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Shock management

Bellal Joseph, Kareem Ibraheem, Ansab A Haider, Narong Kulvatunyou, Andrew Tang, Terence O'Keeffe, Zachary M Bauman, Donald J Green, Rifat Latifi, Peter Rhee
BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings. METHODS: We performed a 4-year retrospective review of all RTs performed at our Level I trauma center...
November 2016: Journal of Trauma and Acute Care Surgery
Yoshihiro Ohara, Hitoshi Ohto, Tetsunori Tasaki, Hideki Sano, Kazuhiro Mochizuki, Mitsuko Akaihata, Shogo Kobayashi, Tomoko Waragai, Masaki Ito, Mitsuaki Hosoya, Kenneth E Nollet, Kazuhiko Ikeda, Chitose Ogawa, Takahiro Kanno, Yayoi Shikama, Atsushi Kikuta
BACKGROUND: Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload. STUDY DESIGN AND METHODS: We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6...
September 30, 2016: Transfusion and Apheresis Science
Li Liu, Wanjun Chen, Xiaoye Lu, Keji Zhang, Changqing Zhu
BACKGROUND: Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease. OBJECTIVE: To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition. METHODS: This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015...
October 17, 2016: Journal of Emergency Medicine
Moon Seong Baek, Jeongsuk Son, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Hye-Sung Won, Jae-Yoon Shim, Sang-Bum Hong
AIM: Some recent studies have reported that early intervention by a medical emergency team (MET) for clinical deterioration before intensive care unit (ICU) admission was associated with a survival benefit in critically ill cancer patients. We hypothesized that early MET intervention for an obstetric crisis in the general wards would be related to favorable outcomes in critically ill obstetric patients. METHODS: Data of obstetric patients who were managed by a MET were collected retrospectively from 1 March 2008 to 30 April 2015...
October 20, 2016: Journal of Obstetrics and Gynaecology Research
Daniel Silva de Azevedo, Angela Salomao Macedo Salinet, Marcelo de Lima Oliveira, Manoel Jacobsen Teixeira, Edson Bor-Seng-Shu, Ricardo de Carvalho Nogueira
Cerebral microcirculation is gradually compromised during sepsis, with significant reductions in the function of capillaries and blood perfusion in small vessels. Transcranial Doppler ultrasound (TCD) has been used to assess cerebral circulation in a typical clinical setting. This study was to systematically review TCD studies, assess their methodological quality, and identify trends that can be associated with the temporal evolution of sepsis and its clinical outcome. A meta-analysis of systematic reviews was conducted according to the PRISMA statement...
October 18, 2016: Journal of Clinical Monitoring and Computing
Chien Yew Kow, Patrick Chan, Greg Etherington, Lu Ton, Susan Liew, Allen C Cheng, Jeffrey V Rosenfeld
BACKGROUND: Panspinal infection usually presents with fever, back pain, neurological deficit, and in advanced cases multi-organ failure and septic shock. The choice of treatment for panspinal infection is challenging because these patients are usually medically unstable with severe neurological compromise. The objective of this study is to review management and long term outcomes for patients with panspinal infection. METHODS: A retrospective review of patients with panspinal infection treated in our center over a 5-year period [Jan 2010-Dec 2014] and a review of the current published literatures was undertaken...
September 2016: J Spine Surg
Gyuho Song, Yeonho You, Wonjoon Jeong, Junwan Lee, Yongchul Cho, Seungwhan Lee, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo
OBJECTIVE: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) due to an acute myocardial infarction without cardiogenic shock required higher doses of vasopressors with low targeted temperature management (TTM) after return of spontaneous circulation. METHODS: We included consecutive comatose patients resuscitated from OHCA between January 2011 and December 2013. Patients with return of spontaneous circulation, regional wall motion abnormality on echocardiography, and coronary artery stenosis of ≥70% on percutaneous coronary artery angiography were enrolled...
March 2016: Clin Exp Emerg Med
Sarah Pinnington, Brigid Atterton, Sarah Ingleby
Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality...
2016: BMJ Quality Improvement Reports
Julie C Fitzgerald, Scott L Weiss, Niranjan Kissoon
OBJECTIVE: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. DATA SOURCES: The U.S. National Library of Medicine PubMed ( was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion...
September 30, 2016: Pediatric Critical Care Medicine
Maude St-Onge, Kurt Anseeuw, Frank Lee Cantrell, Ian C Gilchrist, Philippe Hantson, Benoit Bailey, Valéry Lavergne, Sophie Gosselin, William Kerns, Martin Laliberté, Eric J Lavonas, David N Juurlink, John Muscedere, Chen-Chang Yang, Tasnim Sinuff, Michael Rieder, Bruno Mégarbane
OBJECTIVE: To provide a management approach for adults with calcium channel blocker poisoning. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Following the Appraisal of Guidelines for Research & Evaluation II instrument, initial voting statements were constructed based on summaries outlining the evidence, risks, and benefits. DATA SYNTHESIS: We recommend 1) for asymptomatic patients, observation and consideration of decontamination following a potentially toxic calcium channel blocker ingestion (1D); 2) as first-line therapies (prioritized based on desired effect), IV calcium (1D), high-dose insulin therapy (1D-2D), and norepinephrine and/or epinephrine (1D)...
October 3, 2016: Critical Care Medicine
Marie Christine Iliou, Jean Christophe Blanchard, Aurélia Lamar-Tanguy, Pascal Cristofini, François Ledru
Large subsets of patients admitted in cardiac rehabilitation centers are having a pacemaker, cardiac resynchronization (CRT) or implantable cardiac defibrillator (ICD). Cardiac rehabilitation for patients, mostly with heart failure, with implanted electronic devices as pacemakers or ICD is a unique opportunity not only to optimize the medical treatment, to increase their exercise capacity and improves their clinical condition but also to supervise the correct functioning of the device. CRT reduces clinical symptoms and increases slightly the exercise capacity...
October 14, 2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Rachel Mourot-Cottet, Frédéric Maloisel, François Séverac, Olivier Keller, Thomas Vogel, Martine Tebacher, Jean-Christophe Weber, Georges Kaltenbach, Jacques-Eric Gottenberg, Bernard Goichot, Jean Sibilia, Anne-Sophie Korganow, Raoul Herbrecht, Emmanuel Andrès
BACKGROUND: Little data is currently available in the literature on neutropenia and agranulocytosis in the elderly, and, to our knowledge, idiosyncratic drug-induced agranulocytosis is particularly poorly covered, or not at all. OBJECTIVE: We herein describe the clinical picture and outcome of patients aged ≥75 years with established idiosyncratic drug-induced agranulocytosis. PATIENTS AND METHODS: Data from 61 patients over 75 years old with idiosyncratic drug-induced agranulocytosis were retrospectively reviewed...
September 5, 2016: Drugs—Real World Outcomes
Antoinette S Birs, Jose A Perez, Mark A Rich, Hubert S Swana
Iatrogenic bladder injuries have been reported in the neonate during umbilical artery/vein catheterization, voiding cystourethrogram, urinary catheterizations, and overwhelming hypoxic conditions. Patients with iatrogenic bladder perforations can present with acute abdomen indicating urinary peritonitis, septic-uremic shock, or subtle symptoms like abdominal distension, pain, hematuria, uremia, electrolyte imbalances, and/or difficulty urinating. The following neonatal case report of perforated bladder includes a review of the signs, symptoms, diagnostic tools, and management of bladder injury in neonates...
2016: Case Reports in Urology
Kumble S Madhusudhan, Nihar R Dash, Adil Afsan, Shivanand Gamanagatti, Deep N Srivastava, Arun K Gupta
Biliovenous fistula occurs due to development of a communication between hepatic duct and portal vein branches and is a rare complication of percutaneous transhepatic biliary drainage (PTBD). Most of them are self-limiting and only occasionally they need interventional management. Placement of biliary stent graft is a viable option. We present here a case of a 56-year-old male with carcinoma of gall bladder presenting with hemodynamic shock due to severe hemobilia after PTBD and treated successfully by biliary covered stent placement...
September 2016: Journal of Clinical and Experimental Hepatology
N M Al-Namnam, P Nambiar, P Shanmuhasuntharam, M Harris
Dengue is a mosquito transmitted flaviviral infection which can give rise to severe haemorrhage (dengue haemorrhagic fever/DHF) and with capillary leakage induces hypovolemic shock (dengue shock syndrome/DSS). Although dengue symptoms and complications have been known for many decades there has only been one documented case of osteonecrosis of the maxilla which was treated by excision of the necrotic bone. In this case of dengue infection, extensive maxillary osteonecrosis and minimal root resorption appeared to follow factitious injury with a toothpick but resolved with nonsurgical management...
October 15, 2016: Australian Dental Journal
Dimitrios Velissaris, Vasilios Karamouzos, Ioanna Kotroni, Charalampos Pierrakos, Menelaos Karanikolas
This article was to review the literature regarding the use of the pulmonary artery catheter (PAC) in the management of patients with sepsis and septic shock. A PubMed search was conducted in order to identify publications evaluating the use of PAC as a tool for management and therapeutic guidance in patients with sepsis. The bibliographies of all identified publications were reviewed for additional relevant references. Much information is identified in the literature regarding the indications for pulmonary artery catheterization in the assessment and treatment of patients with sepsis...
November 2016: Journal of Clinical Medicine Research
Munetaka Hashimoto, Hitoshi Goto, Daijirou Akamatsu, Takuya Shimizu, Ken Tsuchida, Keiichiro Kawamura, Yuta Tajima, Michihisa Umetsu
Objectives: The optimal surgical management for secondary aorto-enteric fistula (sAEF) is controversial. Here, we report the long-term outcomes of a surgical treatment with in situ graft reconstruction for sAEF that was performed at our hospital. Methods: Between 2009 and 2012, 10 consecutive patients (8 males, 2 females, mean age 75.9 years) with sAEF were surgically treated with in situ graft reconstruction. Perioperative and long-term outcomes were reviewed retrospectively by medical records. Results: Clinical manifestations, including gastrointestinal bleeding, shock, sepsis, and back and abdominal pain, were observed during the treatment of the patients...
2016: Annals of Vascular Diseases
Gassan Fuad Muady, Haim Bitterman, Arie Laor, Moshe Vardi, Vitally Urin, Nesrin Ghanem-Zoubi
BACKGROUND: Acute reduction in hemoglobin levels is frequently seen during sepsis. Previous studies have focused on the management of anemia in patients with septic shock admitted to intensive care units (ICU's), including aggressive blood transfusion aiming to enhance tissue oxygenation. AIM: To study the changes in hemoglobin concentrations during the first week of sepsis in the setting of Internal Medicine (IM) units, and their correlation to survival. DESIGN: Observational prospective study...
October 13, 2016: BMC Infectious Diseases
Andrea Vannucchi, Andrea Masi, Gabriele Vestrini, Francesco Tonelli
: Hemorrhagic rupture is a very rare complication of a simple hepatic cyst. We report the first case of a totally extraperitoneal rupture of a recurrent cyst, occurred in a 73-year-old man who presented with acute right hypochondralgia. Computed tomography revealed the rupture of a large hemorrhagic cyst in the right liver lobe and the formation of a voluminous hematoma in the retroperitoneal space. Despite the absence of hemoperitoneum, the entity of the bleeding led us to perform an urgent and successful surgical intervention...
September 30, 2016: Annali Italiani di Chirurgia
Samir B Pancholy, Gaurav Patel, Sukrut P Nanavaty, Maitri S Pancholy
Cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) is a devastating complication and continues to have a high mortality rate. Coronary revascularization with percutaneous coronary intervention (PCI) is the cornerstone in the management of CS; however, PCI-related access-site bleeding has been observed to be more prevalent in CS patients. Historically, PCI by transfemoral access (TFA) has been the preferred approach over transradial access (TRA) in CS patients due to weak radial pulse, operators' inexperience with TRA, and the use of TFA for concomitant mechanical cardiovascular support...
October 11, 2016: Minerva Cardioangiologica
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