Critical Care Commons^™

Acute Thrombotic Thrombocytopenic Purpura: Rare And Life-Threatening Side Effect Of Recent Bnt-162b2 Covid-19 Vaccination, Jay Patel, Muhammad Umair Jahngir, Ahmad Abdulzahir, Ismael Rodriguez

HCA Healthcare Journal of Medicine

Thrombotic thrombocytopenic purpura (TTP) is a rare, potentially life-threatening disorder characterized by uncontrolled and spontaneous clot formation throughout the body. Known secondary causes of TTP include malignancy, bone marrow transplantation, pregnancy, various medications, and HIV infection. TTP in the setting of COVID-19 vaccination is rare and not well reported. Reported cases have been confined primarily to the AstraZeneca and Johnson and Johnson COVID-19 Vaccines. TTP in the setting of Pfizer BNT-162b2 vaccination has only recently been reported. We present a patient with no obvious risk factors for TTP who presented with acute altered mental status and was found to have …

Ratio Of Vascular Pedicle Width And Thoracic Diameter To Differentiate Cardiogenic And Non-Cardiogenic Pulmonary Edema, Rahmi Afifi, Achmad Fachri, Amir Sjarifuddin Madjid, Joedo Prihartono, Marcel Prasetyo, Andreas Christian

Makara Journal of Health Research

Background: Excess intravascular volume evaluation is essential in the intensive care unit (ICU); however, clinical information to differentiate cardiogenic and non-cardiogenic pulmonary edema has been proven ineffective. Thus, this study aimed to distinguish cardiogenic from non-cardiogenic pulmonary edema using the ratio of vascular pedicle width (VPW) to thoracic diameter (VPTR).

Methods: This cross-sectional study was conducted based on secondary data from chest radiographs of 100 patients with clinical symptoms of pulmonary edema in the ICU from January 2013 to December 2015. Cardiogenic and non-cardiogenic pulmonary edema were distinguished using VPW and cardiothoracic ratio measurements (CTR). VPTR was measured …

Nursing Considerations For Post-Traumatic Amnesia After A Traumatic Brain Injury, Hannah Grant

Senior Honors Theses

A period known as post-traumatic amnesia (PTA) often follows a traumatic brain injury (TBI). PTA is characterized by anterograde and retrograde amnesia, confusion, disorientation, and agitation. The duration and severity of PTA is a key indicator of the long-term prognosis after a TBI, so proper assessment and nursing care of a PTA patient is crucial. TBIs range from mild to severe, but primarily affect the fronto-temporal lobes. In PTA, both neural lesions and white matter damage within the parahippocampal region can cause PTA. A nurse must perform a thorough assessment of a TBI patient, but, since PTA is a key …

Why Is Epinephrine Not The Drug Of Choice In Cardiogenic Shock?, Esther Vorovich

Journal of Shock and Hemodynamics

Through the years, epinephrine has been the drug of choice for patients with cardiogenic shock. However, epinephrine was clinically inferior to norepinephrine in comparison studies because of the negative patient outcomes, which were statistically significant. These effects include type B lactic acidosis, tachycardia, increased myocardial oxygen demand, and arrhythmias.

Profound Vasoplegia After Coronary Artery Bypass Grafting, Subhasis Chatterjee

Journal of Shock and Hemodynamics

Vasoplegic shock after cardiac surgery is characterized by a high cardiac output, low systemic vascular resistance, refractory hypotension, and ongoing need for vasopressors. In this case, management considerations are discussed, including vasoactive medications and other adjuncts to sustain a satisfactory mean arterial pressure and improve outcomes.

Reperfusion Injury In Acute Myocardial Infarction Shock- Role Of Mechanical Circulatory Support Devices, Finn Gustafsson

Journal of Shock and Hemodynamics

The efficacy of mechanical circulatory support in acute myocardial infarction is dependent upon the size of the infarct. If applied early, mechanical support to reduce reperfusion injury appears to be effective in reducing infarct size in animal studies. The optimal timing of reperfusion is uncertain and requires further investigation. Efficient unloading appears to be essential in increasing the efficacy of the type of mechanical support and may favor one over another.

Racial Variations In Shock Presentation And Outcome, Steven Bailey

Journal of Shock and Hemodynamics

Working toward inclusive strategies for data sampling, trials, and triage is essential. Whatever the approach, it is important to do better than what has been done in the past when considering race and ethnicity in patient care. Although there may be limited publications with information on this topic, they have shown clear differences in patient outcomes with possible associations with gender, race, and ethnicity. It is critical to view the implications of this on socioeconomic status, access, resources, patient phenotypes, and patient desires and expectations. The disparities must first be recognized before any treatment options can be identified.

Hemodynamic Goals In Shock Management: Is There One Target For All?, Maya Guglin

Journal of Shock and Hemodynamics

The current guidelines for managing cardiogenic shock lack specificity and clarification. The main criterion for cardiogenic shock is low cardiac output, and the most important goal is to achieve adequate output from a shock state. Because of the complex nature of cardiogenic shock, a “one-size-fits-all" outline may not be the best solution. Historically, hemodynamic goals in cardiogenic shock are copied from septic shock. Because septic shock and cardiogenic shock are different hemodynamic entities, the goals should be different.

Hemodynamics And Kinetics Of Heart Failure With Preserved Ejection Fraction Shock, Yevgeniy Brailovsky, J. Eduardo Rame, Thierry Le Jemtel, Indranee Rajapreyar

Journal of Shock and Hemodynamics

The classical paradigm of cardiogenic shock is severe impairment of left ventricular, right ventricular, or biventricular contractility resulting in decreased cardiac output and end-organ failure. In patients with preserved ejection fraction, cardiogenic shock results from impaired left ventricular filling leading to decreased cardiac output and end-organ hypoperfusion. Heart failure with preserved ejection fraction (HFpEF) comprises a heterogenous group of myocardial and systemic metabolic derangements. Cardiogenic shock with preserved left ventricular ejection is thought to be less common than with reduced left ventricular ejection fraction, and therapeutic approaches are not well standardized. We aim to review the pathophysiology of cardiogenic shock …

Early And Progressive Mobility: A Program Implementation Strategy For High Acuity Patient Care Locations, Stefani Poland

Student Scholarly Projects

Despite an increase in the promotion of early progressive mobility, its decrease in hospital-acquired complications and improvement of patient outcomes, there remains a reluctance in staff commitment to daily evaluation and implementation. This is largely due to the fact nurses or other interprofessional staff are the primary individuals responsible for this change in process. A lack of confidence in staff to correctly identify patients that meet criteria and anxiety regarding the safe transfer or mobilization of patients, particularly in high acuity settings have been identified as major barriers. The PICOT question that guided this program development of a CBO toolkit …

Scai Shock: Does The Stage Help With Management Decisions?, Jacob C. Jentzer, David A. Baran

Journal of Shock and Hemodynamics

No abstract for an Editorial.

Future Perspectives In Acute Myocarditis Complicated By Cardiogenic Shock, Giovanni A. Tavecchia, Iside Cartella, Enrico Ammirati

Journal of Shock and Hemodynamics

Acute myocarditis is an inflammatory disease of the myocardium with a highly variable clinical course. Fulminant myocarditis (FM) represents the most threatening scenario with hemodynamic compromise and cardiogenic shock at presentation. Despite medical advances and the availability of promising mechanical circulatory support (MCS), FM is burdened by a dismal prognosis. Early referral to tertiary hospitals with MCS facilities and prompt diagnosis with endomyocardial biopsy are critical steps toward optimal management. Moreover, beyond supportive care, the prevention of irreversible myocardial damage with immunomodulating therapies must be proven in clinical trials. In this editorial, we briefly describe current evidence and future perspectives …

Surviving Sepsis Campaign: Strategies To Implement In Cardiogenic Shock Management, James Burke Md

Journal of Shock and Hemodynamics

The Surviving Sepsis Guidelines can serve as a structure to help educate and create a set of recommendations on how to care for patients through this complicated pathway of shock. Designing a cardiogenic shock bundle could reduce the variability of care and possibly improve survival. Also, a more standard protocol would allow a review of the outcomes and a system to change practice nationally when new data or technology becomes available. This could create a continuous quality improvement cycle. Creating a “Surviving Cardiogenic Shock” system could help provide awareness for recognition of cardiogenic shock and advanced management alternatives needed at …

Role Of Invasive Hemodynamics In Shock Management: Is A Pulmonary Artery Catheter Always Necessary?, Ajay J. Kirtane

Journal of Shock and Hemodynamics

The pulmonary artery (PA) catheter can be a useful tool in the management of patients with cardiogenic shock; however, there are challenges with the use of this catheter, and clinicians must balance the risks and benefits. In addition, clinicians must properly interpret data generated from a PA catheter in the context of other data to optimize a patient's hemodynamics.

An Evidence-Based Skin Management Improvement Project In The Intensive Care Unit, Chelsea Lannoo

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Use Of Agitation Scale Decision Scoring Grid To Improve Care Of Agitated/Anxious Patients In Dsu, Angelica Taneca, Carmyle Seville

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

A Methodological And Clinical Approach To Measured Energy Expenditure In The Critically Ill Pediatric Patient., Jaime Silva-Gburek, Paola Hong Zhu, Marwa Mansour, David Walding, Jorge A. Coss-Bu

Manuscripts, Articles, Book Chapters and Other Papers

The metabolic response to injury and stress is characterized initially by a decreased energy expenditure (Ebb phase) followed by an increased metabolic expenditure (Flow phase). Indirect calorimetry is a methodology utilized to measure energy expenditure and substrate utilization by measuring gas exchange in exhaled air and urinary nitrogen. The use of indirect calorimetry in critically ill patients requires precise equipment to obtain accurate measurements. The most recent guidelines suggested that measured energy expenditure by indirect calorimetry be used to determine energy requirements. This article reviews the methodological and clinical use of indirect calorimetry in critically ill pediatric patients.

Upper Gastrointestinal Bleeding During The Covid-19 Pandemic; Particularities Of Diagnosis And Therapy, Adrian Silaghi, Bogdan Severus Gaspar, Dragos Epistatu, Daniela Gabriela Bălan, Ioana Păunică, Anca Silvia Dumitriu, Stana Paunica, Bogdan Socea, Vlad Denis Constantin

Journal of Mind and Medical Sciences

SARS-COV 2 recently caused a global pandemic, with the first case being reported in Romania in February 2020. Important restrictive measures were imposed, so that the addressability of patients to medical services decreased. Upper gastrointestinal bleeding had more severe forms of evolution at the time of presentation, which required additional methods of diagnosis and treatment. This is a retrospective study performed on 268 patients, which aims to evaluate the type and effectiveness of different treatment methods for upper gastrointestinal bleeding during the COVID 19 pandemic. Severity assessment was performed by measuring the Rockall score and additional methods of diagnosis. The …

Fear Of Covid-19, Anxiety, Depression And Suicide Among Elderly Patients With Chronic Physical Or Mental Diseases, Vasiliki Holeva, Vasiliki Aliki Nikopoulou, Eleni Parlapani, Konstantinos Karkaletsis, Styliani Kokkoni, Dimitrios Nouvakis, Patroklos Theocharis, Ioannis Diakogiannis

Journal of Mind and Medical Sciences

Older age renders individuals vulnerable during public emergency crises. Considering that older adults are a highly heterogeneous and continuously growing demographic subgroup, this study aimed to assess the mental health impact of COVID-19 on two groups of older patients: a group of chronic physical disease and a group of chronic mental disease. A total of 102 patients completed the Fear of COVID-19 Scale, the Generalized Anxiety Disorder scale, the Brief Patient Health Questionnaire (PHQ-9) and several questions regarding demographic characteristics. Suicidality was assessed by the 9th item of the PHQ-9. According to the results, older chronic disease patients showed higher …

Factors Influencing The Use Of Postoperative Bilevel Positive Airway Pressure (Bipap) In Patients Undergoing Adult Cardiac Surgery: A Retrospective Cohort Study, Syed Shabbir Ahmed, Muhammad Saad Yousuf, Khalid Samad, Hameed Ullah, Khalid Maudood Siddiqui

Department of Anaesthesia

Background and aims: Respiratory complications are one of the biggest challenges following cardiac surgery, which can lead to hypoxia and acute respiratory failure (ARF). The aim of this study to identify the factors led to BiPAP application for postoperative respiratory complications and its effectiveness as the main outcome measures after cardiac surgery.
Methods: It was a retrospective cohort study with consecutive sampling technique. A total of 335 postcardiac surgery patients medical record was reviewed who were underwent for surgery from November 1, 2018 to November 30, 2019. 265 patients were finalized for the recruitment, five patients were excluded before the …