Initial Resuscitation and Management of the Hemodynamically Unstable Patient

2016 ◽  
pp. 3-15 ◽  
Author(s):  
Diane A. Schwartz ◽  
John Holcomb
Keyword(s):  
Initial Resuscitation ◽  
Unstable Patient

scholarly journals β1-blocker in sepsis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Daisuke Hasegawa ◽  
Ryota Sato ◽  
Osamu Nishida
Keyword(s):  
Heart Rate ◽  
Oxygen Delivery ◽  
Sinus Tachycardia ◽  
Meta Analysis ◽  
Lactate Production ◽  
Volume Index ◽  
Initial Resuscitation ◽  
Randomized Controlled ◽  
Metabolic Systems

Abstract Background The use of ultrashort-acting β1-blockers recently has attracted attention in septic patients with non-compensatory tachycardia. We summarized the metabolic and hemodynamic effects and the clinical evidence of ultrashort-acting β1-blockers. Main body A recent meta-analysis showed that ultrashort-acting β1-blockers reduced the mortality in septic patients with persistent tachycardia. However, its mechanism to improve mortality is not fully understood yet. We often use lactate as a marker of oxygen delivery, but an impaired oxygen use rather than reduced oxygen delivery has been recently proposed as a more reasonable explanation of hyperlactatemia in patients with sepsis, leading to a question of whether β1-blockers affect metabolic systems. While the stimulation of the β2-receptor accelerates glycolysis and lactate production, the role of β1-blocker in lactate production remains unclear and studies investigating the role of β1-blockers in lactate kinetics are warranted. A meta-analysis also reported that ultrashort-acting β1-blockers increased stroke volume index, while it reduced heart rate, resulting in unchanged cardiac index, mean arterial pressure, and norepinephrine requirement at 24 h, leading to an improvement of cardiovascular efficiency. On the other hand, a recent study reported that heart rate reduction using fast esmolol titration in the very early phase of septic shock caused hemodynamic instability, suggesting that ultrashort-acting β1-blockers should be started only after completing initial resuscitation. While many clinicians still do not feel comfortable controlling sinus tachycardia, one randomized controlled trial in which the majority had sinus tachycardia suggested the mortality benefit of ultrashort-acting β1-blockers. Therefore, it still deems to be reasonable to control sinus tachycardia with ultrashort-acting β1-blockers after completing initial resuscitation. Conclusion Accumulating evidence is supporting the use of ultrashort-acting β1-blockers while larger randomized controlled trials to clarify the effect of ultrashort-acting β1-blockers are still warranted.

Accidental Organophosphate Insecticide Poisoning: a Fatal Child case with Hazards to Emergency Department Staff

2003 ◽  
Vol 10 (4) ◽  
pp. 248-252
Author(s):  
CL Lau ◽  
KL Chung ◽  
CW Kam
Keyword(s):  
Emergency Department ◽  
Healthcare Workers ◽  
Spontaneous Circulation ◽  
Organophosphate Poisoning ◽  
Protective Equipment ◽  
Organophosphate Insecticide ◽  
Secondary Poisoning ◽  
Initial Resuscitation ◽  
Emergency Department Staff ◽  
Department Staff

A 2-year-old boy was accidentally poisoned by one spoonful of organophosphate insecticide and presented in cardiac arrest. Spontaneous circulation was restored after initial resuscitation and antidote therapy (atropine and pralidoxime) but the boy finally succumbed with multiple complications. We reviewed the literature on the clinical features and management of acute organophosphate poisoning, and the appropriate protective equipment for preventing secondary poisoning of healthcare workers.

scholarly journals UK neonatal resuscitation survey

2018 ◽  
Vol 104 (3) ◽  
pp. F324-F325 ◽  
Author(s):  
Elinor Charles ◽  
Katie Hunt ◽  
Vadivelam Murthy ◽  
Christopher Harris ◽  
Anne Greenough
Keyword(s):  
Carbon Dioxide ◽  
Clinical Practice ◽  
Neonatal Resuscitation ◽  
Neonatal Care ◽  
Initial Resuscitation ◽  
Carbon Dioxide Monitoring ◽  
Different Levels

BackgroundPrevious surveys have demonstrated that neonatal resuscitation practices on the delivery suite vary between UK units, particularly according to the hospital’s neonatal unit’s level. Our aim was to determine if recent changes to the Resuscitation Council guidelines had influenced clinical practice.MethodsSurveys of resuscitation practices at UK delivery units carried out in 2012 and 2017 were compared.ResultsComparing 2017 with 2012, initial resuscitation using air was more commonly used in both term (98% vs 75%, p<0.001) and preterm (84% vs 34%, p<0.001) born infants. Exhaled carbon dioxide monitoring was more frequently employed in 2017 (84% vs 19%, p<0.001). There were no statistically significant differences in practices according to the level of neonatal care provided by the hospital.ConclusionThere have been significant changes in neonatal resuscitation practices in the delivery suite since 2012 regardless of the different levels of neonatal care offered.

Detection and management of the unstable patient

2003 ◽  
Vol 11 (3) ◽  
pp. 307-318 ◽  
Author(s):  
David Powell ◽  
Todd Hobgood
Keyword(s):  
Unstable Patient

scholarly journals A Case of Multiple Wasp Stings Causing Multi-organ Dysfunction Syndrome

2019 ◽  
Vol 12 (1) ◽  
pp. 49-52
Author(s):  
Nabin Basnet ◽  
Binod Pantha ◽  
Sanjeev Acharya ◽  
Barsha Shrestha ◽  
Rishi Kafle
Keyword(s):  
Supportive Care ◽  
Kidney Function ◽  
Kidney Injury ◽  
Health Centers ◽  
Local Health ◽  
The Third ◽  
Initial Resuscitation ◽  
Tertiary Hospitals ◽  
Specific Organ ◽  
Wasp Stings

Wasp stings occur commonly and uncomplicated cases are generally managed at local health centers. Complicated cases are referred to tertiary hospitals for multi-specialty care. We report a case of a 30-year old gentleman from a remote center in Nepal who had multiple wasp stings and developed oligo-anuric acute kidney injury, liver failure, and rhabdomyolysis. He was promptly referred to our hospital after initial resuscitation. At our hospital, he was treated with intensive conventional supportive care and specific organ-supportive care including N-Acetylcysteine infusion and hemodialysis. With the treatment given, the general condition of the patient as well as liver function improved within the first week. However, the recovery of kidney function and urine output lagged behind. The patient showed signs of improvement in kidney function at the end of the third week and completely recovered by the 40th day of treatment.

scholarly journals MAINTAINING IMMOBILISATION DEVICES ON TRAUMA PATIENTS DURING CHEST AND PELVIC X-RAY: A FEASIBILITY STUDY

2019 ◽  
Author(s):  
Pål Johan Stokkeland
Keyword(s):  
Clinical Judgment ◽  
Conventional Radiography ◽  
Kappa Coefficient ◽  
Whole Body ◽  
Trauma Patients ◽  
Technical Quality ◽  
Substantial Agreement ◽  
X Ray ◽  
Initial Resuscitation ◽  
Vacuum Mattress

Abstract BACKGROUND The aim of our study was to investigate the effect of different vacuum mattresses on standard resuscitation bay conventional radiography of chest and pelvis, especially regarding artefacts. METHODS We used a mobile X-ray machine to perform chest and pelvic conventional radiography on an anthropomorphic whole body phantom with a trauma transfer board, three different vacuum mattresses and without any stabilization device. The vacuum mattresses were investigated in activated, deactivated and stretched after deactivated states. Two radiologists assessed the artefacts independently. Agreement was measured using kappa coefficient. RESULTS All radiographs were of good technical quality and fully diagnostic. With the exception of one disagreed occurrence, artefacts were seen to hamper clinical judgement exclusively with activated vacuum mattresses. There was substantial agreement between the two radiologists on artefact assessment. The observed agreement was 0,82 with a kappa coefficient of 0,71. The first vacuum mattress caused no artefacts hampering with clinical judgment. CONCLUSION Our study concludes that it is feasible to maintain some vacuum mattresses through resuscitation bay conventional radiography of chest and pelvis. They do not result in artefacts hampering with clinical judgment. Our vacuum mattress nr 1 is recommendable for this purpose. Together with our previous findings our present results indicate that some vacuum mattresses may be used throughout the initial resuscitation bay assessment and CT examination.

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