scholarly journals 659 Four Limb Amputations due to Peripheral Gangrene from Vasopressor Use

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D R Selva Raj ◽  
B Adjei ◽  
W Ken Vin ◽  
N Fumakia
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Blood Vessel ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Ischemic Damage ◽  
Peripheral Gangrene ◽  
Accident And Emergency ◽  
Vasopressor Use ◽  
Underlying Pathophysiology

Abstract Case Symmetrical peripheral gangrene (SPG) is a relatively rare phenomenon characterized by symmetrical distal ischemic damage that leads to gangrene of 2 or more sites in the absence of large blood vessel obstruction, where vasoconstriction rather than thrombosis is implicated as the underlying pathophysiology. We present 2 cases of symmetrical peripheral gangrene (SPG) associated with the use of vasopressors to elevate blood pressure, resulting in four-limb amputation. Both patients had different backgrounds, and each presented to Accident and Emergency (A&E) with Streptococcal septicemia and subsequently septic shock, warranting ICU admission and the use of vasopressors to optimize blood pressure. Both patients then started to develop symmetrical peripheral gangrene of both the upper and lower limbs leading to staged amputations performed electively. Vasopressors including dopamine and norepinephrine are used frequently in the treatment of septic shock and its effectiveness is firmly established. However, it can result in peripheral gangrene due to the prolonged vasoconstrictive effect on peripheral blood vessels. Therefore, it is crucial that the astute physician consider the possibility of the development of peripheral gangrene and amputation when using vasopressors to treat septic shock.

Liberal vs. conservative vasopressor use to maintain mean arterial blood pressure during resuscitation of septic shock: an observational study

2007 ◽  
Vol 34 (1) ◽  
pp. 157-162 ◽  
Author(s):  
Sanjay Subramanian ◽  
Murat Yilmaz ◽  
Ahmer Rehman ◽  
Rolf D. Hubmayr ◽  
Bekele Afessa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Observational Study ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Arterial Blood ◽  
Vasopressor Use

Ionotropes Induced Symmetrical Peripheral Gangrene: A Case Report

2018 ◽  
Vol 3 (09) ◽  
Author(s):  
Naushad .O ◽  
Kaur .S ◽  
Bashir .M
Keyword(s):  
Septic Shock ◽  
Case Report ◽  
Limb Amputation ◽  
Peripheral Gangrene

Symmetrical peripheral gangrene is characterised by presence of distal ischemic changes in two or more extremities without the vessel obstruction[1]. It is a rare but serious complication in patients of septic shock receiving ionotropes[2] which may lead to limb amputation.

COMPARISON OF ANTIHYPERTENSIVE EFFECT OF MOXONIDINE VERSUS CLONIDINE IN RENAL FAILURE PATIENTS.

2018 ◽  
Vol 6 (9) ◽  
Author(s):  
DR.MATHEW GEORGE ◽  
DR.LINCY JOSEPH ◽  
MRS.DEEPTHI MATHEW ◽  
ALISHA MARIA SHAJI ◽  
BIJI JOSEPH ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Blood Flow ◽  
Blood Vessel ◽  
Blood Vessels ◽  
High Blood Pressure ◽  
Antihypertensive Effect ◽  
The Body ◽  
Ability To Work ◽  
Blood Flows

Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. Factors that can increase this force include higher blood volume due to extra fluid in the blood and blood vessels that are narrow, stiff, or clogged(1). High blood pressure can damage blood vessels in the kidneys, reducing their ability to work properly. When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys.

Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

MedPharmRes ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 27-32
Author(s):  
Bien Le ◽  
Dai Huynh ◽  
Mai Tuan ◽  
Minh Phan ◽  
Thao Pham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Fluid Responsiveness ◽  
Statistical Significance ◽  
Venous Pressure ◽  
Fluid Bolus ◽  
Low Blood Pressure ◽  
Low Central Venous Pressure ◽  
Sepsis And Septic Shock

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock. Design: observational study. Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%. Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers). Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

scholarly journals What Is Currently the Role of TcPO2 in the Choice of the Amputation Level of Lower Limbs? A Comprehensive Review

2021 ◽  
Vol 10 (7) ◽  
pp. 1413
Author(s):  
Judith Catella ◽  
Anne Long ◽  
Lucia Mazzolai
Keyword(s):  
Arterial Disease ◽  
Major Amputation ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Quality Of Data ◽  
Amputation Level ◽  
Increased Risk ◽  
Transcutaneous Oximetry ◽  
Peripheral Arterial

Some patients still require major amputation for lower extremity peripheral arterial disease treatment. The purpose of pre-operative amputation level selection is to determine the most distal amputation site with the highest healing probability without re-amputation. Transcutaneous oximetry (TcPO2) can detect viable tissue with the highest probability of healing. Several factors affect the accuracy of TcPO2; nevertheless, surgeons rely on TcPO2 values to determine the optimal amputation level. Background about the development of TcPO2, methods of measurement, consequences of lower limb amputation level, and the place of TcPO2 in the choice of the amputation level are reviewed herein. Most of the retrospective studies indicated that calf TcPO2 values greater than 40 mmHg were associated with a high percentage of successful wound healing after below-knee-amputation, whereas values lower than 20 mmHg indicated an increased risk of unsuccessful healing. However, a consensus on the precise cut-off value of TcPO2 necessary to assure healing is missing. Ways of improvement for TcPO2 performance applied to the optimization of the amputation-level are reported herein. Further prospective data are needed to better approach a TcPO2 value that will promise an acceptable risk of re-amputation. Standardized TcPO2 measurement is crucial to ensure quality of data.

scholarly journals A Retrospective Review of Patients with Radiological Missed Fractures in an Emergency Department in Hong Kong

2003 ◽  
Vol 10 (4) ◽  
pp. 215-222 ◽  
Author(s):  
VCH Ng ◽  
FL Lau
Keyword(s):  
Emergency Department ◽  
Management Plan ◽  
Lower Limbs ◽  
X Rays ◽  
Accident And Emergency ◽  
Assessment And Treatment ◽  
Spinal Region ◽  
Accident And Emergency Department ◽  
Clinical Records ◽  
Christian Hospital

Aim To review the clinical spectrum and outcome of radiological missed fractures in the Accident and Emergency Department of United Christian Hospital (UCH) in 2002. Method In UCH, radiologists report all X-Rays taken in the Accident and Emergency Department (AED) within 48 hours. The study period was from 1st January 2002 to 31st December 2002. AED notes, relevant clinical records and all X-rays of patients with suspected missed fractures as reported by radiologists were reviewed for information on clinical features, treatments and outcomes. Results A total of 286 cases of missed fractures were found. Fourteen (4.9%) involved the skull and maxillofacial region, 83 (29.0%) involved the chest region, 53 (18.5%) involved the spinal region, 72 (25.2%) involved the upper limbs and 64 (22.4%) involved the lower limbs. Of these 286 cases, 137 (47.9%) were followed up in AED, 90 (31.5%) were referred to specialist clinics for further management, 26 (9.1%) required admission to hospital for further assessment and treatment, and 33 (11.5%) defaulted follow up. Furthermore, 87 (30.4%) of these 286 missed fractures required a change in management plan: 3 missed fractures required operative intervention (internal fixation) and 84 missed fractures required some form of external immobilisation. This group of patient did not lodge any complaint or claim. Conclusion A&E doctors missed quite a number of fractures that might result in significant morbidity. However, a reporting system by radiologists within 48 hours from discharge can pick up all these missed fractures, and may prevent complaints and litigations.

scholarly journals Effects of DHA-Rich n-3 Fatty Acid Supplementation and/or Resistance Training on Body Composition and Cardiometabolic Biomarkers in Overweight and Obese Post-Menopausal Women

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2465
Author(s):  
Elisa Félix-Soriano ◽  
Alejandro Martínez-Gayo ◽  
María José Cobo ◽  
Adriana Pérez-Chávez ◽  
Javier Ibáñez-Santos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Composition ◽  
Resistance Training ◽  
Glucose Tolerance ◽  
Bone Mineral Content ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Mineral Content ◽  
Lower Limbs ◽  
Pufa Supplementation

Resistance training (RT) and n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation have emerged as strategies to improve muscle function in older adults. Overweight/obese postmenopausal women (55–70 years) were randomly allocated to one of four experimental groups, receiving placebo (olive oil) or docosahexaenoic acid (DHA)-rich n-3 PUFA supplementation alone or in combination with a supervised RT-program for 16 weeks. At baseline and at end of the trial, body composition, anthropometrical measures, blood pressure and serum glucose and lipid biomarkers were analyzed. Oral glucose tolerance tests (OGTT) and strength tests were also performed. All groups exhibit a similar moderate reduction in body weight and fat mass, but the RT-groups maintained bone mineral content, increased upper limbs lean mass, decreased lower limbs fat mass, and increased muscle strength and quality compared to untrained-groups. The RT-program also improved glucose tolerance (lowering the OGTT incremental area under the curve). The DHA-rich supplementation lowered diastolic blood pressure and circulating triglycerides and increased muscle quality in lower limbs. In conclusion, 16-week RT-program improved segmented body composition, bone mineral content, and glucose tolerance, while the DHA-rich supplement had beneficial effects on cardiovascular health markers in overweight/obese postmenopausal women. No synergistic effects were observed for DHA supplementation and RT-program combination.

Bio-Medico-Mechanical Behavior of Natural Artery Blood Vessel Under Constant and Variable Internal Pulsatile Pressure Flow Test In Vitro

1986 ◽  
Vol 108 (4) ◽  
pp. 295-300 ◽  
Author(s):  
A. T. Yokobori ◽  
T. Maeyama ◽  
T. Ohkuma ◽  
T. Yokobori ◽  
H. Ohuchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Vessel ◽  
Mechanical Behavior ◽  
Arterial System ◽  
Pressure Amplitude ◽  
Constant Amplitude ◽  
Pressure Flow ◽  
Fluctuating Pressure ◽  
Pulsatile Pressure

Studies have been carried out on the bio-medico-mechanical behavior in vitro of natural blood vessel (dogs) under constant and variable internal pulsatile pressure flow. The apparatus designed by us well simulated the arterial system. The studies were made for the case of pressure amplitude kept as constant, of the two-step-multi-duplicated pulsatile pressure and of the fluctuating pressure. For the case of the fluctuating pressure, the strength of the artery becomes considerably lower than those under constant amplitude and two-step-multi-duplicated pulsatile pressure. SEM observations of the inner walls of the artery shows that collagen fibers are more elongated under fluctuating pulsatile pressure flow. In conclusion, in order to avoid the mechanical deterioration of the artery strength, it is useful to keep the pulsatile blood pressure at constant amplitude. Even for the case of the blood pressure fluctuation, it is necessary to manage to keep the blood pressure as near a regular wave as possible, the total number of repeated pulse being equal.

A modern-day solution to a 100-yearold problem: the use of a bespoke offloading brace in the rehabilitation of ‘Deck-Slap’ and other high-energy lower limb injuries

2014 ◽  
Vol 100 (3) ◽  
pp. 337-343
Author(s):  
MA Osborne ◽  
HL Jarvis ◽  
N Bennett ◽  
RD Phillip
Keyword(s):  
Axial Loading ◽  
Cost Effective ◽  
Armed Forces ◽  
High Energy ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Activity Levels ◽  
Prosthetic Devices ◽  
Functional Benefit ◽  
Limb Injuries

Abstract‘Deck-Slap’ is an injury pattern first described at the Battle of Jutland; it is still relevant today, with anti-vehicle mines a significant threat to Coalition troops. The effect of a device exploding beneath a vehicle produces a wave of high energy that is rapidly transmitted through the steel floor; this causes significant axial loading of lower limbs often resulting in severe fractures (notably of the calcaneum). Recent advancements in orthopaedic surgery have allowed for limbs that were destined for immediate amputation following significant trauma to be salvaged. However, despite intense rehabilitation, many of these salvaged limbs have subsequently gone on to delayed amputation, as functional outcomes are often poor. Technologically advanced prosthetic devices are available that afford good quality of life and allow for increased activity levels; these devices are, however, expensive to procure and maintain. This report describes a United Kingdom (UK) Armed Forces soldier who suffered a typical ‘deck-slap’ injury in Afghanistan with subsequent limb salvage. The use of the Bespoke Off-loading Brace (BOB) is discussed. The results presented here indicate that the biomechanical function of a patient with this type of injury improves when wearing the BOB. Further studies are needed to assess long-term clinical outcomes and the functional benefit of the device as a viable and cost-effective alternative to delayed limb amputation.

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