scholarly journals Delirium Superimposed on Dementia in Perioperative Period and Intensive Care

2020 ◽  
Vol 9 (10) ◽  
pp. 3279
Author(s):  
Łukasz J. Krzych ◽  
Natalia Rachfalska ◽  
Zbigniew Putowski
Keyword(s):  
Intensive Care ◽  
Care Setting ◽  
Preventive Measures ◽  
Perioperative Period ◽  
Ageing Population ◽  
Everyday Clinical Practice ◽  
Threatening Condition ◽  
Life Threatening ◽  
Problem Patient ◽  
Delirium Superimposed On Dementia

Delirium is a life-threatening condition, the causes of which are still not fully understood. It may develop in patients with pre-existing dementia. Delirium superimposed on dementia (DSD) can go completely unnoticed with routine examination. It may happen in the perioperative period and in the critical care setting, especially in the ageing population. Difficulties in diagnosing and lack of specific pharmacological and non-pharmacological treatment make DSD a seriously growing problem. Patient-oriented, multidirectional preventive measures should be applied to reduce the risk of DSD. For this reason, anesthesiologists and intensive care specialists should be aware of this interesting condition in their everyday clinical practice.

scholarly journals Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696653 ◽  
Author(s):  
Feike J Loots ◽  
Marleen Smits ◽  
Carlijn van Steensel ◽  
Paul Giesen ◽  
Rogier Hopstaken ◽  
...  
Keyword(s):  
Primary Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Treatment ◽  
Out Of Hours ◽  
Suspected Infection ◽  
Telephone Advice ◽  
Mortality Difference ◽  
Threatening Condition ◽  
Life Threatening

BackgroundSepsis is a life-threatening condition requiring urgent hospital treatment. The rates of recognition and doctors delay in primary care are currently unknown.AimTo explore the role of GP cooperatives in the pre-hospital care for sepsis patients.MethodA retrospective patient record study was conducted of sepsis patients admitted to an intensive care unit (ICU) in Ede, the Netherlands. Adult ICU patients admitted for community-onset sepsis between 2011 and 2015 were identified. Subsequently, all contacts with the co-located GP cooperative in the 72 hours before hospital admission were retrieved. Differences in mortality rates between subgroups were analysed using logistic regression analysis.ResultsOf 263 patients admitted to the ICU, 127 (48.3%) had prior GP cooperative contacts. These contacts concerned home visits (59.1%), clinic consultations (18.1%), direct ambulance deployment (12.6%) or telephone advice (10.2%). Patients assessed by a GP were referred in 64% after the first contact. The median delay to hospital arrival was 1.8 hours. In 43%, the GP had not suspected an infection. In this group the in-hospital mortality rate was significantly higher compared with patients with suspected infections (41.9% versus 17.6%). Mortality difference remained significant after correction for confounders.ConclusionGP cooperatives play an important role in pre-hospital management of sepsis and recognition of sepsis in this setting proved difficult. Efforts to improve management of sepsis in out-of-hours primary care should not be limited to patients with a suspected infection, but also include severely ill patients without clear signs of infection.

scholarly journals Nonspecific abdominal pain: Do I have to allocate a specific diagnosis for every patient?

2022 ◽  
Keyword(s):  
Abdominal Pain ◽  
Care Setting ◽  
Acute Abdominal Pain ◽  
Scoring Systems ◽  
Acute Care Setting ◽  
Acute Setting ◽  
The World ◽  
Threatening Condition ◽  
Chief Complaints ◽  
Life Threatening

Acute abdominal pain is one of the most common chief complaints in the acute setting all over the world. The definitive diagnoses of these patients vary depending on age, gender, geographical and sociodemographic characteristics etc. Apart from these, aging of the population, obesity, advanced diagnostic imaging modalities and changes in nutritional habits also have an impact on the rates of specific diagnoses. On the other hand, nonspecific abdominal pain constitutes almost half of all visits due to acute abdominal pain in the acute care setting. This phenomenon is the main differential diagnostic problem in the management of these patients because missing a life-threatening condition can cause enormous medicolegal problems for the caregivers. Certain diagnostic scoring systems have also been developed to facilitate recognition and management of these conditions. This article aims to review the entity and underline the challenges it can bring to the scene.

scholarly journals Coronavirus Disease 2019 (Covid-19) Outbreak and Pituitary Apoplexy

2021 ◽  
Author(s):  
Rafael Martinez-Perez ◽  
Benjamin W Carroll ◽  
Daniel Duran ◽  
James S Neill ◽  
Gustavo D Luzardo ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Molecular Mechanisms ◽  
Pituitary Apoplexy ◽  
Care Center ◽  
Tertiary Care ◽  
Perioperative Period ◽  
Common Symptom ◽  
Increased Risk ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background. Pituitary apoplexy (PA) is a rare and potentially life-threatening condition characterized by pituitary hemorrhage, often in the setting of a preexisting pituitary adenoma. Risk factors and mechanisms associated to PA are poorly understood. Although involvement of the nervous system in SARS-CoV-2 infection causing intracranial hemorrhagic complications has been documented, the association between COVID-19 infection and PA has yet to be determined. Methods . From a prospectively collected database of patients with pituitary adenomas, we retrospectively reviewed the electronical medical records and scans of patients with pituitary apoplexy during the COVID-19 outbreak, since March 2020 to December 2020, that were treated at a tertiary care center. Results. Herein, we report three consecutive cases of patients with PA and concomitant COVID-19 infection. Most common symptom at presentation was headache and visual worsening. Included patients were successfully treated with surgical decompression and medical management of the hormonal deficits, experiencing moderate to significant improvement of their visual symptoms at last follow up. COVID-19 infection in the perioperative period was corroborated throughout polymerase chain reaction testing in all patients. Conclusions. COVID-19 positive patients may be at an increased risk of developing PA. Angiotensin-converting enzyme 2 receptors expressed in cerebrovascular endothelium may potentially play a role in the molecular mechanisms that induce changes of the vascular autoregulation and cerebral blood flow and predispose to pituitary hemorrhage in patients harboring a pituitary adenoma.

scholarly journals Life-threatening complications of streptococcal sepsis: a PICU contemporary series

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
M. Piastra ◽  
V. Ferrari ◽  
E. Picconi ◽  
T. C. Morena ◽  
L. Pezza ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Setting ◽  
Group A Streptococcus ◽  
Clinical Approach ◽  
Aggressive Treatment ◽  
Intensive Care Setting ◽  
Healthy Infants ◽  
Life Threatening ◽  
Streptococcal Sepsis ◽  
Clinical Pictures

Abstract Background Life-threatening streptococcal sepsis nowadays represents an uncommon event in previously healthy infants and children. Critically ill patients suffering from severe streptococcal sepsis complications may present with pre-antibiotic era clinical pictures and require a timely clinical approach to achieve restitutio ad integrum. Results We report a series of four patient groups affected by an uncommon life-threatening streptococcal sepsis, each of them exhibiting some distinct features. Streptococcus Agalactiae sepsis was associated with cerebral thrombotic/ischaemic lesions, whereas severe cardiogenic shock was prominent in the Streptococcus Viridans group; Streptococcus Faecalis and β-hemolytic group A Streptococcus patients mostly reported lung complications. Conclusions Previous antibiotic treatments should not delay aggressive treatment in the intensive care setting. Early diagnostic suspicion, as well as appropriate and aggressive treatment provided within an intensive care setting are crucial for the clinical outcome.

scholarly journals Interpretable and Continuous Prediction of Acute Kidney Injury in the Intensive Care

2021 ◽  
Author(s):  
Iacopo Vagliano ◽  
Oleksandra Lvova ◽  
Martijn C. Schut
Keyword(s):  
Machine Learning ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Recurrent Neural Networks ◽  
Kidney Injury ◽  
Predictive Performance ◽  
Continuous Model ◽  
Machine Learning Model ◽  
Threatening Condition ◽  
Life Threatening

Acute kidney injury (AKI) is a common and potentially life-threatening condition, which often occurs in the intensive care unit. We propose a machine learning model based on recurrent neural networks to continuously predict AKI. We internally validated its predictive performance, both in terms of discrimination and calibration, and assessed its interpretability. Our model achieved good discrimination (AUC 0.80-0.94). Such a continuous model can support clinicians to promptly recognize and treat AKI patients and may improve their outcomes.

Perioperative calcium and vitamin D supplementation in patients undergoing thyroidectomy – literature review

2018 ◽  
Vol 90 (4) ◽  
pp. 34-38
Author(s):  
Anna Grzegory ◽  
Lech Pomorski
Keyword(s):  
Vitamin D ◽  
Clinical Practice ◽  
Literature Review ◽  
Perioperative Period ◽  
Vitamin D Supplementation ◽  
Economic Consequences ◽  
Postoperative Hypocalcemia ◽  
Everyday Clinical Practice ◽  
Symptomatic Hypocalcemia ◽  
Life Threatening

Sentence recommending the content of work: Due to the health and economic consequences of postoperative hypocalcemia, it is necessary to disseminate knowledge about non-invasive methods of limiting it that can be used in everyday clinical practice such as routine perioperative calcium and vitamin D supplementation. Abstract Introduction: Postoperative hypocalcemia is a narrow but significant problem for patients undergoing thyroid and parathyroid surgery. It is the most common complication after thyroidectomy. It is associated with transient or permanent hypoparathyroidism. It could potentially be life-threatening for patients and increases the costs of hospitalization. The aim of the study was to evaluate the results of studies that routinely administrated calcium and/ or vitamin D during the postoperative period. Materials and Methods: In this article, a literature review – 15 studies that used routine perioperative calcium (7 studies), vitamin D (2 studies) and calcium with vitamin D (11 studies) supplementation was performed. Supplementation effectiveness in prevention of postoperative hypocalcemia was compared to no prophylaxis in 10 studies. Five studies compared the effect of combined administration (calcium and vitamin D) to calcium alone. The number of works dealing with this problem is not particularly large. Results: Supplementation significantly decreased the rate of laboratory and symptomatic hypocalcemia. It was also effective in reducing the severity of symptoms. The combination calcium with vitamin D was the most effective strategy. No hypercalcemia or parathyroid hormone inhibition was observed in the supplemented groups. Routine supplementation was less expensive than performing laboratory tests in the course of treatment of hypocalcemia. Conclusions: The results of analyzed studies showed the clinical and economic advantage of routine perioperative prophylactic supplementation of vitamin D and/ or calcium as compared to no prophylaxis. However, the majority of studies showed a significant range of variability in patients’ characteristics. Numerous studies did not evaluated the preoperative 25-hydroxycholecalciferol level - a risk factor for postoperative hypocalcemia. Discussion: The use of routine prophylactic supplementation of calcium and vitamin D in the perioperative period can be useful in everyday clinical practice. Further research is needed to draw clear guidelines regarding prophylactic calcium and vitamin D therapy for patients after thyroidectomy.

Three case reports of the use of haemodiafiltration in the treatment of salicylate overdose

2001 ◽  
Vol 20 (9) ◽  
pp. 491-495 ◽  
Author(s):  
G Wrathall ◽  
R Sinclair ◽  
A Moore ◽  
D Pogson
Keyword(s):  
Intensive Care ◽  
Acetylsalicylic Acid ◽  
Care Setting ◽  
Case Reports ◽  
Intensive Care Setting ◽  
Small Reduction ◽  
First Case ◽  
Salicylate Poisoning ◽  
Life Threatening

Aspirin (acetylsalicylic acid) is widely available without prescription. Although self-poisoning is rare, if severe it may be life threatening. Haemodialysis has been recommended in severe cases when salicylate levels exceed 7.3 mmol l-1. We describe three cases of severe salicylate poisoning, which were treated with continuous veno-venous haemodiafiltration (CVVHDF). All patients survived. The first case had already undergone haemodialysis before transfer to the ICU, where CVVHDF was commenced because salicylism persisted at 3 mmol l-1. A small reduction in serum salicylate was noted. In the second case, serum salicylate decreased from 8.5 to 3.5 mmol l-1 after 3 h of CVVHDF even though only minimal urine was produced. Our third case is a chronic overdose in whom serum salicylate decreased from 6.2 to 4 mmol l-1 after 4 h and to 1.4 mmol l-1 after a further 7 h. No bicarbonate was administered to this patient and elimination can only be attributed to CVVHDF and urinary clearance, which is known to be slow. We discuss the pathogenesis of severe salicylate toxicity and postulate that CVVHDF, which is widely used in the intensive care setting, may be a useful therapy in severely poisoned patients who are unstable and cannot undergo haemodialysis or in situations where haemodialysis is unavailable.

scholarly journals Pola Bakteri dan Resistensi Antibiotik pada Pasien Sepsis di Intensive Care Unit (ICU) RSUD Arifin Achmad Provinsi Riau Periode 1 Januari – 31 Desember 2017

2019 ◽  
Vol 13 (2) ◽  
pp. 46
Author(s):  
Dicky Septian Wijaksana ◽  
Novita Anggraeni ◽  
Rita Endriani
Keyword(s):  
Intensive Care Unit ◽  
Antibiotic Resistance ◽  
Intensive Care ◽  
Pathogenic Bacteria ◽  
Sepsis Patient ◽  
Resistance Test ◽  
Antibiotics Resistance ◽  
Gender Culture ◽  
Threatening Condition ◽  
Life Threatening

Sepsis is life-threatening condition caused by bacteria. Sepsis patient usually treated in ICU with antibiotic as treatment.Irrationally antibiotic usage can lead to antibiotics resistance which increased morbidity and mortality This studyaimed to know the characteristic of sepsis patients, specimen identification, bacteria analysis, and antibiotic resistanceof sepsis patient in Intensive Care Unit (ICU). The source of data were from medical record including age, gender,culture specimen, bacteria culture test and result of antibiotic resistance test. Result showed that27 of samples, therewere 51,85% male and 48,15% female patient with most common age group was >65 years old (25,93%). Total amountof specimen that had pathogenic bacteria was 37, (67,57% sputum cultures and 18,92% blood cultures). 37 of samplesfound to be gram negative bacteria and highest number was A.baumanii (37,85%). Antibiotic resistance test showedthat sepsis-causing bacteria has highest resistance to ampicillin (100%) and most sensitive to amikacin (72,98%) andtigecyclin (51,36%).

scholarly journals Nurses’ Knowledge Regarding Food-Drug Interaction in the Intensive Care and Emergency Hospitals

2019 ◽  
Vol 4 (2) ◽  
pp. 61-68
Author(s):  
Samir Y Lafi ◽  
Aram Salih Mohammed Amin Kamali ◽  
Bayan Omar Sharif
Keyword(s):  
Intensive Care ◽  
Drug Interaction ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Ethical Point ◽  
Threatening Condition ◽  
Life Threatening ◽  
Level Of Knowledge ◽  
High Level ◽  
Nurses Knowledge

Usually supplement is essential and fundamental components for ensure and creating the human body, also drugs seem to survey the life of each individual and ensure the wellbeing for a long life aimed most of illness, but in case nourishment sedate interaction ignored since of information shortage almost it or any reason maybe lead to futile of medicine for the patients or cause life threatening condition because of that, one of the most significant ethical point in every health care setting in the world is patient's safety;  and  the care for patients must be improved in every country to prevent complication of interaction between food and drug. The main objective of this cross-sectional study has been conducted to assess the nurses' knowledge regarding food-drug interaction (FDI) at the intensive care in both of Shar and emergency hospitals in the Slemani city, the data were collected during the period of October up to the end of December. Non-probability, (purposive sample) of 78 nurses at both hospitals, a questionnaire was designed according to literatures and books regarding FDI which contained 25 items, 8 items for demographic characteristics, and 17 items concerning FDI. The validity of the questionnaire was given to a panel of 7 experts, a pilot study was carried out to check the reliability of the questionnaire which determined through the use of stability reliability (test-retest) approach which was estimated as r = 0.81.  The data were collected through the interviewing of the study sample and analyzed through the using of the Statistical Package for Social Sciences SPSS, version 23, and analyzed through the application of descriptive and inferential statistical analysis. The findings of the present study conclude that more than half of nurses had low knowledge and none of them had high level of knowledge, also there is no significant association between the levels of knowledge with age, gender, educational level, years of experience and working place. The study suggested extends the knowledge of nurses regarding the FDI, by training courses from clinical pharmacologists.

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