جستجوی مقالات مرتبط با کلیدواژه « shock » در نشریات گروه « پزشکی »

Although 1% to 2% of all pregnancies are ectopic, ectopic pregnancy (EP) is the most frequent obstetrical disease leading to maternal mortality and morbidity in the first trimester. The basic diagnostic method for EP is the human chorionic gonadotropin (HCG) test and transvaginal ultrasound. There are some rare EP cases with a negative HCG -beta test.

A 31-years-old woman was referred to the emergency department with hypogastric, periumbilical, right upper quadrant intermittent pain, vaginal bleeding, and prior history of EP 7-months ago that was treated with methotrexate and her intrauterine device had been removed at that time. Her last menstrual period was undetermined. Although the qualitative HCG- betatest was negative (2.08 IU /ml), the ultrasound examination showed an 43×53 mm echogenic, heterogenic complex solid mass in the left adnexa and a large amount of echogenic fluid demonstrating hemoperitoneum. Surgery because of the exceeded abdominal pain, revealed active bleeding in the left salpinx due to a ruptured EP.

Management of patients suspected of EP with a negative HCG-beta test is difficult. In these uncommon cases in an emergency, computed tomography, ultrasound and diagnostic laparoscopy or laparotomy can improve the prognosis of the patient.

Bleeding is a very rare complication of Fasciola species (F. hepatica or F. gigantica) infection. We present here three cases of subcapsular liver bleeding caused by the hepatic phase of Fasciola spp. infection in patients, two of whom were women, aged 22, 66, and 84 years in Diyarbakir Province, southeastern Turkey. They had symptoms of right upper quadrant pain (n = 3), nausea (n = 1), and vomiting (n = 2) for periods ranging from 6 hours to 15 days. All patients with clinical presentations ranging from moderate abdominal pain to hypovolemic shock and ischemic hepatitis were improved with supportive treatment without the need for surgery. They showed complete clinical and laboratory recovery after triclabendazole administration in their follow-up. In conclusion, Fasciola spp. infection should be considered in the etiology of bleeding from liver disease.

Aeromonas hydrophila has been identified as a causative agent of necrotizing fasciitis and myonecrosis, with most reported cases having a connection to aquatic-related trauma. Cases without such trauma history are rare in existing literature. Here, we present the case of a 56-year-old cirrhotic patient who lacked any prior aquatic-related trauma and arrived at the emergency department in a state of septic shock. The suspected route of entry was through necrotizing fasciitis and myonecrosis in his left forearm. Unfortunately, the patient succumbed to multi-organ failure and passed away within 12 hours of admission to the emergency department.

The adherence of the physicians to guidelines in resuscitation of the patientsis of great importance since it can predict the outcome. To evaluate the adherence of thephysicians of our center in hydration of traumatic patients with crystalloids regarding theAdvanced Trauma Life Support (ATLS) guidelines. We designed an algorithm obtained from ATLS guidelines using vital signsand status of bleeding of the traumatic patients to classify them. After categorizing thepatients according to the algorithm, we evaluated the adherence of the physicians to theguideline in hydration of traumatic patients with crystalloids. This is a cross-sectional study in which 998 traumatic patients who were admittedto the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients weremen (89.6%) and the most common causes of traumatic injuries were traffic accidents.Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess. The present study showed that the adherence of physicians in our centerin resuscitation with crystalloid was low. Also, most of the traumatic patients wereoverhydrated with crystalloids. It is suggested that physicians retrain concerning theside effects of over hydration. In addition, we need a user friendly and more applicableguideline for hydration with crystalloids

Decreased tissue perfusion predicts mortality in trauma patients, measured by serum lactic acid, but this isn’t possible in all centers. The reduction of Base Deficiency (BD) in trauma patients is mainly due to lactic acidosis. This variable was used to predict the need for surgery in trauma patients in the present study.

 In this study, 88 trauma patients were referred to the emergency department with a positive abdomen for surgery, free intra-abdominal fluid on fast ultrasound, an abdominal injury on a CT scan test, and candidates for surgery or non-operative management with all measures, were entered the study and their data were statistically analyzed.

Out of 88 participants, eight patients (9.1%) died, and 24 of them (27.3%) required surgical intervention. Mortality rate and hospitalization days increased with increasing BD, which was statistically significant (P = 0.001), but the increase in mortality rate and BD increase did not show a meaningful relationship. The area under the ROC curve for BD and the need for surgery was 0.769, indicating a good BD prediction for the need for surgery. The best BD cut-off point for predicting the need for surgery in patients was BD> 4.45 (sensitivity 79.2% and specificity 65.6%).

BD predicts the need for surgery and the length of hospital stay. Due to a low number of deaths in our study, it is suggested that studies be repeated with a larger statistical population to achieve higher accuracy in the assessments.

The aim of this study was to evaluate the effectiveness of a training program developed for shock for nurses in the intensive care unit (ICU).

The present study was performed on 200 nurses working in the ICUs of selected medical sciences hospitals in Mashhad (Imam Reza, Shariati, and Ghaem) in 2016, based on the Kern educational model. The instruments used in the study included a demographic information questionnaire, an observational checklist, and a researcher-made clinical reasoning skills questionnaire. In order to evaluate the training program developed after the pilot training, the results of clinical reasoning and shock management of participating nurses were reviewed. The difference between the mean scores of nurses was determined using the Wilcoxon test and t-test.

The results showed that the mean score of clinical reasoning for shock diagnosis skills in nurses in pre-test was equal to 1.591±0.287 and in post-test was equal to 1.889±0.136. Also, the average control skills of nurses in the pre-test were 3.158 ±0.752 and in the post-test was 4.151±0.762. In addition, the results of the Wilcoxon test and t-test showed that educational intervention had a positive and significant effect on both diagnosis and control scores of nurses (P=0.001).

The results of this study indicate the importance and positive effect of developing continuing education programs in the field of clinical reasoning skills (diagnosis and control) in order to monitor shock effectively.

Physiologic indexes for therapeutic assessment of shock were introduced long time ago. Recent studies have evaluated central venous pressure (CVP), central venous oxygen saturation (ScvO2), lactate and end-tidal carbon dioxide (ETCO2) levels in this regard. 

To understand the potential diagnostic capability of ETCO2 in comparison with ScvO2, CVP and lactate in patients with suspected septic shock, we aimed to compare these parameters through a quantitative resuscitation treatment approach. 

In this cross-sectional study, 84 patients with suspected septic shock were selected randomly. All patients underwent quantitative resuscitation treatment approach. The following parameters were measured and recorded at baseline: ETCO2, CVP, ScvO2, mean arterial pressure (MAP), percentage of arterial oxygen saturation (SatO2), blood lactate levels, heart rate (HR), respiratory rate (RR), and the exact amount of urine output. At the time of treatment, and 3 hours and 6 hours after, all of the tests and measurements were re-implemented and registered by an emergency medicine specialist. 

There was a significant positive correlation between ETCO2 and ScvO2 at all times (baseline: r=0.566, p<0.001; after 3 hours: r=0.409, p<0.001; after 6 hours: r=0.170, p>0.05). Furthermore, there was a significant inverse correlation between ETCO2 and lactate at all times (baseline: r= -0.538, after 3 hours: r= -0.677, after 6 hours: r= -0.799). There was no significant correlation between ETCO2 and CVP at any time (p>0.05). 

All parameters significantly changed over time, and the correlation between changes in ETCo2, ScvO2 and lactate clearance was significant.

Neonatal intensive care unit (NICU)Conventionally, Central Venous Pressure (CVP) monitoring has beenused by intensivists to measure intravascular volume. However, it is an invasive procedure resulting in many complications. Non-invasive ultrasonographic measurement of inferior vena cava collapsibility index (IVC-CI) is a promising alternative. Therefore, this study wasconducted to evaluate the correlation of central venous pressure with IVC-CIand establish the cut off valuesfor IVC-CI to diagnose and manage neonatal shock. The current research was a prospective longitudinal study.All sick neonates requiring intensive hemodynamic monitoring were enrolled in the study and umbilical vein catheterization was performedto measure CVP. IVC diameters and IVC-CI were measured using ultrasound. Based on CVP, the patients were classified into three categories: hypovolemic (CVP<5 cmH2O), euvolemic (CVP 5-8 cmH2O), and hypervolemic (CVP>8 cmH2O) and managed with intravenous fluid boluses and/or inotropes, accordingly. CVP and IVC-CI were again recorded after the intervention and compared with the previous values. A total of 76(62.3%) males and 46 (37.7%) females were included in the study with a mean age of 27.16±17.5 years. There was a strong negative correlation,which was statistically significant, between CVP and IVC-CI (r= -0.913, n=122, P<0.001). After luid resuscitation in the hypovolemic group, CVP improved from 2.31±0.92 to 5.88±1.79 cmH2O and IVC-CI changed from 62.39±6.005 to 33.02±2.64% which was statistically signi icant(P<0.001). After the administration of inotropes in the hypervolemic group, CVP dropped from 10.86±9.07 to 9.07±1.85cmH2O and IVC-CI changed from 11.27±4.71 to 24.3±13.3% which was again statistically signi icant(P<0.001). The receiver operator characteristic (ROC) curve analysis indicated that the IVC-CI cut-off of 55% predicted CVP <5 cmH2O with 87.9% sensitivity, 82% speci icity, 75.3%positive predictive value and 58.9% negative predictive value. IVC-CI cut-off of 20% predicted CVP >8 cmH2O with 91.1% sensitivity, 83.2% speci icity, 71.8% positive predictive value and 50.6% negative predictive value. The obtained results revealed an inverse correlation between CVP and IVC-CI, and it was concluded that IVC-CI can provide a useful guide in the diagnosis and management of shock in sick newborns.

Effects of ascorbic acid on hemodynamic parameters of septic shock were evaluated in nonsurgical critically ill patients in limited previous studies. In this study, the effect of high‑dose ascorbic acid on vasopressor drug requirement was evaluated in surgical critically ill patients with septic shock.

Patients with septic shock who required a vasopressor drug to maintain mean arterial pressure >65 mmHg were assigned to receive either 25 mg/kg intravenous ascorbic acid every 6 h or matching placebo for 72 h. Vasopressor dose and duration were considered as the primary outcomes. Duration of Intensive Care Unit (ICU) stay and 28‑day mortality has been defined as secondary outcomes.

During the study period, 28patients(14 in each group) completed the trial. Mean dose of norepinephrine during the study period (7.44 ± 3.65 vs. 13.79 ± 6.48 mcg/min, P=0.004) and duration of norepinephrine administration(49.64±25.67vs. 71.57±1.60h, P = 0.007) were significantly lower in the ascorbic acid than the placebo group. No statistically significant difference was detected between the groups regarding the length of ICU stay. However, 28‑day mortality was significantly lower in the ascorbic acid than the placebo group (14.28% vs. 64.28%, respectively; P = 0.009).

High‑dose ascorbic acid may be considered as an effective and safe adjuvant therapy in surgical critically ill patients with septic shock. The most effective dose of ascorbic acid and the best time for its administration should be determined in future studies.

 The changes before and after fluid resuscitation in patients with septic shock and their relationship with prognosis have rarely been reported.

 We aimed to observe the correlation between pulmonary vascular permeability index (PVPI), shock index (SI), and severity of septic shock.

 This case-control study retrospectively analyzed the clinical data of 154 patients with septic shock treated at our hospital (Weifang, China) from October 2016 to October 2018. They were divided into a survival group or a death group according to the 28-day prognosis. Univariate analysis was performed for vital signs, the acute physiology and chronic health evaluation II (APACHE-II) score, the sequential organ failure assessment (SOFA) score at admission, SI at admission (SI1), SI at 3 h after fluid resuscitation (SI2), PVPI at admission (PVPI1), PVPI at 3 h after fluid resuscitation (PVPI2), and lactate clearance rate (LCR). The correlations of PVPI and SI with the APACHE-II score, SOFA score, and LCR were analyzed by plotting the receiver operating characteristic curves.

 Among the 154 cases, 70 survived after 28 days and 84 died. We observed that SI1, SI2, PVPI1, PVPI2, APACHE-II score, and SOFA score were significantly lower in the survival group than in the death group, while LCR was significantly higher (P < 0.05). Also, SI1, SI2, PVPI1, and PVPI2 were positively correlated with APSCHE-II and SOFA scores of patients with septic shock, but negatively correlated with LCR (P < 0.05). Moreover, SI2 predicted the prognosis of patients with septic shock significantly better than SI1, PVPI1, and PVPI2 did. When SI2 was 1.22, the Youden index was 0.822, the sensitivity was 91.23%, the specificity was 89.47%, the positive predictive value was 0.912, and the negative predictive value was 0.924. The positive and negative likelihood ratios were 0.897 and 0.375, respectively.

 Based on the study, SI after fluid resuscitation was more valuable for evaluating the prognosis of patients with septic shock than SI at admission, as well as PVPI values at admission and after fluid resuscitation.

The aim of this study is to investigate the renoprotective effect of erythropoietin (EPO) on hypovolemic shock and ischemia/reperfusion (IR) injury on kidneys as end-organs in an experimentally-created ruptured abdominal aortic aneurysm (rAAA) model. Thirty anesthetized Sprague-Dawley male rats were randomized to sham ((Sh n:6) (Sh+EPO n:6)) or shock and I/R groups ((S/IR n:9) (S/IR+EPO n:9)). Additional surgical procedure except aortic exploration was not performed on Sh and Sh+EPO groups. 60 min of shock, 60 min of ischemia, and 120 min of reperfusion were applied on S/IR and S/IR+EPO groups. In the S/IR and S/IR+EPO groups, hemorrhagic shock, lower torso ischemia, and reperfusion were created. At the end of the shock period, saline solutions were separately and equally administered to Sh and S/IR groups, whereas 2000 U/kg EPO was intraperitoneally administered to Sh+EPO and S/IR+EPO groups. At the end of the experimental study, some biochemical and histological parameters were studied in serum and kidney tissues. Biochemical parameters were all significantly increased in the S/IR group compared with the Sh group. These parameters were not statistically significantly different between S/IR+EPO and Sh+EPO groups. In histopathologic examination, EPO prevented high-grade injury. Our data indicate that EPO may have a renoprotective effect and reduce the systemic inflammatory response that resulted from shock and I/R in an experimental model of rAAA.

Septic shock (SS) is a health priority in sub-Saharan Africa. However, there is a dearth of data in this regard. This study aimed to determine the epidemiology, therapeutic patterns, outcome, and challenges in managing SS in a tertiary intensive care unit (ICU) of sub-Saharan Africa. The hospital files of 36 consecutive patients admitted to the ICU of the Douala General Hospital (DGH), Cameroon over the year 2018 were reviewed for SS. SS was diagnosed based on Sepsis-3 definition. Demographic and clinical characteristics, treatment details, and outcomes of patients with SS were reviewed. Data was analyzed using the chi-square or Fisher exact tests and Bonferroni correction. SS accounted for 36 (9.4%) ICU admissions. The majority of patients were males (63.9%). The most common site of infection was the lungs. The mean age, average mean arterial pressure (MAP), and mean sequential organ failure assessment (SOFA) score of patients were 52.9±25.2 years, 52±18 mm Hg, and 9.2 ±2.3, respectively. Noradrenaline was the sole vasopressor used. Therapeutic challenges included the inability to have a specific antibiogram before a mean duration of 7 days. The mortality rate was 39% and associated with age ≤1 year, MAP ≤ 65 mm Hg, Glasgow Coma Score (GCS) ≤8, and mechanical ventilation, which were not attenuated after Bonferroni correction. SS is a frequent cause of ICU admission and is associated with a high mortality rate. SS mortality-related factors can be screened during SS management for more aggressive ICU management geared at preventing death.

Outcomes of patients undergoing damage control laparotomy (DCL) for abdominal gunshot wounds (GSWs) remains relatively unknown. The purpose of this study was to evaluate the impact of DCL on long term morbidity and survival.

This retrospective study was conducted on patients undergoing a damage control laparotomy for abdominal GSWs. The data were collected using 50 consecutive trauma patients over a 4.5-year-period between August 1st, 2004 and September 30th, 2009. The patients were classified regarding the characteristics, such as age, perioperative physiological parameters, trauma indices, number of abdominal GSWs, critical care unit stay, hospital length of stay, morbidity, and mortality. Univariate and multivariate logistic regression was employed to compute the odds of survival and estimate the unadjusted and adjusted association between these factors.

According to the results, the majority of the patients were male (96%) with a mean age of 29.7 years who had a single abdominal gunshot wound (60%). Liver injuries (58%) followed by small bowel (44%), majors venous (40%), and colonic (38%) trauma were observed in the patients. The overall mortality rate was obtained at 54%. The mean length of intensive care unit stay and mean hospital length of stay were 7 and 13 days, respectively. Factors associated with a decreased odds of survival included Penetrating Abdominal Trauma Index (PATI) > 25, intra-operative blood lactate level > 8 mmol/L, and massive transfusion >10 units packed red blood cells.

After controlling the confounding factors, a PATI score of > 25 was associated with a decreased odds of survival (OR: 0.20, P=0.04).

Different scoring systems based on clinical and laboratory findings are designed for prediction ofshort-term mortality of patients with severe sepsis and septic shock. This study aimed to compare the screeningperformance characteristics of PIRO, SOFA and MEDS Scores in predicting one-month mortality of sepsis pa-tients.

This diagnostic accuracy study was performed on septic shock and severe sepsis patients refer-ring to emergency department of Loghmane Hakim Hospital, Tehran, Iran, from 2017 to 2018. The performanceof MEDS, SOFA, and PIRO models in predicting 30-day mortality of patients was evaluated using discriminationand calibration indices.

200 patients with the mean age of 71.03±15.59 years were studied (61% male).During the 30 days, 66 patients died (mortality rate=33%). The area under the ROC curve of PIRO, MEDS, andSOFA scores were 0.83 (95% CI=0.78-0.89), 0.94 (95% CI=0.91-0.97) and 0.87 (95% CI=0.81-0.92), respectively.Based on Brier, BrierScaled and Nagelkerke’s R2of the models, the best performance in predicting one-monthmortality belonged to MEDS score. C-statistic showed that MEDS score had the highest value in the differentia-tion between the survived and non-survived cases.

This study showed that MEDS score performsbetter than PIRO and SOFA scores in predicting one-month mortality of patients with severe sepsis and septicshock.

To investigate the prognostic value of clinical and laboratory tests in prediction of outcome in patients at day 30 post presentation to hospital with shock and to determine the prognostic value of mid regional pro-adrenomedullin (MR-proADM) on mortality prediction at 30 days in the same patient cohort. This prospective multicenter cohort study analyzed data from patients who had presenting with shock to the emergency departments of eleven urban, tertiary-care University hospitals in Spain between March, 2011 and May, 2011. Recruitment of patients was via convenience sampling. Inclusion criteria included age between 14 and 100 years with clinical diagnostic criteria of shock on admission. Various patient parameters were analysed, such as age, sex, past medical history. Other clinical variables were measured on arrival to hospital, including sequential organ failure assessment score (score SOFA), blood pressure, oxygen saturations, capillary refill time and shock index (SI). Laboratory variables investigated included base excess, MR-proADM, lactate, C-Reactive Protein (CRP) and procalcitonin (PCT). There were 212 patients included in the study from the eleven hospitals involved. The mean age was 72.2 years old and 60.4% of the patients were men. In the discriminant analysis only age, MR-proADM and PCT remained in the final discriminant equation. The separate analysis of MR-proADM showed that, in the non-survivors group, MR-proADM levels are significantly higher than those found in the group of survivors (p<0.001). Age, PCT and MR-proADM were useful to predict short-term mortality in patients presenting to the emergency department shock. This suggests that PCT and MR-proADM in combination with the most common prediction models will improve prognostic value.

Prinzmetal’s angina occurs following spasms in a single or multiple vascular beds, resulting in a typical chest pain and an ST-segment elevation in electrocardiography (ECG). It can lead to life-threatening arrhythmias and sudden cardiac death. We describe a 37-year-old woman who was admitted with a typical chest pain and hypotension. Her initial ECG showed an ST-segment elevation in the inferior and precordial leads. She was transferred to the catheterization unit, where coronary angiography illustrated multivessel spasms. The spasms were relieved with a nitroglycerin injection. She was discharged with stable hemodynamics 7 days later, and at 1 month’s follow-up, no recurrent attack was detected.

Aluminium phosphide (Alp) poisoning mortality rate has been reported as high as 70-100%, and refractory hypotension and cardiogenic shock are the two most common presentations leading to death. Due to lack of specific antidote, all treatments are focused on supportive care and recently, intra-aortic balloon pump (IABP) has been suggested to treat cardiogenic shock resulting from toxic myocarditis. In the current paper, we introduce three Alp poisoned patients for whom IABP was applied to manage their refractory shock. Two men and one woman who were admitted to emergency department (ED) of Imam Reza academic Hospital, Mashhad, Iran due to intentional Alp poisoning are reported. The cases visited the ED shortly after ingestion and nearly all of them showed hypotension, tachycardia and metabolic acidosis during early hospitalization. Due to persistent shock state, despite receiving intravenous fluid therapy and vasopressor agents, IABP insertion was performed in these cases. Finally, one of them survived and the other two died. It still cannot be decided whether IABP insertion is effective in cases of Alp poisoning or not. It might be reasonable to try this intervention along with other conservative treatments in patients who survive more than 12 hours and consistently suffer from refractory hypotension.