analysis-of-neonatal-hospital-mortality-rate-and-predictors-of-neonatal-mortality-in-a-sub-urban-hospital-of-cameroon
#11
Paul Koki Ndombo, Quinta Mua Ekei, Joel Noutakdie Tochie, Mazou Ngou Temgoua, Francky Teddy Endomba Angong, Ferdinand Ndom Ntock, Lawrence Mbuagbaw
BACKGROUND: In Cameroon, sustainable effort needs to be done to reduce the current neonatal mortality rate from 21 deaths per 1000 live births to the global target of fewer than ten deaths per 1000 live births by 2035. We aimed to determine the neonatal hospital mortality rate and predictors of neonatal hospital mortality (NHM) in a major referral sub-urban hospital of Cameroon in a bit to formulate interventions to curb this burden. METHODS: This was a prospective cohort study consecutively enrolling all neonates admitted into the neonatology unit of the Bamenda Regional Hospital (BRH) from November 2015 to February 2016...
June 5, 2017: Italian Journal of Pediatrics
https://www.readbyqxmd.com/read/28582277/simulation-based-assessment-identifies-longitudinal-changes-in-cognitive-skills-in-an-anesthesiology-residency-training-program
#12
Avner Sidi, Nikolaus Gravenstein, Terrie Vasilopoulos, Samsun Lampotang
OBJECTIVES: We describe observed improvements in nontechnical or "higher-order" deficiencies and cognitive performance skills in an anesthesia residency cohort for a 1-year time interval. Our main objectives were to evaluate higher-order, cognitive performance and to demonstrate that simulation can effectively serve as an assessment of cognitive skills and can help detect "higher-order" deficiencies, which are not as well identified through more traditional assessment tools. We hypothesized that simulation can identify longitudinal changes in cognitive skills and that cognitive performance deficiencies can then be remediated over time...
June 2, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28582003/controversies-in-out-of-hospital-cardiac-arrest
#13
REVIEW
Rahul P Sharma, Dion Stub
Cardiac arrest is a major cause of morbidity and mortality and accounts for nearly 500,000 deaths annually in the United States. In patients suffering out-of-hospital cardiac arrest, survival is less than 15%, with considerable regional variation. Although most deaths occur during the initial resuscitation, an increasing proportion occur in patients hospitalized after initially successful resuscitation. In these patients, the significant subsequent morbidity and mortality is due to "post cardiac arrest syndrome...
October 2016: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28577679/the-effects-of-sacubitril-valsartan-on-coronary-outcomes-in-paradigm-hf
#14
Ulrik M Mogensen, Lars Køber, Søren L Kristensen, Pardeep S Jhund, Jianjian Gong, Martin P Lefkowitz, Adel R Rizkala, Jean L Rouleau, Victor C Shi, Karl Swedberg, Michael R Zile, Scott D Solomon, Milton Packer, John J V McMurray
BACKGROUND: Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. METHODS AND RESULTS: We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28576433/postictal-apnea-as-an-important-mechanism-for-sudep-a-near-sudep-with-continuous-eeg-ecg-emg-recording
#15
Lang Jin, Ying Zhang, Xiao-Li Wang, Wen-Juan Zhang, Yong-Hong Liu, Zhao Jiang
Sudden unexpected death in epilepsy (SUDEP) is one of the most frequent causes of death among patients with epilepsy. Most SUDEP or near-SUDEP are unwitnessed and not observed or recorded during video-EEG recording in epilepsy monitoring units. This report describes a young woman with post ictal apnea and generalized EEG suppression (PGES) after a secondary generalized tonic-clonic seizure (sGTCS). This was accompanied by bradycardia and then ventricular tachycardia (VT). But at the end of VT, the patient's breath recovered without any intervention, such as cardio-respiratory resuscitation...
May 30, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28573043/a-safety-evaluation-of-profound-hypothermia-induced-suspended-animation-for-delayed-resuscitation-at-90-or-120%C3%A2-min
#16
Yu Liu, Shu Li, Zhi Li, Jian Zhang, Jin-Song Han, Yong Zhang, Zong-Tao Yin, Hui-Shan Wang
BACKGROUND: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia-induced suspended animation for delayed resuscitation (SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest (CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals...
2017: Military Medical Research
https://www.readbyqxmd.com/read/28569187/the-effects-of-acute-renal-denervation-on-kidney-perfusion-and-metabolism-in-experimental-septic-shock
#17
Emiel Hendrik Post, Fuhong Su, Koji Hosokawa, Fabio Silvio Taccone, Antoine Herpain, Jacques Creteur, Daniel De Backer, Jean-Louis Vincent
BACKGROUND: Perfusion deficits likely play an important role in the development of renal dysfunction in sepsis. Renal denervation may improve kidney perfusion and metabolism. METHODS: We randomized 14 female sheep to undergo bilateral surgical renal denervation (n = 7) or sham procedure (n = 7) prior to induction of sepsis. Renal blood flow (RBF) was measured with a pre-calibrated flowprobe. Laser Doppler probes were implanted to measure cortical and medullary perfusion...
May 31, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28568968/effect-of-known-history-of-heart-disease-on-survival-outcomes-after-out-of-hospital-cardiac-arrests
#18
Magdalene Hm Lee, Stephanie Fook-Chong, Win Wah, Sang Do Shin, Tatsuya Nishiuchi, Patrick Chow-In Ko, Ghulam Yasin Naroo, Kwanhathai Darin Wong, Ling Tiah, Apichaya Monsomboon, Fahad J Siddiqui, Marcus Eh Ong
OBJECTIVE: We aimed to investigate the effect of known heart disease on post-out-of-hospital cardiac arrest (OHCA) survival outcomes, and its association with factors influencing survival. METHODS: This was an observational, retrospective study involving an OHCA database from seven Asian countries in 2009-2012. Heart disease was defined as a documented diagnosis of coronary artery disease or congenital heart disease. Patients with non-traumatic arrests for whom resuscitation was attempted and with known medical histories were included...
May 31, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28562475/duration-of-untreated-cardiac-arrest-and-clinical-relevance-of-animal-experiments-the-relationship-between-the-no-flow-duration-and-the-severity-of-post-cardiac-arrest-syndrome-in-a-porcine-model
#19
Gioanni Babini, Luigi Grassi, Ilaria Russo, Deborah Novelli, Antonio Boccardo, Anita Luciani, Francesca Fumagalli, Lidia Staszewsky, Fabio Fiordaliso, Marcella De Maglie, Monica Salio, Davide Danilo Zani, Teresa Letizia, Serge Masson, Mario Vittorio Luini, Davide Pravettoni, Eugenio Scanziani, Roberto Latini, Giuseppe Ristagno
INTRODUCTION: The study investigated the effect of untreated cardiac arrest (CA), i.e. "no-flow" time, on post-resuscitation myocardial and neurological injury, and survival in a pig model to identify an optimal duration that adequately reflects the most frequent clinical scenario. METHODS: An established model of myocardial infarction followed by CA and cardiopulmonary resuscitation was used. Twenty-two pigs were subjected to 3 no-flow durations: short (8-10 min); intermediate (12-13 min); and long (14-15 min)...
May 30, 2017: Shock
https://www.readbyqxmd.com/read/28560683/the-impact-of-a-multifaceted-intervention-including-sepsis-electronic-alert-system-and-sepsis-response-team-on-the-outcomes-of-patients-with-sepsis-and-septic-shock
#20
Yaseen M Arabi, Hasan M Al-Dorzi, Ahmed Alamry, Ra'ed Hijazi, Sami Alsolamy, Majid Al Salamah, Hani M Tamim, Saad Al-Qahtani, Abdulaziz Al-Dawood, Abdellatif M Marini, Fatimah H Al Ehnidi, Shihab Mundekkadan, Amal Matroud, Mohamed S Mohamed, Saadi Taher
BACKGROUND: Compliance with the clinical practice guidelines of sepsis management has been low. The objective of our study was to describe the results of implementing a multifaceted intervention including an electronic alert (e-alert) with a sepsis response team (SRT) on the outcome of patients with sepsis and septic shock presenting to the emergency department. METHODS: This was a pre-post two-phased implementation study that consisted of a pre-intervention phase (January 01, 2011-September 24, 2012), intervention phase I (multifaceted intervention including e-alert, from September 25, 2012-March 03, 2013) and intervention phase II when SRT was added (March 04, 2013-October 30, 2013) in a 900-bed tertiary-care academic hospital...
December 2017: Annals of Intensive Care
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