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https://www.readbyqxmd.com/read/29140948/hypertonic-saline-resuscitation-following-emergent-laparotomy-and-temporary-abdominal-closure
#1
Tyler J Loftus, Philip A Efron, Trina M Bala, Martin D Rosenthal, Chasen A Croft, R Stephen Smith, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
BACKGROUND: Our objective was to establish the safety of 3% hypertonic saline (HTS) resuscitation for trauma and acute care surgery patients undergoing emergent laparotomy and temporary abdominal closure (TAC) with the hypothesis that HTS administration would be associated with hyperosmolar hypercholoremic acidosis, lower resuscitation volumes, and higher fascial closure rates, without adversely affecting renal function. METHODS: We performed a retrospective cohort analysis of 189 trauma and acute care surgery patients who underwent emergent laparotomy and TAC, comparing patients with normal baseline renal function who received 3% HTS at 30 mL/h (n=36) to patients with standard resuscitation (n=153) by baseline characteristics, resuscitation parameters, and outcomes including primary fascial closure and KDIGO stages of acute kidney injury...
November 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29132516/decompensated-cirrhosis-and-fluid-resuscitation
#2
REVIEW
Erin Maynard
The critically ill patient with decompensated cirrhosis has a unique physiology and alterations in albumin that need to be understood to properly resuscitate them and minimize morbidity and mortality. Little data exist on specific resuscitation of the patient with cirrhosis compared with those patients without liver disease. The effectiveness of albumin administration compared with saline administration in common settings, such as large-volume paracentesis, can be extrapolated to the care of the general surgical patient but further studies in this area are warranted...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29131347/critical-care-ultrasound-a-national-survey-across-specialties
#3
Jeffrey R Stowell, Ross Kessler, Resa E Lewiss, Igor Barjaktarevic, Bikash Bhattarai, Napatkamon Ayutyanont, John L Kendall
PURPOSE: Management of the critically ill patient requires rapid assessment and differentiation. Point-of-care ultrasound (POCUS) improves diagnostic accuracy and guides resuscitation. This study sought to describe the use of critical care related POCUS amongst different specialties. METHODS: This study was conducted as an online 18-question survey. Survey questions queried respondent demographics, preferences for POCUS use, and barriers to implementation. RESULTS: 2735 recipients received and viewed the survey with 416 (15...
November 13, 2017: Journal of Clinical Ultrasound: JCU
https://www.readbyqxmd.com/read/29123911/perimortem-cesarean-delivery-and-subsequent-emergency-hysterectomy-new-strategy-for-maternal-cardiac-arrest
#4
Mayako Goto, Hiroaki Watanabe, Kazuhide Ogita, Tetsuya Matsuoka
Cases: Perimortem cesarean delivery (PMCD) is the only way to resuscitate pregnant women in cardiac arrest, and has been found to increase maternal resuscitation rate by increasing circulating plasma volume. However, many obstetricians have not experienced a case of PMCD, as situations requiring it are rare. We report our strategy for cases of maternal cardiac arrest, on the basis of a review of published work, and present two case reports from our medical center. Outcomes: In case 1, PMCD led to death by massive bleeding...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29123888/cardiac-arrest-caused-by-rapidly-increasing-ascites-in-a-patient-with-tafro-syndrome-a-case-report
#5
Masatoshi Okumura, Atsushi Ujiro, Yasunori Otsuka, Hiroshi Yamamoto, Sho Wada, Hirofumi Iwata, Toshiaki Kan, Seiji Miyauchi, Atsushi Hashimoto, Yuko Sato, Yoshihito Fujita, Yoshihiro Fujiwara, Hideki Shimaoka
Case: Thrombocytopenia, anasarca, fever, renal insufficiency, and organomegaly (TAFRO) syndrome is a newly defined systemic inflammatory disorder with gradual progression of symptoms. A 59-year-old man with fever and ascites of unknown cause developed sudden-onset shock and respiratory failure in the general ward. Cardiac arrest immediately followed. Although he was resuscitated, frequent administration of adrenaline was required to maintain his blood pressure. His circulation was most effectively stabilized by drainage of fluid from his distended abdomen...
July 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29122552/nephroprotection-through-the-akt-enos-pathway-by-centrally-administered-erythropoietin-in-a-rat-model-of-fixed-volume-hemorrhage
#6
Behjat Seifi, Mehri Kadkhodaee, Mina Ranjbaran, Enayatollah Bakhshi
AIMS: This study was designed to investigate the protective effects of centrally administered erythropoietin (EPO) on brain oxidative stress and inflammatory markers to protect the kidneys during hemorrhagic shock (HS). MAIN METHODS: Animals were assigned into three groups (n=6). Sham rats were subjected to cannulation of femoral artery and vein as well as stereotaxic surgery. In HS group, 50% of total blood volume was withdrawn and resuscitation was started 2h later...
November 6, 2017: Life Sciences
https://www.readbyqxmd.com/read/29115659/application-of-pulsed-arterial-resuscitation-in-a-rabbit-model-of-hemorrhagic-shock
#7
Wendong Sun, Zhihui Shao, Haisong Xu, Wusi Qiu, Jiahua Sun
BACKGROUND: Hemorrhagic shock is characterized by tissue hypoperfusion caused by a sharp reduction in the effective circulating volume of blood. The key to successful resuscitation lies in eliminating the shock as soon as possible while simultaneously restoring blood perfusion to vital organs. We present the applicability of pulsed arterial blood reinfusion for resuscitation of hemorrhagic shock. METHODS: Sixty rabbits were randomly assigned to resuscitation and control groups...
November 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29112650/maternal-pulse-pressure-and-the-risk-of-postepidural-complications-a-randomized-controlled-trial
#8
Justin R Lappen, Stephen A Myers, Norman Bolen, Brian M Mercer, Edward K S Chien
OBJECTIVE: To test the hypothesis that increasing the intravenous fluid bolus volume at the time of epidural placement in women with narrow pulse pressure would reduce postepidural fetal heart rate (FHR) abnormalities, hypotension, and resuscitative obstetric interventions. METHODS: We performed a single-center randomized controlled trial. Eligible participants were normotensive with a nonanomalous singleton gestation at or after 35 weeks and with a narrow pulse pressure (less than 45 mm Hg) on admission...
November 3, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29096928/complications-of-trans-arterial-embolization-during-the-resuscitation-of-pelvic-fractures
#9
Boopalan Ramasamy, Dominic Thewlis, Mary J Moss, Francois Fraysse, Mark Rickman, Lucian Bogdan Solomon
INTRODUCTION: Trans arterial embolization (TAE) can stem uncontrolled bleeding associated with pelvic fractures, but is associated with potential complications. This study investigated and compared the early to midterm complications in two patient cohorts: one who did and one who did not undergo TAE. METHODOLOGY: The results of 14 patients who underwent TAE in the resuscitation phase, and then had their pelvic fractures managed non-operatively, the study group (Group 1), were compared with those of a control group (Group 2) of 14 patients matched for age, sex, injury and management, that did not undergo TAE...
October 28, 2017: Injury
https://www.readbyqxmd.com/read/29095204/improvement-of-blood-brain-barrier-integrity-in-traumatic-brain-injury-and-hemorrhagic-shock-following-treatment-with-valproic-acid-and-fresh-frozen-plasma
#10
Vahagn C Nikolian, Simone E Dekker, Ted Bambakidis, Gerald A Higgins, Isabel S Dennahy, Patrick E Georgoff, Aaron M Williams, Anuska V Andjelkovic, Hasan B Alam
OBJECTIVE: Combined traumatic brain injury and hemorrhagic shock are highly lethal. Following injuries, the integrity of the blood-brain barrier can be impaired, contributing to secondary brain insults. The status of the blood-brain barrier represents a potential factor impacting long-term neurologic outcomes in combined injuries. Treatment strategies involving plasma-based resuscitation and valproic acid therapy have shown efficacy in this setting. We hypothesize that a component of this beneficial effect is related to blood-brain barrier preservation...
October 31, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29091127/basic-life-support-evaluation-of-learning-using-simulation-and-immediate-feedback-devices1
#11
Lucia Tobase, Heloisa Helena Ciqueto Peres, Edenir Aparecida Sartorelli Tomazini, Simone Valentim Teodoro, Meire Bruna Ramos, Thatiane Facholi Polastri
OBJECTIVE: to evaluate students' learning in an online course on basic life support with immediate feedback devices, during a simulation of care during cardiorespiratory arrest. METHOD: a quasi-experimental study, using a before-and-after design. An online course on basic life support was developed and administered to participants, as an educational intervention. Theoretical learning was evaluated by means of a pre- and post-test and, to verify the practice, simulation with immediate feedback devices was used...
October 30, 2017: Revista Latino-americana de Enfermagem
https://www.readbyqxmd.com/read/29088951/update-on-critical-care-for-acute-spinal-cord-injury-in-the-setting-of-polytrauma
#12
John K Yue, Ethan A Winkler, Jonathan W Rick, Hansen Deng, Carlene P Partow, Pavan S Upadhyayula, Harjus S Birk, Andrew K Chan, Sanjay S Dhall
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29079917/permissive-hypotensive-resuscitation-in-adult-patients-with-traumatic-haemorrhagic-shock-a-systematic-review
#13
REVIEW
Mohammed Albreiki, David Voegeli
BACKGROUND: Permissive hypotensive resuscitation (PHR) is an advancing concept aiming towards deliberative balanced resuscitation whilst treating severely injured patients, and its effectiveness on the survival rate remains unexplored. This detailed systematic review aims to critically evaluate the available literature that investigates the effects of PHR on survival rate. METHODS: A systematic review design searched for comparative and non-comparative studies using EMBASE, MEDLINE, PubMed, Web-of-Science and CENTRAL...
October 27, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29079377/are-three-ports-better-than-one-an-evaluation-of-flow-rates-using-all-ports-of-a-triple-lumen-central-venous-catheter-in-volume-resuscitation
#14
Stephanie Traylor, Aveh Bastani, Nora Butris-Daut, Matthew Christensen, Pamela Marsack, Lauren Rodgers, Brett Todd
BACKGROUND: Poiseuille's law states flow rates are directly proportional to the radius to the 4th power and indirectly proportional to the length of a tube. Because of this property, large bore catheters are commonly used in the resuscitation of the critically ill patient. However, there are no studies comparing simultaneous use of all three lumens of a triple lumen (TL) central venous catheter (CVC) with other catheter types. Our objective was to compare the flow rates of normal saline (NS) through various resuscitation catheters against a TL CVC using all 3 ports...
October 4, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29077660/successful-resuscitation-of-maternal-cardiac-arrest-with-disseminated-intravascular-coagulation-guided-by-rotational-thromboelastometry-and-transesophageal-echocardiography-a-case-report
#15
Hannah Brown, Helen L Barrett, Julie Lee, Jason M Pincus, Rebecca M Kimble, Victoria A Eley
We present a case of maternal cardiac arrest during an elective cesarean delivery. Transesophageal echocardiography identified a large pulmonary artery mass, and guided resuscitation efforts. After return of spontaneous circulation, the patient developed disseminated intravascular coagulation with massive hemorrhage. Blood product selection and volume replacement were guided by rotational thromboelastometry and transesophageal echocardiography, respectively. Correction of coagulopathy was observed clinically and confirmed by rotational thromboelastometry...
October 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29076967/the-call-and-the-challenge-of-pediatric-resuscitation-and-simulation-research-in-low-resource-settings
#16
Amy R L Rule, Meredith Tabangin, David Cheruiyot, Priscilla Mueri, Beena D Kamath-Rayne
The greatest burden of younger than 5 years mortality is in low- and middle-income nations where education resources are often few. The World Health Organization recommends scale-up of simulation in these settings, but it has been poorly studied. Although there has been an increase of contextualized resuscitation simulation programs designed for these settings, sustaining clinical outcomes and provider skill retention have remained research gaps. Our team designed a study to evaluate skill retention after an initial Helping Babies Breathe training at a rural Kenya referral hospital between randomized learner groups receiving supervised mock codes with debriefing versus just-in-time training with a peer...
October 25, 2017: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/29075932/effect-of-ringers-acetate-in-different-doses-on-plasma-volume-in-rat-models-of-hypovolemia
#17
Svajunas Statkevicius, Attila Frigyesi, Peter Bentzer
BACKGROUND: Even though crystalloids are the first choice for fluid resuscitation in hemodynamically unstable patients, their potency as plasma volume expanders in hypovolemia of different etiologies is largely unknown. The objective of the study was to investigate dose-response curves of a crystalloid in hypovolemia induced by either sepsis or hemorrhagic shock. RESULTS: Rats were randomized to resuscitation with Ringers acetate at a dose 10, 30, 50, 75, or 100 ml/kg at 4 h after induction of sepsis by cecal ligation and puncture (CLP) or 2...
October 26, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29075482/fluid-resuscitation-practices-in-cardiac-surgery-patients-in-the-usa-a-survey-of-health-care-providers
#18
Solomon Aronson, Paul Nisbet, Martin Bunke
BACKGROUND: Fluid resuscitation during cardiac surgery is common with significant variability in clinical practice. Our goal was to investigate current practice patterns of fluid volume expansion in patients undergoing cardiac surgeries in the USA. METHODS: We conducted a cross-sectional online survey of 124 cardiothoracic surgeons, cardiovascular anesthesiologists, and perfusionists. Survey questions were designed to assess clinical decision-making patterns of intravenous (IV) fluid utilization in cardiovascular surgery for five types of patients who need volume expansion: (1) patients undergoing cardiopulmonary bypass (CPB) without bleeding, (2) patients undergoing CPB with bleeding, (3) patients undergoing acute normovolemic hemodilution (ANH), (4) patients requiring extracorporeal membrane oxygenation (ECMO) or use of a ventricular assist device (VAD), and (5) patients undergoing either off-pump coronary artery bypass graft (OPCABG) surgery or transcatheter aortic valve replacement (TAVR)...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29065123/supplemental-arginine-vasopressin-during-the-resuscitation-of-severe-hemorrhagic-shock-preserves-renal-mitochondrial-function
#19
Carrie A Sims, Guan Yuxia, Khushboo Singh, Evan C Werlin, Patrick M Reilly, Joseph A Baur
Arginine vasopressin (AVP), a hormone secreted by the posterior pituitary, plays a vital role in maintaining vasomotor tone during acute blood loss. We hypothesized that decompensated hemorrhagic shock is associated with decreased AVP stores and supplementation during resuscitation would improve both blood pressure and renal function. Using a decompensated hemorrhagic shock model, male Long-Evans rats were bled to mean arterial blood pressure (MAP) of 40mmHg and maintained until the MAP could not be sustained without fluid...
2017: PloS One
https://www.readbyqxmd.com/read/29061119/computer-controlled-closed-loop-drug-infusion-system-for-automated-hemodynamic-resuscitation-in-endotoxin-induced-shock
#20
Kazunori Uemura, Toru Kawada, Can Zheng, Meihua Li, Masaru Sugimachi
BACKGROUND: Hemodynamic resuscitation in septic shock requires aggressive fluid replacement and appropriate use of vasopressors to optimize arterial pressure (AP) and cardiac output (CO). Because responses to these drugs vary between patients and within patient over time, strict monitoring of patient condition and repetitive adjustment of drug dose are required. This task is time and labor consuming, and is associated with poor adherence to resuscitation guidelines. To overcome this issue, we developed a computer-controlled closed-loop drug infusion system for automated hemodynamic resuscitation in septic shock, and evaluated the performance of the system in a canine model of endotoxin shock...
October 23, 2017: BMC Anesthesiology
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