scholarly journals A History of Fluid Management—From “One Size Fits All” to an Individualized Fluid Therapy in Burn Resuscitation

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 187
Author(s):  
Dorothee Boehm ◽  
Henrik Menke
Keyword(s):  
Fluid Therapy ◽  
Point Of Care ◽  
Fluid Management ◽  
Point Of Care Ultrasound ◽  
Burn Patients ◽  
Starting Point ◽  
History Of ◽  
Definition Of ◽  
Historical Developments ◽  
Burn Resuscitation

Fluid management is a cornerstone in the treatment of burns and, thus, many different formulas were tested for their ability to match the fluid requirements for an adequate resuscitation. Thereof, the Parkland-Baxter formula, first introduced in 1968, is still widely used since then. Though using nearly the same formula to start off, the definition of normovolemia and how to determine the volume status of burn patients has changed dramatically over years. In first instance, the invention of the transpulmonary thermodilution (TTD) enabled an early goal directed fluid therapy with acceptable invasiveness. Furthermore, the introduction of point of care ultrasound (POCUS) has triggered more individualized schemes of fluid therapy. This article explores the historical developments in the field of burn resuscitation, presenting different options to determine the fluid requirements without missing the red flags for hyper- or hypovolemia. Furthermore, the increasing rate of co-morbidities in burn patients calls for a more sophisticated fluid management adjusting the fluid therapy to the actual necessities very closely. Therefore, formulas might be used as a starting point, but further fluid therapy should be adjusted to the actual need of every single patient. Taking the developments in the field of individualized therapies in intensive care in general into account, fluid management in burn resuscitation will also be individualized in the near future.

scholarly journals TOWARDS A PANEVOLUTIONARY THEORY (PANEVO THEORY), FOLLOWING THE ACADEMIC OF FISIOCRITICI ENZO TIEZZI

2017 ◽  
Vol 8 (1-IT) ◽  
Author(s):  
Mario Tanga ◽  
Giacomo Gelati ◽  
Marco Casazza
Keyword(s):  
Charles Darwin ◽  
Current Knowledge ◽  
Close Contact ◽  
Rachel Carson ◽  
Starting Point ◽  
Science And Culture ◽  
History Of ◽  
Living Species ◽  
Definition Of ◽  
Scientific Fields

6Contemporary science and culture show more and more extended and meaningful signs about the increasing explaining power of evolutionary paradigm. This power overcomes the field of the history of living species. We consider “On the Origin of Species” of 1859 by Charles Darwin as the establishment of this paradigm, but this original and fruitful idea has received the several and different contributions from near and (seemingly) far scientific fields. This process happened according distinguishable waves and leaded the evolutionary theory very far from its starting point, making it something wider and different. The current knowledge of this theory involves many kinds of scholars: biologists, zoologists, botanists, development biologists, genetics/genomics scholars and also scholars of many other disciplines, as statistics, mathematics, ecology, environmental sciences, physics, chemistry, linguistics, sociology, neuro-sciences, epidemiology, informatics, immunology. During the end of XX Century, the study of complexity, of self-organization and of emerging properties has been a decisive factor to extend evolution until beyond the boundaries of Biology. These phenomena, or properties, or features, that are shown by “living” and “not-living” systems (so called basing ourselves on traditional definitions), have deeply modified even the “properly” biologic evolution itself and besides this has demonstrated that, mutatis mutandis, evolutionary processes or phenomena happen also out of biologic dominion, referring “biologic” to “wet-ware world”. This is to say the class of evolutionary phenomena is more widely and more inclusively extended than our opinion. We can mean this as a revolution (according to Kuhn’s definition) that imposes us to restructure the definition of evolution itself and even to redraw the boundaries and the map of Biology itself. Aiming to establish a name of this field of study we propose “PanEvolutionary Theory” (PanEvo Theory). No doubt Prigogine offered an important contribution to this area. The thinking and the work of Enzo Tiezzi can be placed seen in the same perspective. Disregarding direct connections and contacts with the Nobel Prize Prigogine, however the studies of Enzo Tiezzi are neither a fully unexpected work nor a theory lacking of important potentialities: it is not a strange or eccentric academic exercise. Except the close contact and the dense exchanges with Prigogine, we collocate Enzo Tiezzi in the same context of Gregory Chaitin, of Rachel Carson, of John Harte and Robert H. Socolow, of James Paul Wesley, of Sertorio, of Oort and Peixoto, just to cite the most strictly related. Our Academy had the privilege and the honor of having Enzo Tiezzi in its ranks. We think that merits and developments of the thinking of this scholar have to produce important and lasting fruits in the future.

scholarly journals Stillbirth in Canada: anachronistic definition and registration processes impede public health surveillance and clinical care

2021 ◽  
Author(s):  
K.S. Joseph ◽  
Lily Lee ◽  
Laura Arbour ◽  
Nathalie Auger ◽  
Elizabeth K. Darling ◽  
...  
Keyword(s):  
Public Health ◽  
Public Health Surveillance ◽  
Fetal Death ◽  
Clinical Care ◽  
Induced Abortion ◽  
Death Registration ◽  
Starting Point ◽  
Induced Abortions ◽  
History Of ◽  
Definition Of

AbstractThe archaic definition and registration processes for stillbirth currently prevalent in Canada impede both clinical care and public health. The situation is fraught because of definitional problems related to the inclusion of induced abortions at ≥20 weeks’ gestation as stillbirths: widespread uptake of prenatal diagnosis and induced abortion for serious congenital anomalies has resulted in an artefactual temporal increase in stillbirth rates in Canada and placed the country in an unfavourable position in international (stillbirth) rankings. Other problems with the Canadian stillbirth definition and registration processes extend to the inclusion of fetal reductions (for multi-fetal pregnancy) as stillbirths, and the use of inconsistent viability criteria for reporting stillbirth. This paper reviews the history of stillbirth registration in Canada, provides a rationale for updating the definition of fetal death and recommends a new definition and improved processes for fetal death registration. The recommendations proposed are intended to serve as a starting point for reformulating issues related to stillbirth, with the hope that building a consensus regarding a definition and registration procedures will facilitate clinical care and public health.

scholarly journals Fluid Therapy in Pulmonary Disease: How Careful Do We Need to Be?

2021 ◽  
Vol 8 ◽  
Author(s):  
Sophie Adamantos
Keyword(s):  
Fluid Therapy ◽  
Fluid Overload ◽  
Point Of Care ◽  
Pulmonary Complications ◽  
Point Of Care Ultrasound ◽  
Protective Mechanisms ◽  
Non Invasive ◽  
Life Saving ◽  
Severe Hemorrhage ◽  
Healthy Dogs

Intravenous fluid therapy is a vital and life-saving therapeutic in veterinary medicine. In the absence of heart or lung disease, trauma or sepsis there is limited evidence that fluid therapy will have a detrimental effect on lung function. In healthy dogs there is a reasonable level of experimental evidence that supraphysiologic rates of fluid are required before signs of fluid overload are made evident. In cats, however, this may not be the case. There are higher rates of asymptomatic myocardial disease, but even in the absence of that it seems that some cats may be susceptible to fluid overload. Where systemic inflammation already exists the careful homeostatic and protective mechanisms within the lung are deranged and increases in hydrostatic pressure are more likely to result in fluid movement into the lung tissues. Strategies including restricting the use of intravenous crystalloid fluid administration and using blood products for management of severe hemorrhage are of increasing importance in human trauma and seem to be associated with fewer pulmonary complications, and lower mortality. Managing dogs and cats with sepsis and acute respiratory distress syndrome is already challenging, but ensuring adequate vascular expansion needs to be balanced with avoiding excessive volume administration which may negatively impact pulmonary function. While fluids remain crucial to management of these conditions, there will be an ongoing requirement to balance need without providing excess. The use of point of care ultrasound may provide clinicians with a non-invasive and accessible way to do this.

scholarly journals On “The dictionary of active Polish and Ukrainian phraseology” [Leksykon aktywnej frazeologii polskiej i ukraińskiej]. Contrastive linguistics and culture

2017 ◽  
Author(s):  
Wojciech Paweł Sosnowski ◽  
Roman Tymoshuk
Keyword(s):  
Cultural Context ◽  
New Method ◽  
Starting Point ◽  
History Of ◽  
Contrastive Linguistics ◽  
Primary Focus ◽  
Definition Of

On The dictionary of active Polish and Ukrainian phraseology [Leksykon aktywnej frazeologii polskiej i ukraińskiej]. Contrastive linguistics and cultureThe Dictionary of Active Polish and Ukrainian Phraseology [Leksykon aktywnej frazeologii polskiej i ukraińskiej] is the first publication of its kind in the history of Polish and Ukrainian lexicography. It consists of equivalent phrasal units in Polish and Ukrainian. The innovative aspect of the lexicon is that it uses a semantic metalanguage to establish equivalent units. The authors developed a new method of searching for equivalent units which uses the meaning — not the form — as the starting point. This method enables the identification of equivalent units in both languages. Moreover, it enables the identification of units that do not have equivalents. The units which lack equivalents are usually deeply rooted in Poland’s or Ukraine’s historical and cultural context, and are thus defined as culturemes. Even though they lack equivalents, it was decided not to exclude them from the Leksykon’s structure, as they are actively used by the speakers of Polish and Ukrainian. This paper provides an overview of the Leksykon’s methodology and presents the authors’ definition of phraseologism. The most important points in the paper are illustrated with a number of example entries from the dictionary. The primary focus of the paper rests on phrasal units which lack equivalents. O Leksykonie aktywnej frazeologii polskiej i ukraińskiej. Konfrontacja językowa a kulturaOpracowywany przez nas Leksykon aktywnej frazeologii polskiej i ukraińskiej jest pierwszym dziełem tego typu w historii leksykografii polskiej i ukraińskiej. W leksykonie prezentujemy odpowiedniości jednostek frazeologicznych w języku polskim i ukraińskim za pomocą semantycznego języka pośrednika. Wyznaczenie kierunku od znaczenia ku formie pozwoliło dobrać ekwiwalenty jednostek frazeologicznych w obu językach. Zestawienie polskiego i ukraińskiego materiału pozwoliło również wyodrębnić poszczególne jednostki nieposiadające odpowiedników. Jednostki te są ściśle związane z kulturą i historią narodu polskiego i ukraińskiego. W związku z tym zaliczamy je do kulturemów, ale nie pomijamy w strukturze leksykonu ze względu na ich aktywność w mówionym języku współczesnym. W niniejszym artykule prezentujemy metodologię zastosowaną w leksykonie, definicję roboczą frazeologizmu w leksykonie, przykładowe hasła oraz skupiamy się na pokazaniu jednostek frazeologicznych nieposiadających pełnej odpowiedniości.

scholarly journals Point-of-care Ultrasound in the Diagnosis of Calciphylaxis

2020 ◽  
Vol 4 (3) ◽  
pp. 495-496
Author(s):  
Natasha Tobarran ◽  
Mark Collin
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Computed Tomography Imaging ◽  
Case Presentation ◽  
Tomography Imaging ◽  
History Of ◽  
Calcium Deposits ◽  
Stage Renal Disease ◽  
End Stage

Case Presentation: A 63-year-old male with a past medical history of end stage renal disease presented to the emergency department with painful, lower-extremity necrotic ulcerations. Ultrasound and computed tomography imaging showed concerns for calcium deposits. Biopsy confirmed the diagnosis of calciphylaxis, a rare lethal disease. Discussion: Emergency physicians should keep this disease on their differential due to the high mortality rate.

scholarly journals A Case Report on Paget-Schroetter Syndrome Presenting as Acute Localized Rhabdomyolysis

2020 ◽  
Vol 4 (3) ◽  
pp. 358-361
Author(s):  
Jonathan Lee ◽  
Ami Kurzweil ◽  
Shadi Lahham
Keyword(s):  
Case Report ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Axillary Vein ◽  
Vein Thrombosis ◽  
Chiari Type 1 Malformation ◽  
Arm Swelling ◽  
History Of ◽  
Vein Stenosis ◽  
Deep Vein

Introduction: The life- or limb-threatening differential diagnosis for upper extremity swelling can include deep vein thrombosis (DVT), infectious processes, and compartment syndrome. Chronic anatomic abnormalities such as axillary vein stenosis are rarely a consideration in the emergency department. Case Report: We present a 26-year-old female with history of Chiari type 1 malformation who presented with acute left arm swelling. Initial workup, including point-of-care ultrasound, revealed the presence of significant soft tissue swelling without evidence of DVT. Conclusion: Further workup revealed an early, localized rhabdomyolysis secondary to axillary vein stenosis or venous thoracic outlet syndrome, also known as Paget-Schroetter syndrome.

Case Report: Early signs of tamponade may be detected by cardiac point-of-care ultrasound

POCUS Journal ◽  
2017 ◽  
Vol 2 (3) ◽  
pp. 24-25 ◽  
Author(s):  
Michael Cenkowski, MD ◽  
Amer M. Johri, MD ◽  
Raveen Pal, MD ◽  
Jennifer Hutchison, RDCS
Keyword(s):  
Blood Pressure ◽  
End Stage Renal Disease ◽  
Point Of Care ◽  
Vital Signs ◽  
Point Of Care Ultrasound ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

A 35-year-old male with a past medical history of end stage renal disease on hemodialysis and a chronic pericardial effusion secondary to dialysis presented to the Emergency Room (ER) with a 2-week history of a flu-like illness and pleuritic chest pain. He was compliant with dialysis three times per week. His blood pressure was 150/85 mmHg with a heart rate of 85 beats per minute and the remainder of his vital signs were stable. Pulsus paradoxus was not present.

Management of the Patient with Thermal Injuries

2016 ◽  
Author(s):  
Michael J. Mosier ◽  
Nicole S. Gibran
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Fluid Management ◽  
Clinical Manifestations ◽  
Injured Patient ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Burn Care ◽  
Burn Resuscitation ◽  
Burn Patient

Optimal care of the burn patient requires not only specialized equipment but also, more importantly, a team of dedicated surgeons, nurses, therapists, nutritionists, pharmacists, social workers, psychologists, and operating room staff. Burn care was one of the first specialties to adopt a multidisciplinary approach, and over the past 30 years, burn centers have decreased burn mortality by coordinating prehospital patient management, resuscitation methods, and surgical and critical care of patients with major burns. This review covers where to treat burn patients, fluid management, airway management, temperature regulation, airway control, nutrition, anemia, pain management, deep vein thrombosis prophylaxis, and putting it all together: an algorithmic approach to early care of the burn-injured patient. Figures show that the size of a burn can be estimated by means of the Rule of Nines, which assigns percentages of total body surface to the head, the extremities, and the front and back of the torso, the approach to the burn patient in the first 24 hours, and the approach to the burn patient during the second to fifth days after burn injury. Tables list American Burn Association criteria for burn injuries that warrant referral to a burn unit, criteria for outpatient management of burn patients, acute physiologic changes during burn resuscitation, acute biochemical and hematologic changes during burn resuscitation, measures of pulmonary function, mechanisms of pulmonary dysfunction and indications for mechanical ventilation, clinical manifestations of carbon monoxide poisoning, half-life of carbon monoxide–hemoglobin bonds with inhalation therapy, increased acute kidney injury in patients treated with hydroxocobalamin for suspected inhalation injury, clinical findings associated with specific inhaled products of combustion, bronchoscopic criteria used to grade inhalation injury, and formulas for estimating caloric needs in burn patients. This review contains 3 highly rendered figures, 12 tables, and 134 references

Theoretical and Empirical Background to the eBook

2017 ◽  
pp. 150-172
Author(s):  
Azza A Abubaker ◽  
Joan Lu
Keyword(s):  
Young People ◽  
Education Level ◽  
The Other ◽  
The Internet ◽  
Sentence Structure ◽  
Starting Point ◽  
History Of ◽  
Use Of The Internet ◽  
Definition Of ◽  
Textual Content

A textbook in any e-educational system is an important element that requires a closer look at its components and structure, as well as identifying the barriers that affect the level of learning. This can be achieved in different aspects such as the analysis of textual content or sentence structure which is one of the concerns of linguists. On the other hand, examining the textual content can determine the appropriateness of the education level for students. This type of assessment is part of educators' concerns and by examining and defining the factors that could affect reading a text on screen, this is usually related to the way of displaying text such as font size, colour, background colour, amount of text and the location of the text on the screen. This is a key focus of this research. In this chapter, the concern will be to define the concepts and the structure of an e- document as a starting point to investigate the usability of e-texts as it covers the following: definition of e-document; history of eBook; structure of e-textbook; contribution of e-textbook for education; comparison between reading electronic and paper book; young people and the use of the internet and computer; statistical data for using the internet in Arabic countries; designing an e-textbook.

Utilization and Efficacy of Resuscitation Endpoints in Trauma and Burn Patients: A Review Article

2021 ◽  
pp. 000313482110604
Author(s):  
Miguel Belaunzaran ◽  
Shahm Raslan ◽  
Aleeza Ali ◽  
Kevin Newsome ◽  
Mark McKenney ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Guideline Development ◽  
Point Of Care ◽  
Strong Ion Difference ◽  
Point Of Care Ultrasound ◽  
Burn Patients ◽  
Multiple Endpoints ◽  
Compensatory Reserve ◽  
Improve Patient

Shock is a sequelae in trauma and burn patients that substantially increases the risk for morbidity and mortality. The use of resuscitation endpoints allows for improved management of these patients, with the potential to prevent further morbidity/mortality. We conducted a review of the current literature on the efficacy of hemodynamic, metabolic, and regional resuscitation endpoints for use in trauma and burn patients. Hemodynamic endpoints included mean arterial pressure (MAP), heart rate (HR), urinary output (UO), compensatory reserve index (CRI), intrathoracic blood volume, and stroke volume variation (SVV). Metabolic endpoints measure cellular responses to decreased oxygen delivery and include serum lactic acid (LA), base deficit (BD), bicarbonate, anion gap, apparent strong ion difference, and serum pH. Mean arterial pressure, HR, UO, and LA are the most established markers of trauma and burn resuscitation. The evidence suggests LA is a superior metabolic endpoint marker. Newer resuscitation endpoint technologies such as point-of-care ultrasound (PoCUS), thromboelastography (TEG), and rotational thromboelastometry (ROTEM) may improve patient outcomes; however, additional research is needed to establish the efficacy in trauma and burn patients. The endpoints discussed have situational strengths and weaknesses and no single universal resuscitation endpoint has yet emerged. This review may increase knowledge and aid in guideline development. We recommend clinicians continue to integrate multiple endpoints with emphasis on MAP, HR, UO, LA, and BD. Future investigation should aim to standardize endpoints for each clinical presentation. The search for universal and novel resuscitation parameters in trauma and burns should also continue.

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