We invite you to join our discussion groups and engage with other professionals on the latest critical care trials and advancements. Stay up to date on healthcare breakthroughs, trends, and reviews in the world of critical care; become a part of our collaborative community today!
65 year-old male with acute respiratory failure secondary to pulmonary edema who was intubated and placed on mechanical ventilation. His course was complicated with left parietal occipital and temporal infarction. The following graphs have been observed;
Please identify the abnormality and answer the following question:
This patient-ventilator asynchrony is caused by:
Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning
Would you intubate a 37 years old who presented with acute alcohol intoxication and GCS of 7 but adequate oxygenation and ventilation?
Research Question:
What is the effect of withholding intubation compared to routine practice on clinical outcomes in comatose patients with acute poisoning and a Glasgow Coma Scale score of less than 9?
What is the impact of conservative oxygenation targets (SpO2 88–92%) compared to liberal oxygenation targets (SpO2 >94%) on the duration of organ support or incidence of death within 30 days in critically ill children admitted to pediatric intensive care units and requiring invasive ventilation and supplemental oxygen?
Population: Critically ill children admitted as emergencies to PICUs, aged between 38 weeks corrected gestational age and under 16 years, requiring invasive ventilation and supplemental oxygen. The study included 1872 children out of 2040 randomized, with a near-equal distribution of genders in both groups.
65 years old with submasdive pulmonary embolism, DVT, atrial flutter, and non-ischemic cardiomyopathy. Intubated and placed on mechanical ventilation at night (A/C mode VT 500, Flow of 50, RR 22 and PEEP 5). The following was observed during the morning round:
Based on the pressure over time waveform, how would you approach this case?
What would you do next?
You can vote for more than one answer.
Hyponatremia, characterized by low plasma sodium concentration (pNa), is the most prevalent electrolyte disorder in hospitalized patients, affecting about 15%. While the majority of cases are mild, with pNa levels at or above 130 mmol/L, about 4% of patients experience severe hyponatremia with pNa dropping below 130 mmol/L. The leading cause of this significant drop in pNa is the Syndrome of Inappropriate Antidiuresis (SIAD), which occurs due to an excessive release of arginine vasopressin (AVP) despite low serum tonicity. In cases of severe symptomatic hyponatremia, which may present with symptoms like vomiting, seizures, and a reduced conscious state, it is considered a medical emergency. Immediate treatment with a bolus of hypertonic saline, specifically 100 mL of 3% NaCl for up to three doses, is recommended to increase pNa by 4 to 6 mmol/L, aiming to reduce intracranial pressure (ICP).
For chronic or uncertain-duration hyponatremia, to prevent osmotic demyelination syndrome (ODS),…
Please notice the volume over time scalar as indicated by the light orange arrow and provide your feedback:
@Everyone
Please select your answer and you may provide your explanation in the comment section.
The noticed abnormality is caused by:
This is a good review article of GBS, and I thought it would of interest to you to share. @Everyone
https://www.frontiersin.org/articles/10.3389/fphar.2021.608130/full
Pharmacological therapeutic targets of GBS. The hyperreactive cellular and/or humoral immune responses in GBS are the main targets of current pharmacological interventions. IVIg can inhibit the production of pathogenic antibodies and pro-inflammatory mediators released by T helper cells and activated B cells via functioning on Tregs. IVIg also promotes the dimerization of antiganglioside antibodies and inhibits APCs to alleviate immune responses. PE mainly replaces plasm rich in antiganglioside antibodies and pro-inflammatory mediators with fresh frozen plasma/albumin. Eculizumab, nafamostat mesilate, and rEV576 are complement inhibitors that can prevent MAC formation. IFN-β attenuates inflammation induced by cytokines and chemokines. Cysteine protease degrades pathogenic antibodies and mitigates hyperreactive immune responses. Abbreviations: APC, antigen-presenting cell; C. jejuni, Campylobacter jejuni; GBS, Guillain–Barré syndrome; IFN-β, interferon β; IL, interleukin; IVIg, intravenous immunoglobulin; LOS, lipo-oligosaccharide; MAC,…
In Disseminated Intravascular Coagulation (DIC), patients may present with both necrotic and hemorrhagic skin lesions, reflecting the complex and severe nature of this condition. The necrotic lesions arise from widespread microthrombi formation in small blood vessels, leading to impaired blood flow and subsequent tissue death, manifesting as purplish, black, or red patches on the skin. Concurrently, hemorrhagic lesions occur due to the significant depletion of platelets and clotting factors, a result of the excessive clotting process, leading to spontaneous bleeding under the skin. These may appear as petechiae, purpura, or ecchymoses, scattered across various parts of the body.
@Everyone
https://www.annemergmed.com/article/S0196-0644(23)01281-7/fulltext
This study aimed to evaluate the effectiveness of tranexamic acid (TXA) in reducing mortality in emergency trauma cases. A systematic review and meta-analysis of randomized controlled trials were conducted, focusing on TXA's impact compared to a placebo. The main outcome was 1-month mortality. Seven trials met the criteria, and the results showed an 11% decrease in death risk at 1 month with TXA use. There was also a reduction in 24-hour mortality, and no significant increase in vascular occlusive events was observed.
