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https://www.readbyqxmd.com/read/28044331/cerebral-oximetry-and-its-role-in-adult-cardiac-non-cardiac-surgery-and-resuscitation-from-cardiac-arrest
#1
REVIEW
D W Green, G Kunst
Monitors using near-infra red spectroscopy to assess cerebral oxygenation levels non-invasively in discrete areas of the brain have been used clinically for over 20 years. Interest has intensified recently, especially during cardiac surgery, and there are now five commercially available devices. Despite the attraction of being able to measure oxygen supply/demand in such a critical area, there has been only limited uptake of this technology in overall clinical anaesthetic practice. This narrative review aims to explore not only the rationale for using this technology but also the factors which have restricted its more widespread use...
January 2017: Anaesthesia
https://www.readbyqxmd.com/read/28041551/-haemostatic-resuscitation-in-bleeding-trauma-patients
#2
Jakob Stensballe, Pär I Johansson, Jacob Steinmetz
Trauma haemorrhage is a common reversible cause of death. Haemostatic resuscitation focuses on replacing the lost blood with transfusions equivalent to whole blood as early as possible. In Denmark, the optimal ratio for transfusions in massive bleeding is four packs of red blood cells, four packs of plasma and one pool of platelets (equal to ratio 1:1:1 in USA). Haemostatic resuscitation also includes a restricted use of crystalloids, early tranexamic acid, and a goal-directed transfusion therapy by using viscoelastic haemostatic assays to detect coagulopathy and the need for additional transfusions or pro-haemostatics...
December 26, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28033136/permissive-hypotension-and-trauma-can-fluid-restriction-reduce-the-incidence-of-ards
#3
Melissa Kolarik, Eric Roberts
Emergency care, including the resuscitation of patients involved in traumatic events, has evolved over the years. A prior practice of utilizing large volumes of crystalloids has been found to contribute to complications such as coagulopathy, fluid overload, and adult respiratory distress syndrome (ARDS). In contrast, permissive hypotension is a method of fluid restriction that allows for low blood pressure and mean arterial pressure during the resuscitation period. When permissive hypotension occurs and fluids are restricted in trauma patients, the incidence of ARDS can be reduced significantly with improvement in patient outcomes...
January 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28027250/important-developments-in-burn-care
#4
Kevin J Zuo, Abelardo Medina, Edward E Tredget
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Explain the epidemiology of severe burn injury in the context of socioeconomic status, gender, age, and burn cause. 2. Describe challenges with burn depth evaluation and novel methods of adjunctive assessment. 3. Summarize the survival and functional outcomes of severe burn injury. 4. State strategies of fluid resuscitation, endpoints to guide fluid titration, and sequelae of overresuscitation. 5. Recognize preventative measures of sepsis...
January 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28004964/patient-safety-under-deep-sedation-for-digestive-endoscopic-procedures
#5
Julián Álvarez, Rafael Cabadas, Manuel de la Matta
Deep sedation with Propofol has become popular in recent years. The safety of this technique when administered by non-anaesthesiologists has created much controversy which at times is masked in a contentious debate on the economic sustainability of the health system. In 2011, the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy, along with 20 other organisations from European countries, revoked the recommendations of the European Society of Gastrointestinal Endoscopy on the administration of Propofol by non-anaesthesiologists, citing that it is "extremely dangerous for the safety and quality of endoscopic procedures"...
December 22, 2016: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/27915124/a-literature-review-examining-the-barriers-to-the-implementation-of-family-witnessed-resuscitation-in-the-emergency-department
#6
REVIEW
Catherine Johnson
BACKGROUND: Caring for people near death in the Emergency Department (ED) is challenging for professionals, duty bound to respond to the needs of the dying. Family witnessed resuscitation (FWR) is practiced internationally, allowing relatives to be present at the time of a patient's death, offering comfort to the dying and aiding the bereaved along a healthy grief trajectory. AIM: The literature review elicits barriers to the implementation of FWR in the ED, examining why practice is sporadic despite numerous professional bodies calling for implementation...
November 30, 2016: International Emergency Nursing
https://www.readbyqxmd.com/read/27914759/fluid-management-in-patients-with-trauma-restrictive-versus-liberal-approach
#7
REVIEW
Lee Palmer
Massive hemorrhage remains a major cause of traumatic deaths. The ideal fluid resuscitative strategy is much debated. Research has provided inconsistent results regarding which fluid strategy is ideal; the optimum fluid type, timing, and volume remains elusive. Aggressive large-volume resuscitation has been the mainstay based on controlled hemorrhage animal models. For uncontrolled hemorrhagic shock, liberal fluid resuscitative strategies exacerbate the lethal triad, invoke resuscitative injury, and increase mortality while more restrictive fluid strategies tend to ameliorate trauma-induced coagulopathy and favor a greater chance of survival...
December 1, 2016: Veterinary Clinics of North America. Small Animal Practice
https://www.readbyqxmd.com/read/27906869/early-and-sustained-vasopressin-infusion-augments-the-hemodynamic-efficacy-of-restrictive-fluid-resuscitation-and-improves-survival-in-a-liver-laceration-model-of-hemorrhagic-shock
#8
Raúl J Gazmuri, Kasen Whitehouse, Karla Whittinghill, Alvin Baetiong, Kruti Shah, Jeejabai Radhakrishnan
BACKGROUND: Current management of hemorrhagic shock favors restrictive fluid resuscitation before control of the bleeding source. We investigated the additional effects of early and sustained vasopressin infusion in a swine model of hemorrhagic shock produced by liver laceration. METHODS: Forty male domestic pigs (32-40 kg) had a liver laceration inflicted with an X-shaped blade clamp, 32 received a second laceration at minute 7.5, and 24 received two additional lacerations at minute 15...
February 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27871539/liberal-or-restrictive-fluid-management-during-elective-surgery-a-systematic-review-and-meta-analysis
#9
REVIEW
Pim B B Schol, Ivon M Terink, Marcus D Lancé, Hubertina C J Scheepers
This article reviews if a restrictive fluid management policy reduces the complication rate if compared to liberal fluid management policy during elective surgery. The PubMed database was explored by 2 independent researchers. We used the following search terms: "Blood transfusion (MESH); transfusion need; fluid therapy (MESH); permissive hypotension; fluid management; resuscitation; restrictive fluid management; liberal fluid management; elective surgery; damage control resuscitation; surgical procedures, operative (MESH); wounds (MESH); injuries (MESH); surgery; trauma patients...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27831907/randomised-crossover-trial-of-rate-feedback-and-force-during-chest-compressions-for-paediatric-cardiopulmonary-resuscitation
#10
Rachael Kathleen Gregson, Tim James Cole, Sophie Skellett, Emmanouil Bagkeris, Denise Welsby, Mark John Peters
OBJECTIVE: To determine the effect of visual feedback on rate of chest compressions, secondarily relating the forces used. DESIGN: Randomised crossover trial. SETTING: Tertiary teaching hospital. SUBJECTS: Fifty trained hospital staff. INTERVENTIONS: A thin sensor-mat placed over the manikin's chest measured rate and force. Rescuers applied compressions to the same paediatric manikin for two sessions...
October 24, 2016: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/27828823/hold-the-pendulum-rates-of-acute-kidney-injury-are-increased-in-patients-who-receive-resuscitation-volumes-less-than-predicted-by-the-parkland-equation
#11
Stephanie A Mason, Avery B Nathens, Celeste C Finnerty, Richard L Gamelli, Nicole S Gibran, Brett D Arnoldo, Ronald G Tompkins, David N Herndon, Marc G Jeschke
OBJECTIVE: To determine whether restrictive fluid resuscitation results in increased rates of acute kidney injury (AKI) or infectious complications. BACKGROUND: Studies demonstrate that patients often receive volumes in excess of those predicted by the Parkland equation, with potentially detrimental sequelae. However, the consequences of under-resuscitation are not well-studied. METHODS: Data were collected from a multicenter prospective cohort study...
December 2016: Annals of Surgery
https://www.readbyqxmd.com/read/27821597/are-sociodemographic-characteristics-associated-with-spatial-variation-in-the-incidence-of-ohca-and-bystander-cpr-rates-a-population-based-observational-study-in-victoria-australia
#12
Lahn D Straney, Janet E Bray, Ben Beck, Stephen Bernard, Marijana Lijovic, Karen Smith
BACKGROUND: Rates of out-of-hospital cardiac arrest (OHCA) and bystander cardiopulmonary resuscitation (CPR) have been shown to vary considerably in Victoria. We examined the extent to which this variation could be explained by the sociodemographic and population health characteristics of the region. METHODS: Using the Victorian Ambulance Cardiac Arrest Registry, we extracted OHCA cases occurring between 2011 and 2013. We restricted the calculation of bystander CPR rates to those arrests that were witnessed by a bystander...
November 7, 2016: BMJ Open
https://www.readbyqxmd.com/read/27806176/abrupt-onset-of-refractory-heart-failure-associated-with-light-chain-amyloidosis-in-hypertrophic-cardiomyopathy
#13
Benedetta Tomberli, Francesco Cappelli, Federico Perfetto, Iacopo Olivotto
Importance: The natural history of hypertrophic cardiomyopathy (HCM) is complex and may include progressive heart failure and severe left ventricular dysfunction. When disease progression is abrupt, however, other coexisting diseases should be ruled out. This may be difficult in the case of amyloidosis, which classically mimics HCM. Results: We present an example of severe clinical deterioration in a patient with HCM due to superimposed amyloid light-chain amyloidosis...
January 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/27750266/implementation-of-feeding-guidelines-hastens-the-time-to-initiation-of-enteral-feeds-and-improves-growth-velocity-in-very-low-birth-weight-infants
#14
Christine Culpepper, Kendra Hendrickson, Susan Marshall, Jessica Benes, Theresa R Grover
BACKGROUND: Growth and nutrition are critical in neonatal care. Whether feeding guidelines improve growth and nutrition and reduce morbidity is unknown. PURPOSE: Feeding guidelines for very low birth-weight (VLBW) infants were implemented in our neonatal intensive care unit (NICU) to start and achieve full enteral feeds sooner, and increase weight gain over the first month. METHODS: Feeding guidelines for VLBW infants were implemented in January 2014, stratified by birth weight (<750, 750-1000, and 1000-1500 g)...
October 7, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/27748221/impact-of-process-improvements-on-measures-of-emergency-department-efficiency
#15
Alexander K Leung, Shawn D Whatley, Dechang Gao, Marko Duic
OBJECTIVE: To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. METHODS: This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage...
October 17, 2016: CJEM
https://www.readbyqxmd.com/read/27686349/restricting-volumes-of-resuscitation-fluid-in-adults-with-septic-shock-after-initial-management-the-classic-randomised-parallel-group-multicentre-feasibility-trial
#16
Peter B Hjortrup, Nicolai Haase, Helle Bundgaard, Simon L Thomsen, Robert Winding, Ville Pettilä, Anne Aaen, David Lodahl, Rasmus E Berthelsen, Henrik Christensen, Martin B Madsen, Per Winkel, Jørn Wetterslev, Anders Perner
PURPOSE: We assessed the effects of a protocol restricting resuscitation fluid vs. a standard care protocol after initial resuscitation in intensive care unit (ICU) patients with septic shock. METHODS: We randomised 151 adult patients with septic shock who had received initial fluid resuscitation in nine Scandinavian ICUs. In the fluid restriction group fluid boluses were permitted only if signs of severe hypoperfusion occurred, while in the standard care group fluid boluses were permitted as long as circulation continued to improve...
September 30, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27681706/venoarterial-extracorporeal-membrane-oxygenation-for-refractory-cardiogenic-shock-post-cardiac-arrest
#17
Marc Pineton de Chambrun, Nicolas Bréchot, Guillaume Lebreton, Matthieu Schmidt, Guillaume Hekimian, Pierre Demondion, Jean-Louis Trouillet, Pascal Leprince, Jean Chastre, Alain Combes, Charles-Edouard Luyt
PURPOSE: To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest. METHODS: We retrospectively analyzed data collected prospectively (March 2007-January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included...
September 28, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27650943/physician-staffed-helicopter-emergency-medical-systems-can-provide-advanced-trauma-life-support-in-mountainous-and-remote-areas
#18
Julia Ausserer, Elizabeth Moritz, Matthias Stroehle, Hermann Brugger, Giacomo Strapazzon, Simon Rauch, Peter Mair
INTRODUCTION: In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission. PATIENTS: 58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1...
January 2017: Injury
https://www.readbyqxmd.com/read/27640888/eeg-power-as-a-biomarker-to-predict-the-outcome-after-cardiac-arrest-and-cardiopulmonary-resuscitation-induced-global-ischemia
#19
Lindsay-Rae Weitzel, Dayalan Sampath, Kaori Shimizu, Andrew M White, Paco S Herson, Yogendra H Raol
AIMS: Cardiac arrest (CA) is a major cause of mortality and survivors often develop neurologic deficits. The objective of this study was to determine the effect of CA and cardiopulmonary resuscitation (CPR) in mice on the EEG and neurologic outcomes, and identify biomarkers that can prognosticate poor outcomes. MAIN METHODS: Video-EEG records were obtained at various periods following CA-CPR and examined manually to determine the presence of spikes and sharp-waves, and seizures...
November 15, 2016: Life Sciences
https://www.readbyqxmd.com/read/27633658/abdominal-intra-compartment-syndrome-a-non-hydraulic-model-of-abdominal-compartment-syndrome-due-to-post-hepatectomy-hemorrhage-in-a-man-with-a-localized-frozen-abdomen-due-to-extensive-adhesions-a-case-report
#20
Alexsander K Bressan, Andrew W Kirkpatrick, Chad G Ball
BACKGROUND: Postoperative hemorrhage is a significant cause of morbidity and mortality following liver resection. It typically presents early within the postoperative period, and conservative management is possible in the majority of cases. We present a case of late post-hepatectomy hemorrhage associated with overt abdominal compartment syndrome resulting from a localized functional compartment within the abdomen. CASE PRESENTATION: A 68-year-old white man was readmitted with sudden onset of upper abdominal pain, vomiting, and hemodynamic instability 8 days after an uneventful hepatic resection for metachronous colon cancer metastasis...
September 15, 2016: Journal of Medical Case Reports
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