Evaluation and Management of Shock States

2010 ◽  
Vol 24 (1) ◽  
pp. 44-60 ◽  
Author(s):  
Michael P. Moranville ◽  
Katherine D. Mieure ◽  
Elena M. Santayana
Keyword(s):  
Patient Outcomes ◽  
Treatment Plan ◽  
Hypovolemic Shock ◽  
Clinical Signs ◽  
Specific Treatment ◽  
Signs And Symptoms ◽  
Therapeutic Interventions ◽  
Initial Assessment ◽  
Patient Specific ◽  
Therapeutic Goals

Shock states have multiple etiologies, but all result in hypoperfusion to vital organs, which can lead to organ failure and death if not quickly and appropriately managed. Pharmacists should be familiar with cardiogenic, distributive, and hypovolemic shock and should be involved in providing safe and effective medical therapies. An accurate diagnosis is necessary to initiate appropriate lifesaving interventions and target therapeutic goals specific to the type of shock. Clinical signs and symptoms, as well as hemodynamic data, help with initial assessment and continued monitoring to provide adequate support for the patient. It is necessary to understand these hemodynamic parameters, medication mechanisms of action, and available mechanical support when developing a patient-specific treatment plan. Rapid therapeutic intervention has been proven to decrease morbidity and mortality and is crucial to providing the best patient outcomes. Pharmacists can provide their expertise in medication selection, titration, monitoring, and dose adjustment in these critically ill patients. This review will focus on parameters used to assess hemodynamic status, the major causes of shock, pathophysiologic factors that cause shock, and therapeutic interventions that should be employed to improve patient outcomes.

scholarly journals Sonography of musculoskeletal infection in children

Ultrasound ◽  
2020 ◽  
Vol 28 (2) ◽  
pp. 103-117
Author(s):  
Monique Shahid ◽  
Colin Holton ◽  
Sean O’Riordan ◽  
Jeannette K Kraft
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Bone Infection ◽  
Initial Assessment ◽  
General Anaesthetic ◽  
Portable Equipment ◽  
Musculoskeletal Infection ◽  
Source Of Infection ◽  
Early Imaging ◽  
Clinical Signs And Symptoms

Musculoskeletal infection, especially in young children, often presents with non-specific clinical signs and symptoms necessitating early imaging to identify the source of infection. While MRI is the investigation of choice to demonstrate bone infection, it is expensive and often requires a general anaesthetic in the young child. Ultrasound can be a useful tool in the initial assessment due to its easy availability and portable equipment. It does not involve ionising radiation and is used to guide aspiration and drainage procedures. This review explains sonographic features of septic arthritis, osteomyelitis, pyomyositis and soft tissue infection in children and highlights advantages and limitations of sonography when assessing the child with suspected musculoskeletal infection.

Optical Coherence Tomography-Based Patient-Specific Residual Multi-Thrombus Coronary Plaque Models with Fluid-Structure Interaction for Better Treatment Decisions: A Biomechanical Modeling Case Study

2021 ◽  
Author(s):  
Liang Wang ◽  
Luping He ◽  
Haibo Jia ◽  
Rui Lv ◽  
Xiaoya Guo ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Solid Mechanics ◽  
Treatment Plan ◽  
Specific Treatment ◽  
Coronary Plaque ◽  
Patient Specific ◽  
Optical Coherence ◽  
Aspiration Thrombectomy ◽  
Coronary Syndrome ◽  
Residual Thrombus

Abstract Intracoronary thrombus from plaque erosion could cause fatal acute coronary syndrome (ACS). A conservative anti-thrombotic therapy has been proposed to treat ACS patients in lieu of stenting. It is speculated that the residual thrombus after aspiration thrombectomy would influence the prognosis of this treatment. However, biomechanical mechanisms affecting intracoronary thrombus remodeling and clinical outcome remain largely unknown. In vivo optical coherence tomography (OCT) data of a coronary plaque with two residual thrombi after anti-thrombotic therapy were acquired from an ACS patient with consent obtained. Three OCT-based FSI models with different thrombus volumes, fluid-only and structure-only models were constructed to simulate and compare the biomechanical interplay among blood flow, residual thrombus and vessel wall mimicking different clinical situations. Our results showed that residual thrombus would decrease coronary volumetric flow rate by 9.3%, but elevate wall shear stress (WSS) by 29.4% and 75.5% at Thrombus 1 & 2, respectively. WSS variations in a cardiac cycle from structure-only model were 12.1% and 13.5% higher at the two thrombus surfaces than those from FSI model. Intracoronary thrombi were subjected to compressive forces indicated by negative thrombus stress. Tandem intracoronary thrombus might influence coronary hemodynamics and solid mechanics differently. Computational modeling could be used to quantify biomechanical conditions under which patients could receive patient-specific treatment plan with optimized outcome after anti-thrombotic therapy. More patient studies with follow-up data are needed to continue the investigation and better understand mechanisms governing thrombus remodeling process.

Neuroleptic malignant syndrome

2011 ◽  
Vol 26 (S2) ◽  
pp. 1235-1235
Author(s):  
A. Cruz
Keyword(s):  
Risk Factors ◽  
Neuroleptic Malignant Syndrome ◽  
Rare Complication ◽  
Clinical Signs ◽  
Specific Treatment ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Altered Mental Status ◽  
Antipsychotic Therapy ◽  
Mesh Terms

IntroductionNeuroleptic malignant syndrome (NMS) is a rare and potentially fatal idiosyncratic drug reaction usually defined as a complication of treatment with antipsychotics. It is manifested by altered mental status, hyperpyrexia, rigidity and autonomic instability. This syndrome occurs in response to administration of drugs that induce dopamine blockage.ObjectivesStudy the risk factors, diagnosis, treatment and complications of NMS, by performing a literature review.AimsSummarize the main aspects of NMS that may have importance in usual clinical practice.MethodsPubMed was used to identify NMS articles published after 2000, associated with the MeSH terms “neuroleptic malignant syndrome” and “antipsychotic agents”.ResultsNMS is not dose-related and its aetiology is still unknown. There are many risk factors associated with the syndrome, such as demographic, individual, genetic and environmental factors and medication. In order to evaluate the medical situation, an accurate clinical history and physical examination should be fulfilled. NMS is also characterized by changes in laboratory investigation. There are no patognomonic findings, thus other different diagnosis should be considered. Specific treatment remains controversial. Treatment should be individualized for each patient, regarding characteristics, duration and severity of the clinical signs and symptoms. Resolution is usually verified in one to two weeks. Though there are cases in which the symptoms persist and comorbid process may occur.ConclusionsAlthough NMS is a rare complication of antipsychotic therapy, early diagnosis and treatment is essential to improve prognosis.

scholarly journals Can Treatment Adherence Be Improved by Using Rubin's Four Tendencies Framework to Understand a Patient's Response to Expectations

2017 ◽  
Vol 2 (Suppl. 1) ◽  
pp. 1-12
Author(s):  
Jeremy Kirk ◽  
Anita MacDonald ◽  
Paul Lavender ◽  
Jessica Dean ◽  
Gretchen Rubin
Keyword(s):  
Treatment Adherence ◽  
Patient Outcomes ◽  
Healthcare Costs ◽  
Healthcare Professionals ◽  
Treatment Plan ◽  
Patient Specific ◽  
Call To Action ◽  
Specific Strategy ◽  
Key Factor ◽  
Plan Movement

Within the context of poorer patient outcomes and rising healthcare costs, we need to better understand why many patients do not engage fully with their treatment plan. Movement away from talking about “compliance” towards “adherence” and “concordance” is evidence of a recognition that this is a two-way process. Whilst healthcare professionals expect patients to engage in treatment, equally, patients have expectations (whether positive or negative) of their treatment and their need for engagement. There is a need for an effective method that can specifically target those interventions that will provide the most benefit to individual patients and which, crucially, is easy and inexpensive to administer in everyday practice and widely applicable. Rubin's Four Tendencies model identifies a patient's “response to outer and inner expectations” as a key factor in adherence. The model therefore provides an opportunity to test such a targeted, patient-specific strategy and we present a call to action for research in this area.

scholarly journals Can Treatment Adherence Be Improved by Using Rubin's Four Tendencies Framework to Understand a Patient's Response to Expectations

2017 ◽  
Vol 2 (2) ◽  
pp. 1-12
Author(s):  
Jeremy Kirk ◽  
Anita MacDonald ◽  
Paul Lavender ◽  
Jessica Dean ◽  
Gretchen Rubin
Keyword(s):  
Treatment Adherence ◽  
Patient Outcomes ◽  
Healthcare Costs ◽  
Healthcare Professionals ◽  
Treatment Plan ◽  
Patient Specific ◽  
Call To Action ◽  
Specific Strategy ◽  
Key Factor ◽  
Plan Movement

Within the context of poorer patient outcomes and rising healthcare costs, we need to better understand why many patients do not engage fully with their treatment plan. Movement away from talking about “compliance” towards “adherence” and “concordance” is evidence of a recognition that this is a two-way process. Whilst healthcare professionals expect patients to engage in treatment, equally, patients have expectations (whether positive or negative) of their treatment and their need for engagement. There is a need for an effective method that can specifically target those interventions that will provide the most benefit to individual patients and which, crucially, is easy and inexpensive to administer in everyday practice and widely applicable. Rubin's Four Tendencies model identifies a patient's “response to outer and inner expectations” as a key factor in adherence. The model therefore provides an opportunity to test such a targeted, patient-specific strategy and we present a call to action for research in this area.

scholarly journals Heterophilic antibodies may be a cause of falsely low total IGF1 levels

2009 ◽  
Vol 161 (4) ◽  
pp. 561-565 ◽  
Author(s):  
M P Brugts ◽  
J G L M Luermans ◽  
E G W M Lentjes ◽  
N J van Trooyen-van Vrouwerff ◽  
F A L van der Horst ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Receptor Activation ◽  
Therapeutic Interventions ◽  
Heterophilic Antibodies ◽  
First Case ◽  
Secondary Hypothyroidism ◽  
Activation Assay ◽  
Clinical Signs And Symptoms ◽  
Low Serum

BackgroundA low serum total IGF1 is considered as a diagnostic indicator of GH deficiency (GHD) in the presence of hypopituitarism. Introduction of IRMA and chemiluminescent immunometric assay (CLIA) IGF1 immunoassays has introduced endogenous antibodies as a new source of interference. In general, this goes unnoticed and might lead to unnecessary diagnostic and therapeutic interventions.CaseA 56-year-old man was referred with a decline in physical performance, unexplained osteopenia, and weight loss of 3 kg over the past 8 months. Although clinical signs and symptoms were unremarkable, laboratory results pointed to secondary hypothyroidism and secondary hypogonadism. In addition, the serum total IGF1 level (CLIA; Siemens Medical Solutions Diagnostics) was in the low normal range. Two GH stimulation tests were performed, but these tests did not support the diagnosis GHD. Moreover, IGF1 bioactivity measured by the kinase receptor activation assay was normal. Interference of heterophilic antibodies was considered. After pretreatment with specific heterophilic blocking tubes that contain blocking reagents to eliminate heterophilic antibodies, serum-free thyroxine, testosterone, and IGF1 levels turned out to be normal.ConclusionTo the best of our knowledge, we here describe the first case in the literature of a patient with low serum total IGF1 levels due to interference from heterophilic antibodies in the used IGF1 immunoassay. When confronted with low-IGF1 levels that do not fit the clinical picture, interference of heterophilic antibodies should be considered in the differential diagnosis.

scholarly journals Infantile cranial fasciitis

2019 ◽  
Vol 18 (4) ◽  
pp. 66-78
Author(s):  
A. Yu. Kugushev ◽  
A. V. Lopatin ◽  
S. A. Yasonov ◽  
D. V. Rogozhin
Keyword(s):  
Histopathological Examination ◽  
Benign Lesion ◽  
Clinical Signs ◽  
Specific Treatment ◽  
Signs And Symptoms ◽  
Malignant Neoplasms ◽  
Surgical Removal ◽  
True Incidence ◽  
Cranial Fasciitis ◽  
Clinical Signs And Symptoms

Cranial fasciitis (CF) is a rare benign lesion of the skull. Due to the rarity of this disease, prospective studies of it have not been conducted. The first description dedicated of the case of CF was in 1980. Later were descriptions of only clinical cases of observation and treatment of children with this pathology. For these reasons, questions regarding true incidence, genetic risk factors, prognosis and long-term still unanswered. Clinically, CF is represented by a dense, painless, growing mass on the scalp. Given the rarity of the occurrence of CF in differential diagnosis, it is usually not considered. In addition, there are no pathognomonic clinical signs and symptoms, and changes on MRI are often non-specific. Treatment involves removal of the tumor mass, after which a histopathological examination confirms the diagnosis of CF. As a rule, a good result is observed with complete resection, however, in this case it has to necessary to perform auto-bone grafting of the skull bone defect. CF is a rare and underexplored fibroproliferative disease. Because of its locally invasive nature and nonspecific manifestations of CF, it is often difficult to distinguish from malignant neoplasms and infections. Complete surgical removal is the best choice to make diagnosis and successful treatment. Parents gave their consent to use information about the child in the article.

Treating the Deviated or Wide Nasal Dorsum

2017 ◽  
Vol 33 (02) ◽  
pp. 139-156 ◽  
Author(s):  
Richard Davis ◽  
Allen Foulad
Keyword(s):  
Treatment Plan ◽  
Specific Treatment ◽  
Preoperative Assessment ◽  
Patient Specific ◽  
Nasal Airway ◽  
Nasal Dorsum ◽  
Suture Fixation ◽  
Nasal Surgery ◽  
Developmental Growth ◽  
Nasal Trauma

AbstractBoth deviation and excessive width of the nasal dorsum result in conspicuous facial disharmony and are often attended by nasal airway dysfunction. Whether the result of developmental growth disturbances, nasal trauma, failed nasal surgery, or combinations therein, deviation and splaying of the nasal dorsum can be exceedingly difficult to treat. Individualized treatment is paramount because contour variations are seemingly endless, and a careful preoperative assessment of the anatomic, physiologic, cosmetic, and psychosocial factors that characterize the deformity is necessary to devise an effective patient-specific treatment plan. Ensuring the linearity, strength, alignment, and aesthetically pleasing profile dimensions of the nasal L-strut is the requisite first step in successful treatment. Releasing all deformed components in a controlled and precise manner using powered instrumentation (whenever possible) to facilitate minimally traumatic and effective repositioning, followed by structural reconstitution of the skeletal framework using autologous graft materials, and then consolidation of the newly created construct with suture fixation completes the transformation to normalcy. Paying equal attention to both cosmetic and functional wellness, while simultaneously seeking to maximize structural stability, serves to optimize the final outcome.

Comparison of treatment plans feasible through AI enabled multidisciplinary online tumor board solution versus NCCN-based clinical decision support system (CDSS).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 816-816
Author(s):  
Bhawna Sirohi ◽  
Sushil Beriwal ◽  
C. S. Pramesh ◽  
Supriya Chopra ◽  
Mahesh Goel ◽  
...  
Keyword(s):  
Large Scale ◽  
Treatment Plan ◽  
Specific Treatment ◽  
Treatment Decisions ◽  
Added Value ◽  
Tumor Board ◽  
Patient Specific ◽  
Clinical Scenarios ◽  
Tumor Boards ◽  
Treatment Plans

816 Background: Multidisciplinary tumor boards at Academic Medical Centers (AMC) maximize cancer outcomes. Guidelines based CDSS are alternatives to determine care pathways. Since 2015, 300 AMC cancer experts in USA and India use an AI enabled online tumor board solution, “NAVYA,” to scale low cost access to multidisciplinary expertise, on 1-2 minutes of expert time per decision (ASCO 2017). Methods: GI patients who used NAVYA between 5/1/15-8/31/19 were analyzed. Actionable treatment plans generated by NAVYA were compared to NCCN. Actionable treatment plans include chemotherapy protocols (doses, frequencies), radiation protocols (sites, fractions), etc. Inactionable specialty level decisions (CT-RT vs. surgery) lack specificity. Results: 1302 patients (4638 treatment decisions) were analyzed: 61% (794) male, 80% between age 45 to 75, mostly with Colon, Pancreas, Gallbladder, Rectum, or Stomach cancer; 49.7% non-metastatic. Cohort was comparable to GLOBOCAN estimates. In 82.2% (3812/4638) decisions, NAVYA added value beyond NCCN. First, in 4.5% (212/4638), NAVYA recommended a patient-specific treatment plan that was not part of NCCN. Second, in 3.2% (148/4638), NAVYA recommended treatments plan for clinical scenarios not covered by NCCN, (for eg. 3rd line therapies). Third, in 74.5% (3452/4638), NAVYA used patient specific criteria including resource constraints and patient preference to choose a treatment plan amongst the multiple pathways provided by NCCN and added actionable treatment details. Conclusions: Guideline based CDSS are insufficient to make the vast majority of actionable treatment decisions. Scaling rapid access to multidisciplinary experts is critical. Leapfrogging existing guidelines based CDSS, NAVYA online tumor board makes actionable expert treatment plans possible at a large scale.

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