David Sweet , Julian Marsden , Kendall Ho , Christina Krause , James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: British Columbia Medical Journal
Peter Galos, Michael Hultström, Angeliki Dimopoulou Creusen, Gösta Eggertsen, Jozef Urdzik, Magnus von Seth
INTRODUCTION AND IMPORTANCE: Hypertensive crisis may be a life-threatening condition to any patient and represents an even more serious condition in trauma patients following severe hemorrhage. CASE PRESENTATION: We present a case were surgical drape packing induced hypertensive crisis in a trauma patient, recently resuscitated from abdominal hemorrhage. CLINICAL DISCUSSION: We argue that direct compression of the kidney by the surgical drapes induced hypersecretion of renin with a mechanism equal to Page kidney...
April 7, 2021: International Journal of Surgery Case Reports
Malkhaz Mizandari, Tamta Azrumelashvili, Pedram Keshavarz, Nagy Habib
PURPOSE: To study the safety, efficacy, and long-term outcomes of percutaneous pancreatic duct drainage (PPDD) for treating pancreatic duct (PD) obstruction. MATERIALS AND METHODS: This prospective observational cohort study included 73 patients with PD obstruction between December 2010 and June 2020. Patients underwent PPDD under ultrasound and fluoroscopy guidance, computed tomography (CT) and fluoroscopy guidance, or CT guidance only. They were categorized into two groups: nonmalignant (26 patients with PD obstruction due to acute and chronic pancreatitis or postoperative stricture) and malignant (47 patients with pancreatic head and ampullary tumors)...
April 12, 2021: Journal of Vascular and Interventional Radiology: JVIR
Asel S Arykbaeva, Dorottya K de Vries, Jason B Doppenberg, Marten A Engelse, Thomas Hankemeier, Amy C Harms, Leonie G Wijermars, Alexander F Schaapherder, Jaap A Bakker, Rutger J Ploeg, Ian P J Alwayn, Jan H N Lindeman
Normothermic machine perfusion (NMP) is emerging as a novel preservation strategy. During NMP, the organ is maintained in a metabolically active state that may not only provide superior organ preservation, but which also facilitates viability testing prior to transplantation, and ex-situ resuscitation of marginal kidney grafts. While the prevailing perfusion protocols for renal NMP are refined from initial pioneering studies concerning short periods of NMP, it could be argued that these protocols are not optimally tailored to address the putatively compromised metabolic plasticity of marginal donor grafts (i...
April 12, 2021: Kidney International
Joseph Edwards, Hossam Abdou, Marta J Madurska, Neerav Patel, Michael J Richmond, David Poliner, Joseph M White, Todd E Rasmussen, Thomas M Scalea, Jonathan J Morrison
AIM: To evaluate the mean aortic-right atrial pressure (AoP-RAP) gradients and mean coronary perfusion pressures (CPPs) observed during open cardiac massage (OCM) versus those obtained with selective aortic arch perfusion (SAAP) in post-mortem hypovolemic swine. METHODS: Post-mortum, male swine, utilized in prior studies of hemorrhage, were included in the study. Animals were bled ∼ 25-50% of circulating volume prior to death. Animals either underwent clamshell thoracotomy and OCM immediately after death was confirmed (n = 6) or underwent SAAP within 5-15 minutes of death (n = 6)...
April 12, 2021: Resuscitation
David R Velez
The understanding and management of hemorrhagic shock have evolved significantly over the last 400 years. Injured patients in shock mandate immediate surgeon involvement. Every graduating surgical resident and every surgeon taking trauma call should thoroughly understand the concepts of damage control resuscitation and be prepared to care for these patients. This review seeks to revisit the history of hemorrhagic shock and the evolution of damage control resuscitation.
April 15, 2021: American Surgeon
Craig D Nowadly, Andrew D Fisher, Matthew A Borgman, Kennedy S Mdaki, Ronnie L Hill, Susannah E Nicholson, James A Bynum, Steven G Schauer
BACKGROUND: Evidence from military populations showed that resuscitation using whole blood (WB), as opposed to component therapies, may provide additional survival benefits to traumatically injured patients. However, there is a paucity of data available for the use of WB in uninjured patients requiring transfusion. We sought to describe the use of WB in non-trauma patients at Brooke Army Medical Center (BAMC). MATERIALS AND METHODS: Between January and December 2019, the BAMC ClinComp electronic medical record system was reviewed for all patients admitted to the hospital who received at least one unit of WB during this time period...
April 15, 2021: Military Medicine
Chrissy Liu, Miriam Andrusier, Michael Silver, Liat Applewhite, Camille A Clare
While data have shown that Black populations are disproportionately affected by COVID-19, few studies have evaluated birth outcomes in these understudied populations. This study hypothesized that SARS-CoV-2 infection would confer worse maternal and neonatal outcomes in a predominantly Black and underserved population in Brooklyn, New York City. In particular, SARS-CoV-2 is associated with higher rates of preterm birth, cesarean delivery, postpartum hemorrhage, lower APGAR scores, and neonatal resuscitation...
April 15, 2021: Journal of Community Health
Iil Dwi Lactona, Suryanto Suryanto
The COVID-19 pandemic has made it difficult to carry out face-to-face training activities in various higher institutions. This has led to a negative impact on the skills and abilities of nursing students in performing cardiopulmonary resuscitation (CPR) and the cessation of their clinical practice programs in hospitals. Therefore, the aim of this study is to determine the efficacy and knowledge of nursing students in performing CPR by implementing a blended learning program, through online learning platforms...
April 14, 2021: Journal of Public Health Research
Chienhsiu Huang, Jin-Cherng Chen
Background: Ninety-one intracranial hemorrhage prolonged mechanical ventilation patients were successfully weaned from the ventilator. No article had discussed the factors related to 1-year survival in successfully weaned prolonged mechanical ventilation patients with intracranial hemorrhage. This study aimed to evaluate the factors influencing the one-year survival of successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients. The identification of patients with a poor long-term prognosis could guide long-term care decisions after discharge in such patients...
2021: International Journal of General Medicine
Ryo Yamamoto, Masaru Suzuki, Jo Yoshizawa, Yusho Nishida, Junichi Sasaki
BACKGROUND: The benefits of physician-staffed emergency medical services (EMS) for trauma patients remain unclear due to conflicting results on survival. Some studies suggested potential delays in definitive hemostasis due to prolonged prehospital stay when physicians are dispatched to the scene. We examined hypotensive trauma patients who were transported by ambulance, with the hypothesis that physician-staffed ambulances would be associated with increased inhospital mortality, compared with EMS-personnel-staffed ambulances...
April 12, 2021: Journal of Trauma and Acute Care Surgery
Daniela Schmulevich, Pamela Z Cacchione, Sara Holland, Kristin Quinlan, Alyson Hinkle, Chris Meador, Benjamin S Abella, Jeremy W Cannon
BACKGROUND: Damage control resuscitation (DCR) improves trauma survival; however, consistent adherence to DCR principles through multiple phases of care has proven challenging. Clinical decision support may improve adherence to DCR principles. In this study we designed and evaluated a DCR decision support system using an iterative development and human factors testing approach. METHODS: The phases of analysis included initial needs assessment and prototype design (Phase 0), testing in a multi-dimensional simulation (Phase 1), and testing during initial clinical use (Phase 2)...
April 12, 2021: Journal of Trauma and Acute Care Surgery
Jan Bakker
PURPOSE OF REVIEW: Current goals of resuscitation in septic shock are mainly a fixed volume of fluids and vasopressors to correct hypotension and improve tissue perfusion indicated by decreasing lactate levels. RECENT FINDINGS: Abnormal peripheral perfusion by objective and subjective parameters are associated with increased mortality in various phases of the treatment of critically ill patients including patients with septic shock. Ongoing resuscitation in septic shock patients with normal peripheral perfusion is not associated with improved outcome, rather with increased mortality...
April 14, 2021: Current Opinion in Critical Care
S Kumar, A Kumar, M Dayal, V Prakash
Gastric lipomas are rare benign neoplasms of the stomach. These submucosal lesions and located mostly in the antral region of the stomach. Small lipomas are usually asymptomatic and are detected incidentally. When large, they may present with abdominal pain, gastrointestinal (GI) bleeding or gastric outlet obstruction. We hereby present a case of gastric lipoma in a 54-year-old man presenting with massive upper GI bleed and haemodynamic instability. The diagnosis was established with endoscopy and contrast-enhanced computed tomography of the abdomen...
April 14, 2021: Annals of the Royal College of Surgeons of England
Long Wang, Jingsheng Lou, Jiangbei Cao, Tao Wang, Jing Liu, Weidong Mi
Background: Fluid resuscitation is important for correcting hypovolemia. Isotonic crystalloids are the preferred solution for the initial clinical management of patients with multiple traumas. Bicarbonated Ringer's solution (BRS), offering physiological levels of bicarbonate ions and electrolyte ions, can be used for supplementing missing extracellular fluid and correcting metabolic acidosis. We here investigated the effects of BRS on the resuscitation of hemorrhagic shock models and compared the resuscitation performance of three crystalloids, including BRS, acetated Ringer's solution (ARS), and normal saline...
March 2021: Annals of Translational Medicine
Johanne Jahnsen, Alvaro González, Jorge Fabres, Alejandra Bahamondes, Alberto Estay
OBJECTIVE: To assess tidal volume (Vt) and minute ventilation (MV) during cardiopulmonary resuscitation (CPR) with two different chest compressions techniques: two-finger (TFT) or two-thumb technique (TTT) in a neonatal model. METHODS: Vt and MV were continuously measured during consecutive periods of resuscitation in an intubated manikin. Thirty participants performed the two compression techniques in a random order for 2-min periods while performing positive pressure ventilation using a T-piece resuscitator (TPR) or a self-inflating bag (SIB)...
April 13, 2021: Journal of Perinatology: Official Journal of the California Perinatal Association
Anup Katheria, Henry C Lee, Ronny Knol, Leigh Irvine, Sumesh Thomas
There is a large body of evidence demonstrating that delaying clamping of the umbilical cord provides benefits for term and preterm infants. These benefits include reductions in mortality in preterm infants and improved developmental scores at 4 years of age in term infants. However, non-breathing or non-vigorous infants at birth are excluded due to the perceived need for immediate resuscitation. Recent studies have demonstrated early physiological benefits in both human and animal models if resuscitation is performed with an intact cord, but this is still an active area of research...
April 13, 2021: Journal of Perinatology: Official Journal of the California Perinatal Association
Krishna Kishore Umapathi, Henry Schmidt, Natalia Salazar, Cyndi Sosnowski, Marylouise Kiyana Wilkerson, Latania K Logan
A male individual aged 18 years with no significant past medical history presented with fever, headache, dry cough, and chest pain. On clinical examination, he had tachycardia and hypotension needing intravenous fluid resuscitation and inotropic support. A chest radiograph revealed streaky lung opacities, and he was treated with antibiotics for suspected community-acquired pneumonia complicated by septic shock. Significant elevation of cardiac enzymes was noted, and there was a continued need for inotropes to maintain normotension...
April 13, 2021: Pediatrics
Peter Kingsley, Jonathan Merefield, Robert G Walker, Fred W Chapman, Mark Faulkner
A 3 month old boy, with no known health conditions, suffered a sudden collapse at home. On first EMS arrival, ventricular fibrillation (VF) cardiac arrest was identified and resuscitation following UK national guidelines was initiated. He remained in cardiac arrest for over 25 min, during which he received 10 defibrillation shocks, each effective, but with VF reoccurring within a few seconds of each of the first 9. A return of spontaneous circulation (ROSC) was achieved after the 10th shock. The resuscitation was conducted fully in his home, with the early involvement of Advanced Paramedic Practitioners specialising in critical care (APP- CC)...
April 13, 2021: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Frédéric Ehrler, Cyril Sahyoun, Sergio Manzano, Oliver Sanchez, Alain Gervaix, Christian Lovis, Delphine S Courvoisier, Laurence Lacroix, Johan N Siebert
BACKGROUND: Effective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR...
April 13, 2021: Trials
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