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Fluid managment

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https://www.readbyqxmd.com/read/29342033/meningoencephalocele-and-cerebrospinal-fluid-leak-complicating-orbital-decompression
#1
Liza M Cohen, Juan C Jiménez Pérez, Eric H Holbrook, William T Curry, Michael K Yoon
A 51-year-old man who had undergone right orbital decompression 5 months earlier developed a meningoencephalocele extending in the right sphenoid sinus through a skull base defect of the right ethmoid, sphenoid, and frontal bones. The authors report the third case to their knowledge of meningoencephalocele with cerebrospinal fluid leak after orbital decompression and discuss its management and measures that can be taken to prevent this rare but serious complication.
January 16, 2018: Ophthalmic Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29340799/fully-automated-life-support-an-implementation-and-feasibility-pilot-study-in-healthy-pigs
#2
Wilfried Klingert, Jörg Peter, Christian Thiel, Karolin Thiel, Wolfgang Rosenstiel, Kathrin Klingert, Christian Grasshoff, Alfred Königsrainer, Martin Schenk
BACKGROUND: Automated systems are available in various application areas all over the world for the purpose of reducing workload and increasing safety. However, such support systems that would aid caregivers are still lacking in the medical sector. With respect to workload and safety, especially, the intensive care unit appears to be an important and challenging application field. Whereas many closed-loop subsystems for single applications already exist, no comprehensive system covering multiple therapeutic aspects and interactions is available yet...
January 16, 2018: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29338892/treatment-of-intraoral-ranulas-with-a-two-incision-fistula-technique-the-management-of-recurrence
#3
Qingtong Zhao, Mengyu Li, Renfa Lai, Shaoyi Wang
The two-incision fistula technique for the treatment of oral ranulas has recently been introduced to clinical practice. We reviewed 52 patients who had recurrences after this treatment, and explored the possible causes and underlying mechanisms. A total of 13/53 ranulas had recurred, so we repeated the operation, and one patient had the ranula and the sublingual gland resected. We found that the thin mucous membrane cracked at the double incisions, which led to the formation of a fistula and promoted the drainage of cystic fluid...
January 12, 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29338148/novel-applications-of-bedside-monitoring-to-plumb-patient-hemodynamic-state-and-response-to-therapy
#4
Fabio Guarracino, Pietro Bertini, Michael R Pinsky
Hemodynamic monitoring is essential during the treatment of the critically ill in order to address the hemodynamic alterations and assess the response to treatment. Traditionally classified causes of shock and underlying pathophysiological mechanisms are often neglected by resuscitative strategies included in the guidelines. Most of hemodynamic management focuses on the ability to early recognise patients susceptible to increase cardiac output (CO) and mean arterial pressure (MAP) after a defined fluid challenge by eliciting Starling's law of the heart, and less is known of the ones presenting in shock and not volume responsive...
January 16, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29337792/early-fluid-management-in-sepsis-yes
#5
Peter Thomas Morley
No abstract text is available yet for this article.
February 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29337704/the-what-when-and-how-in-performing-and-interpreting-microbiological-diagnostic-tests-in-skin-and-soft-tissue-infections
#6
Carolina Navarro-San Francisco, Patricia Ruiz-Garbajosa, Rafael Cantón
PURPOSE OF REVIEW: To summarize and classify the most recent and relevant microbiological studies for each type of skin and soft tissue infection (SSTI). RECENT FINDINGS: Following Infectious Diseases Society of America and Food and Drug Administration classifications of SSTIs, we differentiate between two large groups, the superficial or uncomplicated infections and the complicated infections with deep involvement. It is not usually necessary to obtain microbiological samples in uncomplicated infections, except in cases of recurrences or for epidemiological control purposes...
January 11, 2018: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/29336990/failure-of-intracardiac-pacing-after-fatal-propafenone-overdose-a-case-report
#7
Ivan Zeljković, Nikola Bulj, Matea Kolačević, Vedran Čabrilo, Diana Delić Brkljačić, Šime Manola
BACKGROUND: Propafenone is a sodium-channel blocker, class IC antiarrhythmic drug, frequently used to manage supraventricular dysrhythmias, especially atrial fibrillation. We report a self mono-intoxication with propafenone. CASE REPORT: A 68-year-old woman presented with a decreased level of consciousness, hypotension, and electrocardiogram showing QRS widening with atrial asystole and extreme bradycardia < 20 beats/min. After initial stabilization with transcutaneous pacing, laboratory findings detected normal electrolyte ranges and metabolic acidosis, and her medical history revealed availability of propafenone due to paroxysmal atrial fibrillation and depressive syndrome, which led to the suspicion of intoxication...
January 11, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29333566/principles-of-management-of-central-nervous-system-infections
#8
REVIEW
Sunit Singhi, Suresh Kumar Angurana
CNS infections in children are medical emergency and are associated with high mortality and morbidity. For diagnosis, a high index of suspicion is required. Clinical assessment should be supplemented by laboratory investigations including CSF Gram stain and cultures, blood culture, PCR on CSF, serological tests, and imaging. Commonly associated life threatening complications include coma, seizure, raised intracranial pressure (ICP), focal deficits, shock, respiratory failure, and fluid and electrolyte abnormalities...
January 15, 2018: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/29333494/ensuring-adequate-vascular-access-in-patients-with-major-trauma-a-quality-improvement-initiative
#9
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/29333425/outcomes-of-selective-surgery-in-patients-with-suspected-small-bowel-injury-from-blunt-trauma
#10
Hyoung-Chul Park, Jong Whan Kim, Min Jeong Kim, Bong Hwa Lee
Purpose: The role of initial conservative therapy with selective surgery for patients with suspected blunt bowel injury by radiologic evaluation is less clear. The aim of the study is to assess the outcomes of patients who received initial conservative therapy with selective delayed surgery, compared to emergency surgery. Methods: During this 8-year study, a total of 77 patients who were hemodynamically stable were enrolled, in which computed tomography verified suspected bowel injury from blunt trauma (mesenteric hematoma, mesenteric fat infiltration, bowel wall thickening, and free fluid without solid organ injury) was managed with either initial conservative therapy with selective delayed surgery (group A; n = 42) or emergency surgery (group B; n = 35)...
January 2018: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/29333010/sinusoidal-obstruction-syndrome-during-treatment-for-wilms-tumor-a-life-threatening-complication
#11
Sidharth Totadri, Amita Trehan, Deepak Bansal, Richa Jain
Context: Survival rates exceed 90% in Wilms' tumor (WT). Actinomycin-D (ACT-D) which is indispensable in the management of WT is associated with the development of sinusoidal obstruction syndrome (SOS), a potentially fatal complication. Aims: The aim is to study the presentation, management, and outcome of SOS complicating ACT-D administration in WT. Settings and Design: Retrospective file review conducted in a Pediatric Hematology-Oncology unit...
October 2017: Indian Journal of Medical and Paediatric Oncology
https://www.readbyqxmd.com/read/29331494/a-novel-difficult-airway-prediction-tool-for-emergency-airway-management-validation-of-the-heaven-criteria-in-a-large-air-medical-cohort
#12
Edward Kuzmack, Travis Inglis, David Olvera, Allen Wolfe, Kona Seng, Daniel Davis
BACKGROUND: Difficult-airway prediction tools help identify optimal airway techniques, but were derived in elective surgery patients and may not be applicable to emergency rapid sequence intubation (RSI). The HEAVEN criteria (Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination, Neck mobility issues) may be more relevant to emergency RSI patients. OBJECTIVE: To validate the HEAVEN criteria for difficult-airway prediction in emergency RSI using a large air medical cohort...
January 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#13
REVIEW
Jacob C Jentzer, Saraschandra Vallabhajosyula, Ashish K Khanna, Lakhmir S Chawla, Laurence W Busse, Kianoush B Kashani
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory shock, with short-term mortality exceeding 50%. Refractory vasodilatory shock develops from uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing failure of physiologic vasoregulatory mechanisms. Standard approaches to initial management of shock include fluid resuscitation and initiation of norepinephrine...
January 9, 2018: Chest
https://www.readbyqxmd.com/read/29329518/the-use-of-eculizumab-in-gemcitabine-induced-thrombotic-microangiopathy
#14
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/29329448/the-prevalence-and-management-of-dehydration-amongst-neonatal-admissions-to-general-paediatric-wards-in-kenya-a-clinical-audit
#15
Samuel Akech, Beatrice Rotich, Mercy Chepkirui, Philip Ayieko, Grace Irimu, Mike English
An audit of randomly selected case records of 810 patients admitted to 13 hospitals between December 2015 and November 2016 was done. Prevalence of dehydration was 19.7% (2293 of 11 636) [95% CI: 17.1-22.6%], range across hospitals was 9.4% to 27.0%. Most cases with dehydration were clinically diagnosed (82 of 153; 53.6%), followed by excessive weight loss (54 of 153; 35.3%) and abnormal urea/electrolytes/creatinine (23 of 153; 15.0%). Documentation of fluids prescribed was poor but, where data were available, Ringers lactate (30 of 153; 19...
January 9, 2018: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/29329118/ce-managing-sepsis-and-septic-shock-current-guidelines-and-definitions
#16
Mary Beth Flynn Makic, Elizabeth Bridges
Recent updates emphasize early recognition and prompt intervention. ABSTRACT: Sepsis is a leading cause of critical illness and hospital mortality. Early recognition and intervention are essential for the survival of patients with this syndrome. In 2002, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) launched the Surviving Sepsis Campaign (SSC) to reduce overall patient morbidity and mortality from sepsis and septic shock by driving practice initiatives based on current best evidence...
January 11, 2018: American Journal of Nursing
https://www.readbyqxmd.com/read/29328792/identification-and-management-of-nontraumatic-splenic-rupture
#17
Samanthi De Silva
A 43-year old previously fit and well gentleman presented to the emergency department (ED) with a two day history of worsening epigastric pain. He had had coryzal symptoms the preceding week but had no other past medical history. He was haemodynamically stable at presentation and an ultrasound scan (US) performed in the ED could not definitively rule out intra-abdominal fluid. In view of his tender abdomen on examination and a haemoglobin level of 9.2g/dL, a computerised tomography (CT) scan was performed and revealed extensive high-density fluid within the peritoneal cavity, raising the possibility of a concealed bleed but no obvious source was identified by the scan...
December 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29327521/cerebrospinal-fluid-a-clinicopathologic-analysis
#18
Asha Shenoy, Heena Desai, Aparna Mandvekar
Context and Objective: This study aims to emphasize the importance of an appropriate CSF examination in patients of suspected CNS disease and the necessity of correlating it with the clinico-radiologic findings which will help in early diagnosis of CNS diseases and guide the further management of the disease. Design: In this 2 year study, 215 CSF samples from patients with clinically suspected diseases of the CNS were studied. The CSF samples were analyzed for gross examination, protein, sugar, adenosine deaminase (ADA) levels, microscopic examination and microbiologic examination...
December 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29327078/the-role-of-the-thioredoxin-thioredoxin-reductase-system-in-the-metabolic-syndrome-towards-a-possible-prognostic-marker
#19
REVIEW
Alexey A Tinkov, Geir Bjørklund, Anatoly V Skalny, Arne Holmgren, Margarita G Skalnaya, Salvatore Chirumbolo, Jan Aaseth
Mammalian thioredoxin reductase (TrxR) is a selenoprotein with three existing isoenzymes (TrxR1, TrxR2, and TrxR3), which is found primarily intracellularly but also in extracellular fluids. The main substrate thioredoxin (Trx) is similarly found (as Trx1 and Trx2) in various intracellular compartments, in blood plasma, and is the cell's major disulfide reductase. Thioredoxin reductase is necessary as a NADPH-dependent reducing agent in biochemical reactions involving Trx. Genetic and environmental factors like selenium status influence the activity of TrxR...
January 11, 2018: Cellular and Molecular Life Sciences: CMLS
https://www.readbyqxmd.com/read/29326837/one-stage-approach-for-hybrid-atrial-fibrillation-treatment
#20
Vincent Umbrain, Christian Verborgh, Gian-Battista Chierchia, Carlo De Asmundis, Pedro Brugada, Mark La Meir
The one-stage approach for hybrid atrial fibrillation involves the simultaneous and close cooperation of different medical specialties. This review attempts to describe its challenging issues, exposing a plan to balance thrombotic risk and bleeding risk. It describes the combined surgical-electrophysiological procedure. Specific topics, involving hemodynamic, fluid and respiratory management during surgery are considered, and problems related to postoperative pain are surveyed.
December 2017: Arrhythmia & Electrophysiology Review
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