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Shock management

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https://www.readbyqxmd.com/read/29157918/purpura-fulminans-mechanism-and-management-of-dysregulated-hemostasis
#1
REVIEW
Meaghan E Colling, Pavan K Bendapudi
Purpura fulminans (PF) is a highly thrombotic subtype of disseminated intravascular coagulation that can accompany severe bacterial, and more rarely, viral infections. PF is associated with an extremely high mortality rate, and patients often die of overwhelming multisystemic thrombosis rather than septic shock. Survivors typically experience amputation of involved extremities and significant scarring in affected areas. Despite the devastating clinical course associated with this hemostatic complication of infection, the mechanism of PF remains poorly understood...
October 16, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/29154747/disseminated-methicillin-susceptible-staphylococcus-aureus-infection
#2
David R Perkins, James A Hall, Lisa M Lopez, Lizbeth Janice Cahuayme-Zuniga
INTRODUCTION: When clinicians think about Staphylococcus aureus bacteria, what comes to the mind of most is the dreaded methicillin-resistant form. However, clinicians should not forget the methicillin-susceptible type, which is just as virulent. CASE PRESENTATION: The authors present the case of a 20-year-old woman who was admitted with septic shock and multi-organ failure and was found to have disseminated methicillin-susceptible Staphylococcus aureus (MSSA) infection...
November 20, 2017: Journal of Medical Microbiology
https://www.readbyqxmd.com/read/29151592/diet-resistant-obesity-is-characterized-by-a-distinct-plasma-proteomic-signature-and-impaired-muscle-fiber-metabolism
#3
A B Thrush, G Antoun, M Nikpay, D A Patten, C DeVlugt, J-F Mauger, B L Beauchamp, P Lau, R Reshke, É Doucet, P Imbeault, R Boushel, D Gibbings, J Hager, A Valsesia, R Slack, O Y Al-Dirbashi, R Dent, R McPherson, M-E Harper
BACKGROUND/OBJECT: Inter-individual variability in weight loss during obesity treatment is complex and poorly understood. Here we use whole body and tissue approaches to investigate fuel oxidation characteristics in skeletal muscle fibers, cells, and distinct circulating protein biomarkers before and after a high fat meal (HFM) challenge in those who lost the most (obese diet-sensitive; ODS), vs the least (obese diet-resistant; ODR) amount of weight in a highly controlled weight management program...
November 20, 2017: International Journal of Obesity: Journal of the International Association for the Study of Obesity
https://www.readbyqxmd.com/read/29151364/a-clinical-prediction-model-to-identify-patients-at-high-risk-of-hemodynamic-instability-in-the-pediatric-intensive-care-unit
#4
Cristhian Potes, Bryan Conroy, Minnan Xu-Wilson, Christopher Newth, David Inwald, Joseph Frassica
BACKGROUND: Early recognition and timely intervention are critical steps for the successful management of shock. The objective of this study was to develop a model to predict requirement for hemodynamic intervention in the pediatric intensive care unit (PICU); thus, clinicians can direct their care to patients likely to benefit from interventions to prevent further deterioration. METHODS: The model proposed in this study was trained on a retrospective cohort of all patients admitted to a tertiary PICU at a single center in the United States, and validated on another retrospective cohort of all patients admitted to the PICU at a single center in the United Kingdom...
November 20, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29151002/management-of-arrhythmia-in-sepsis-and-septic-shock
#5
Martin Balik, Vojtech Matousek, Michal Maly, Tomas Brozek
The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of a sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when a sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents...
November 18, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29149944/management-of-sepsis-induced-immunosuppression
#6
REVIEW
Fabienne Venet, Thomas Rimmelé, Guillaume Monneret
It is now well established that profound immunosuppression develops within a few days after sepsis onset in patients. This should be considered additional organ failure because it is associated with increased rate of nosocomial infections, mortality, and long-term complications, thus constituting the rationale for immunomodulation in patients. Nevertheless, the demonstration of the efficacy of such therapeutic strategy in improving deleterious outcomes in sepsis remains to be made. Results from clinical trials based on interleukin 7 and granulocyte macrophage colony-stimulating factor immunoadjuvant therapies in septic shock patients are expected for 2018...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29148290/single-centre-experience-with-the-impella-cp-5-0-and-rp-in-109-consecutive-patients-with-profound-cardiogenic-shock
#7
Peter Blom Jensen, Sigrun Høegholm Kann, Karsten Tange Veien, Ole Kristian Møller-Helgestad, Jordi Sanchez Dahl, Charlotte Svejstrup Rud, Marianne Kjær Jensen, Lisette Okkels Jensen, Henrik Schmidt, Jacob Eifer Møller
RATIONALE: Short-term mechanical circulatory support is increasingly used in the management of cardiogenic shock, but data from controlled studies are sparse. Thus, real-life data on complication rates and predictors of adverse outcome are important. OBJECTIVE: The objective of this study was to analyse the experience with Impella devices in the management of profound cardiogenic shock. METHODS AND RESULTS: A retrospective study of 109 consecutive patients with severe shock after myocardial infarction, acute heart failure, or cardiac surgery...
November 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29147570/management-of-an-acute-catecholamine-induced-cardiomyopathy-and-circulatory-collapse-a-multidisciplinary-approach
#8
R T Casey, B G Challis, D Pitfield, R M Mahroof, N Jamieson, C J Bhagra, A Vuylsteke, S J Pettit, K C Chatterjee
A phaeochromocytoma (PC) is a rare, catecholamine-secreting neuroendocrine tumour arising from the adrenal medulla. Presenting symptoms of this rare tumour are highly variable but life-threatening multiorgan dysfunction can occur secondary to catecholamine-induced hypertension or hypotension and subsequent cardiovascular collapse. High levels of circulating catecholamines can induce an acute stress cardiomyopathy, also known as Takotsubo cardiomyopathy. Recent studies have focused on early diagnosis and estimation of the prevalence of acute stress cardiomyopathy in patients with PC, but very little is reported about management of these complex cases...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29147478/abdominal-pain-with-a-twist-a-rare-presentation-of-acute-gastric-volvulus
#9
David P Chen, Saqib Walayat, Imran L Balouch, Daniel K Martin, Teresa J Lynch
Acute gastric volvulus is a life threatening condition requiring early diagnosis and aggressive management. Diagnosis of gastric volvulus remains a challenge for clinicians due to variable, non-specific clinical presentation, which requires a high level of suspicion. It should be considered in patients presenting with chest pain and/or epigastric pain, especially in the elderly population. Endoscopic de-rotation could be initially attempted as a therapeutic modality especially in patients who cannot undergo surgery...
2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29145832/upper-urinary-tract-stone-disease-in-patients-with-poor-performance-status-active-stone-removal-or-conservative-management
#10
Shimpei Yamashita, Yasuo Kohjimoto, Yasuo Hirabayashi, Takashi Iguchi, Akinori Iba, Masatoshi Higuchi, Hiroyuki Koike, Takahito Wakamiya, Satoshi Nishizawa, Isao Hara
BACKGROUND: It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor performance status and to compare life prognosis with those managed conservatively. METHODS: We retrospectively reviewed 74 patients with Eastern Cooperative Oncology Group performance status 3 or 4 treated for upper urinary tract calculi at our four hospitals between January 2009 and March 2016...
November 16, 2017: BMC Urology
https://www.readbyqxmd.com/read/29142540/clinical-audit-of-dengue-related-deaths-in-2011-mayo-hospital-lahore-pakistan
#11
Somia Iqtadar, Nabeel Akbar, Mehreen Mehmood, Sajid Abaidullah
Background and Objective: Dengue infection has evolved into an epidemic during last few years in Pakistan and has been associated with poor outcomes. Literature with respect to mortality risk factors in Dengue infection is not sufficient. This compelled us to conduct this study to find out major contributory factors to death in patients with dengue viral infection at one of Asia's ancient hospital setting with an aim to recognize complications at earliest and improve case management in future...
September 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/29142280/mild-heat-induces-a-distinct-eustress-response-in-chinese-hamster-ovary-cells-but-does-not-induce-heat-shock-protein-synthesis
#12
Begüm Peksel, Imre Gombos, Mária Péter, László Vigh, Ádám Tiszlavicz, Mario Brameshuber, Gábor Balogh, Gerhard J Schütz, Ibolya Horváth, László Vigh, Zsolt Török
The current research on cellular heat stress management focuses on the roles of heat shock proteins (HSPs) and the proteostasis network under severe stress conditions. The mild, fever-type stress and the maintenance of membrane homeostasis are less well understood. Herein, we characterized the acute effect of mild, fever-range heat shock on membrane organization, and HSP synthesis and localization in two mammalian cell lines, to delineate the role of membranes in the sensing and adaptation to heat. A multidisciplinary approach combining ultrasensitive fluorescence microscopy and lipidomics revealed the molecular details of novel cellular "eustress", when cells adapt to mild heat by maintaining membrane homeostasis, activating lipid remodeling, and redistributing chaperone proteins...
November 15, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29141498/incidence-and-natural-progression-of-neurogenic-shock-following-traumatic-spinal-cord-injury
#13
Ian A Ruiz, Jordan W Squair, Aaron A Phillips, Christine D Lukac, Dayan Huang, Patrick Oxciano, Dong Yan, Andrei V Krassioukov
Neurogenic shock, a distributive type of circulatory shock following spinal cord injury (SCI), results in profound hypotension. The consequent hemodynamic instability complicates clinical management, delays surgical intervention, and impacts neurological outcome. Moreover, the reported incidence of this condition varies significantly. Here, we establish the true incidence of neurogenic shock by comparing the most common clinical definitions used to diagnose the condition. Further, we characterize the acute progression and recovery of neurogenic shock...
November 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29134498/vasoplegic-shock-treated-with-methylene-blue-complicated-by-severe-serotonin-syndrome
#14
Betty S Chan, Therese Becker, Angela L Chiew, Ahmed M Abdalla, Tom A Robertson, Xin Liu, Michael S Roberts, Nicholas A Buckley
INTRODUCTION: Management of severe vasoplegic shock in overdose can be very challenging. We describe a case of severe refractory vasodilatory shock in poisoning where methylene blue (MB) was used with success. However, the patient subsequently developed severe Serotonin Syndrome (SS) as a result of an interaction between serotonergic drugs and MB. CASE REPORT: A 15-year-old male developed severe vasoplegic shock 1.5 hours after overdosing on several different medications including quetiapine slow release, quetiapine immediate release, desvenlafaxine slow release, venlafaxine, amlodipine, ramipril, fluoxetine, promethazine and lithium...
November 13, 2017: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/29134345/trends-in-mechanical-circulatory-support-use-and-hospital-mortality-among-patients-with-acute-myocardial-infarction-and-non-infarction-related-cardiogenic-shock-in-the-united-states
#15
Mahek Shah, Soumya Patnaik, Brijesh Patel, Pradhum Ram, Lohit Garg, Manyoo Agarwal, Sahil Agrawal, Shilpkumar Arora, Nilay Patel, Joyce Wald, Ulrich P Jorde
BACKGROUND: Recent trends on outcomes in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) suggest improvements in early survival. However, with the ever-changing landscape in management of CS, we sought to identify age-based trends in these outcomes and mechanical circulatory support (MCS) use among patients with both AMI and non-AMI associated shock. METHODS: We queried the 2005-2014 Nationwide Inpatient Sample databases to identify patients with a diagnosis of cardiogenic shock...
November 13, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29133025/perivalvular-mitral-abscess-fistulised-to-the-pericardial-cavity-revealing-staphylococcal-endocarditis
#16
Paul Desaint, Anthony Chauvat, Thomas Garaud, Olivier Andremont, Gaëtan Plantefève, Hervé Mentec, Damien Contou
BACKGROUND: Fistula to the pericardial cavity is a very rare complication of perivalvular abscess during infective endocarditis, with Staphylococcus aureus being the most commonly associated microorganism. METHODS: We report a fatal septic shock due to a mitral endocarditis revealed by a myocardial abscess fistulised toward the pericardial cavity. RESULTS: A 66-year-old female without previous valvular disease was admitted to intensive care for severe sepsis...
October 31, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29132978/intensive-care-in-severe-malaria-report-from-the-task-force-on-tropical-diseases-by-the-world-federation-of-societies-of-intensive-and-critical-care-medicine
#17
REVIEW
Dilip R Karnad, Mohd Basri Mat Nor, Guy A Richards, Tim Baker, Pravin Amin
Severe malaria is common in tropical countries in Africa, Asia, Oceania and South and Central America. It may also occur in travelers returning from endemic areas. Plasmodium falciparum accounts for most cases, although P vivax is increasingly found to cause severe malaria in Asia. Cerebral malaria is common in children in Africa, manifests as coma and seizures, and has a high morbidity and mortality. In other regions, adults may also develop cerebral malaria but neurological sequelae in survivors are rare...
November 8, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29132581/resuscitation-resequenced-a-rational-approach-to-patients-with-trauma-in-shock
#18
REVIEW
Andrew Petrosoniak, Christopher Hicks
Trauma resuscitation is a complex and dynamic process that requires a high-performing team to optimize patient outcomes. More than 30 years ago, Advanced Trauma Life Support was developed to formalize and standardize trauma care; however, the sequential nature of the algorithm that is used can lead to ineffective prioritization. An improved understanding of shock mandates an updated approach to trauma resuscitation. This article proposes a resequenced approach that (1) addresses immediate threats to life and (2) targets strategies for the diagnosis and management of shock causes...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132057/predictors-of-hemodynamic-derangement-during-intubation-in-the-critically-ill-a-nested-case-control-study-of-hemodynamic-management-part-ii
#19
Nathan J Smischney, Mohamed O Seisa, Katherine J Heise, Robert A Wiegand, Kyle D Busack, Jillian L Deangelis, Theodore O Loftsgard, Darrell R Schroeder, Daniel A Diedrich
PURPOSE: Our primary aim was to identify predictors of immediate hemodynamic decompensation during the peri-intubation period. METHODS: We conducted a nested case-control study of a previously identified cohort of adult patients needing intubation admitted to a medical-surgical ICU during 2013-2014. Hemodynamic derangement was defined as cardiac arrest and/or the development of systolic blood pressure <90mmHg and/or mean arterial pressure <65mmHg 30min following intubation...
October 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29131374/social-capital-s-role-in-recovery-evidence-from-communities-affected-by-the-2010-pakistan-floods
#20
Muhammad Siddique Akbar, Daniel P Aldrich
Pakistan suffered large-scale flooding in summer 2010 that caused damage amounting to approximately USD 43 billion, claimed the lives of at least 1,700 people, and negatively affected some 20 million others. Observers have debated the degree to which social capital plays a role in recovery after a catastrophe of this magnitude. Using new survey data on 450 residents impacted by the disaster, this study found that, controlling for various confounding factors, the social capital levels of victims serve as robust correlates of life recovery...
November 13, 2017: Disasters
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