scholarly journals BIOMARKERS OF SEPSIS

JMS SKIMS ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 2-4
Author(s):  
Bashir Ahmad Fomda
Keyword(s):  
Altered Mental Status ◽  
Respiratory Alkalosis ◽  
Blood Stream ◽  
Rapid Progression ◽  
Microbial Invasion ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Infectious Source

“Sepsis is a state caused by microbial invasion from a local infectious source into the blood stream which leads to signs of systemic illness in remote organs,” this was the first scientific definition of sepsis proposed by Dr. Schottmuller in 1914.Sepsis is among the most common causes of death in hospitalized patients. Its death toll is in the same range as that of myocardial infarction. 1 Early and reliable diagnosis is imperative, because of the remarkably rapid progression of sepsis into a life-threatening condition.2 Findings in a patient with suspected or proven infection include fever or hypothermia, tachypnea, tachycardia, leukocytosis or leucopenia, acutely altered mental status, thrombocytopenia, an elevated blood lactate level, respiratory alkalosis, or hypotensions. 3  JMS 2017; 20(1):2-4

Anaphylaxis in the OR—Causes, Recognition, and Treatment

2018 ◽  
pp. 199-206
Author(s):  
Surangama Sharma ◽  
Lovkesh Arora
Keyword(s):  
Body Mass Index ◽  
Laparoscopic Cholecystectomy ◽  
Operating Room ◽  
Clinical Manifestations ◽  
Preventative Measures ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Elective Laparoscopic Cholecystectomy

Anaphylaxis in the operating room is a life-threatening condition that can evolve rapidly. As an anesthesiologist, it is important to understand the pathophysiology, diagnose the condition, recognize the inciting agent/agents, and manage it appropriately. It is equally important to confirm the diagnosis for preventing a catastrophic event from happening in future. This chapter defines anaphylaxis, discusses the clinical manifestations and most common causes, and describes ways it can be diagnosed. It also considers treatment and preventative measures. The chapter uses a case study of a 55-year-old female, weighing 85 kg and a body mass index of 36 with no other known comorbidities, who is scheduled to undergo elective laparoscopic cholecystectomy.

scholarly journals Unexpected source of Proteus mirabilis bacteraemia

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-226744
Author(s):  
Sureshkumar Nagiah ◽  
Rassam Badbess
Keyword(s):  
Proteus Mirabilis ◽  
Elderly Woman ◽  
High Morbidity ◽  
Vascular Risk ◽  
Infected Aneurysm ◽  
Gram Negative ◽  
Delay In Diagnosis ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening

Mycotic (infected) aneurysm involving the thoracic aorta is an exceedingly rare and life-threatening condition that is associated with high morbidity and mortality. We report an unusual source of Proteus mirabilis bacteraemia thought to be due to an infected aneurysm in the thoracic aortic arch in an elderly woman. Source of gram-negative bacteraemia is usually isolated to an intra-abdominal or a pelvic source. Proteus bacteraemia from an intrathoracic pathology is very uncommon, and in this case led to a delay in diagnosis. Although an infected aneurysm is a rare source of gram-negative bacteraemia, it must always be considered when common causes of bacteraemia have been ruled out especially in patients with vascular risk factors.

scholarly journals P058: Paramedic recognition and management of anaphylaxis in the prehospital setting

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S77-S77
Author(s):  
M. Welsford ◽  
R. Gupta ◽  
K. Samoraj ◽  
S. Sandhanwalia ◽  
M. Kerslake ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Prehospital Treatment ◽  
Case Identification ◽  
System Involvement ◽  
Service Areas ◽  
Before And After ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Treatment Priorities

Introduction: Anaphylaxis is a life-threatening condition that paramedics are equipped to treat effectively in the field. Current literature suggests improvements in paramedic recognition and treatment of anaphylaxis could be made. The aim of this study was to compare the proportion of cases of anaphylaxis appropriately treated with epinephrine by paramedics before and after a targeted educational intervention. Methods: This was a retrospective medical records review of patients with anaphylaxis managed by primary or advanced care paramedics in five Emergency Medical Service areas in Ontario, before and after an educational module was introduced. This module included education on anaphylaxis diagnosis, recognition, treatment priorities, and feedback on the recognition and management from the before period. All paramedic call records (PCRs) coded as local allergic reaction or anaphylaxis during 12-month periods before and after the intervention were reviewed by trained data abstractors to determine if patients met an international definition of anaphylaxis. The details of interventions performed by the paramedics were used to determine primary and secondary outcomes. Results: Of the 600 PCRs reviewed, 99/120 PCRs in the before and 300/480 in the after period were included. Of the charts included, 63/99 (63.6%) in the before and 136/300 (45.3%) in the after period met criteria for anaphylaxis (p=0.002). Of the cases meeting anaphylaxis criteria, 41/63 (65.1%) in the before and 88/136 (64.7%) in the after period were correctly identified as anaphylaxis (p=0.96). Epinephrine was administered in 37/63 (58.7%) of anaphylaxis cases in the before period and 76/136 (55.9%) in the after period (p=0.70). Anaphylactic patients with only two-system involvement received epinephrine in 20/40 (50.0%) cases in the before period and 45/93 (48.4%) in the after period (p=0.86). Conclusion: There are gaps in paramedic recognition and management of anaphylaxis, particularly in cases of two-system involvement. These gaps persisted after the implementation of an educational intervention. Other quality interventions and periodic refreshers may be necessary to improve prehospital treatment of anaphylaxis. Limitations include an increase in overall cases and decrease in rate of true anaphylaxis in the after period, which may relate to better case identification after electronic PCR implementation and changes in paramedic recognition.

Surgical management of esophageal perforation: role of primary closure

2019 ◽  
Vol 27 (3) ◽  
pp. 192-198 ◽  
Author(s):  
Vu Huu Vinh ◽  
Nguyen Viet Dang Quang ◽  
Nguyen Van Khoi
Keyword(s):  
Hospital Admission ◽  
Esophageal Perforation ◽  
Primary Closure ◽  
Primary Repair ◽  
Time Interval ◽  
Mortality And Morbidity ◽  
Thoracic Level ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening

Objective Esophageal perforation is a life-threatening condition associated with high mortality and morbidity. Ambiguous clinical presentation is one of the most common causes of delayed and difficult diagnosis of esophageal perforation. In this retrospective single-center study, we reviewed the outcome of primary closure in patients with esophageal perforation between 2009 and 2017. Methods The data of 65 patients attending our department of thoracic surgery (from 2009 to 2017) for esophageal perforation were reviewed. Primary repair was attempted in 63 patients irrespective of the site of perforation and time interval between injury and hospital admission. In intrathoracic lesions, continuous mediastinal and pleural irrigation was undertaken, whereas in cervical perforations, gauze packing and local irrigation were performed. Jejunotomy was carried out in patients with inadequate healing. Results Of the 65 patients, 63 underwent primary closure and 2 were left to heal spontaneously. The majority of patients ( n = 44) had an esophageal perforation at the thoracic level, and only one was admitted early (<24 h after injury). Among the 63 patients managed with primary closure, 55 had satisfactory healing with one surgery. Healing was delayed in the other 10 patients. No mortality was reported. Conclusions Esophageal perforation can be well managed by primary closure, irrespective of the time interval between injury and hospital admission and the site of perforation. Conservative management might lead to an increased rate of complications such as empyema or necrotizing mediastinitis, and increased morbidity and mortality.

scholarly journals Neonatal Purpura Fulminans

2014 ◽  
Vol 34 (1) ◽  
pp. 80
Author(s):  
D Sharma ◽  
J Yadav
Keyword(s):  
Purpura Fulminans ◽  
Severe Infection ◽  
High Morbidity ◽  
S Deficiency ◽  
Rapid Spread ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Gram Negative Organisms

Neonatal purpura fulminans is a rare, life-threatening condition of dermal microvascular thrombosis associated with DIC and perivascular hemorrhage in the newborn period associated with high morbidity and mortality [1]. Gram negative organisms and Staphylococcus species are the most common causes of the acute infectious type [2]. It may be congenital, as a result of protein C and S deficiency, or acquired due to severe infection. It is characterized by the rapid spread of symmetrical, bluish-black hemorrhages into the skin, affecting mainly the extensor surfaces of the extremities and showing a tendency to deep necrosis and the formation of sero-sanguineous bullae. The haemorrhagic areas are well defined and are surrounded by oedema. These lesions are accompanied by a high fever and intense systemic symptoms.DOI: http://dx.doi.org/10.3126/jnps.v34i1.8975 J Nepal Paediatr Soc 2014;34(1):80

Endovascular Embolization of Gastroduodenal Artery in its Pancreatogenous Arrosia: a Clinical Case

2019 ◽  
Vol 64 (6) ◽  
pp. 88-90
Author(s):  
M. Popov ◽  
S. Voskanyan ◽  
A. Dunaev ◽  
A. Bashkov ◽  
M. Aronov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Case ◽  
Pancreatic Pseudocyst ◽  
Pancreatic Head ◽  
Endovascular Embolization ◽  
Gastroduodenal Artery ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Vascular Structures

Arrosion of the peripancreatic vascular structures is a rare, but life-threatening condition and requires surgical treatment. One of the most common causes of arrosia is the presence of pancreatic pseudocyst. Imaging methods play a crucial role not only in terms of identifying the described pathology, but also in planning the tactics of surgical treatment. We present a clinical case of a patient, a 44-year-old male, with pseudocyst in the pancreatic head in the presence of chronic pancreatitis, complicated by bleeding into its cavity as a result of an arrosion of the gastroduodenal artery, which required endovascular embolization and drainage of the pseudocyst. This clinical case shows the possibility of endovascular embolization of the injured gastroduodenal artery with microspirals.

scholarly journals Emphysematous Pyelonephritis Caused by a Giant Fecaloma

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Mikael Abi Abdallah ◽  
Nehme Raad ◽  
Naim Yarak ◽  
Jean Paul Noujeim ◽  
Antoine Noujeim
Keyword(s):  
Septic Shock ◽  
Fecal Impaction ◽  
Routine Clinical Practice ◽  
Rapid Progression ◽  
Aggressive Treatment ◽  
Emphysematous Pyelonephritis ◽  
First Case ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Emphysematous pyelonephritis (EPN) is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. It is a life-threatening condition that requires a high index of suspicion, an early diagnosis and an aggressive treatment. Rapid progression to septic shock may occur. We report, to the best of our knowledge, the first case of obstructive EPN caused by a giant fecaloma. The patient was successfully treated with percutaneous drainage and broad-spectrum antibiotics, in addition to fecaloma evacuation using fleet enemas and oral laxatives. This shows how fecal impaction, a common pathology in routine clinical practice, can cause some serious complications if left untreated, including extrinsic ureteral compression.

Hyperthermia and neuroleptic malignant syndrome-Case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s829-s830
Author(s):  
K. Puljić ◽  
M. Herceg ◽  
V. Jukić
Keyword(s):  
Malignant Hyperthermia ◽  
Neuroleptic Malignant Syndrome ◽  
Altered Mental Status ◽  
Muscle Rigidity ◽  
Idiosyncratic Reaction ◽  
Malignant Neuroleptic Syndrome ◽  
Neuroleptic Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Competing Interest

Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases. Malignant hyperthermia (MH) or malignant hyperpyrexia is a rare life-threatening condition that is usually triggered by exposure to certain drugs. The 46-years-old female patient was diagnosed schizophrenia at the age of 22. Currently, she is hospitalized due to psychotic decompensation. The patient was admitted with following daily dose therapy of: haloperidol 15 mg, biperiden 4 mg and diazepam 15 mg. During this hospitalization she developes muscle rigidity, tremor, hyperthermia, and laboratory results showed increase of enzimes CPK and LDH, so we started treatment of suspected malignant neuroleptic syndrome. After a treatment and recovery with complete withdrawal of all presented symptoms, our patient developed a malignant hypertermia that was resistant to all applicated medications. Our dilemma is whether presented symptoms of malignant hyperthermia are related to malignant neuroleptic syndrome or not?Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Pheochromocytoma during pregnancy - a rare diagnose with a complex multidisciplinary approach

2021 ◽  
Vol 10 (9) ◽  
pp. 3587
Author(s):  
Rita Silva ◽  
Catarina R. Carvalho ◽  
Madalena Andrade Tavares ◽  
Celia Pedroso ◽  
Paula Tapadinhas
Keyword(s):  
Multidisciplinary Approach ◽  
Gestational Hypertension ◽  
Cardiovascular Complications ◽  
Fetal Mortality ◽  
Common Causes ◽  
Threatening Condition ◽  
Fetal Complications ◽  
Life Threatening ◽  
The Common ◽  
In Pregnancy

Hypertension is a common problem in pregnancy that can result in significant maternal and fetal morbidity and mortality. The common causes include pre-eclampsia, gestational hypertension and essential hypertension. Although pheochromocytoma is a rare of hypertension in pregnancy, it can lead to potentially life-threatening cardiovascular complications for the mother and increased fetal mortality if left undiagnosed and untreated. Early diagnosis and timely, appropriate management reduce possible maternal and fetal complications. We report a case of a 32-week pregnant woman diagnosed with hypertension secondary to pheochromocytoma. An elective caesarian section was performed at 37 weeks of gestational age and underwent a laparoscopic left adrenalectomy with success. A multidisciplinary approach is of utmost importance and essential during the management of this life-threatening condition during pregnancy.

scholarly journals Head-up tilt test – rational using in diagnosis of syncope

2020 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Adam Stanczyk
Keyword(s):  
Added Value ◽  
Tilt Test ◽  
Neurocardiogenic Syncope ◽  
Common Causes ◽  
Medical Consultations ◽  
Threatening Condition ◽  
Life Threatening ◽  
Head Up Tilt ◽  
Head Up Tilt Test ◽  
Interdisciplinary Process

Fainting and loss of consciousness (including syncope) are one of the most common causes of medical consultations. A detailed history is of particular importance in their diagnosis. It allows to select a group of patients with a high risk of life-threatening condition and to direct further interdisciplinary process with the participation of a cardiologist, neurologist, psychiatrist and psychologist. The head-up tilt test (HUTT) has a special place in the diagnosis of neurocardiogenic syncope. The main purpose of this review is to highlight the indications for HUTT and indicate situations in which it should be avoided due to the lack of added value of the applied therapy.

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