Spend any time in the NeuroICU and you will encounter an abundance of ADH.
Search Results for: septic shock
CONTENTS Rapid Reference Preamble: what this chapter is about Clinical presentation Coinfection Bacterial coinfection Aspergillus coinfection Diagnostic panel Treatment Resuscitation Antibiotics Anti-viral therapy Respiratory support Adjunctive therapy Virus-associated hemophagocytic syndrome (VAHS) Approach to treatment failure Extrapulmonary complications Virology of influenza Podcast Questions & Discussions Pitfalls severe influenza checklist ✅ diagnostic tests (more) COVID PCR. Nares […]
CONTENTS Rapid Reference 🚀 Diagnosis of ARDS Definition of ARDS Cardiogenic pulmonary edema vs. ARDS Why is the patient in ARDS? Common causes of ARDS Evaluating the cause of ARDS ARDS pathophysiology: Intrapulmonary shunting Treatment: Basics Treating the cause of ARDS Steroid Conservative fluid strategy Treatment: Non-intubated patient High-flow nasal cannula & CPAP/BiPAP Awake proning […]
CONTENTS Rapid Reference 🚀 Preamble Diagnosis & risk stratification Is PE driving the patient’s instability? Risk stratification – primary factors General schema for stratification Prognostic factors which don’t add much Risk stratification & lysis without a CT scan Physiology of the PE death spiral Resuscitation Avoid procedures if possible Fluid management Inotropes & vasopressors Inhaled […]
CONTENTS Rapid Reference 🚀 Caveat: Lack of evidentiary support Background RV failure & pulmonary hypertension: Relationships & definitions Pathophysiology of RV failure Causes of pulmonary hypertension Diagnosis Diagnosis of RV failure Echocardiography Pulmonary artery catheterization Treatment 1st Tier: Core treatments for all RV failure patients: Correct any precipitating factors Optimize the lungs Volume management Establish […]
The case: A ~65 year-old human presents to the ICU with a working diagnosis of vasopressor-dependent septic shock. The patient was previously healthy with no significant medical problems or medications. History is notable for mild nonspecific symptoms (chills, nausea, and a headache), with nothing in particular standing out. Physical examination is unrevealing, with the patient […]
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers NLR Procalcitonin C-Reactive Protein Evaluation for the source Sepsis mimics Treatment Vasopressors Antibiotics Source control Fluid Steroid DVT prophylaxis with heparin Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real value Background Disclaimer Brief […]
0 Introduction 0 With publication of the PROCESS and ARISE trials, many hemodynamic goals are being disproven. There is a growing tide of nihilism. Should we should just give septic patients a couple bags of fluid, some antibiotics, and hope for the best? 0 Probably not. PROCESS and ARISE have showed us what we can […]
Septic shock is perhaps the defining illness of medical intensive care. As such it is an enormously broad and controversial topic. This chapter attempts to provide a unified and straight-forward approach. However, every physicians has a different approach to septic shock, so it’s impossible to claim that this is the best approach. There will doubtless […]
. . Introduction . The Surviving Sepsis Campaign has raised awareness that septic shock is a medical emergency. However, these guidelines recommend a stepwise approach to resuscitation, which commonly results in a gradual escalation of treatment intensity. Additional therapies are added over several hours if the patient fails to reach treatment goals. For some patients, […]
Background Septic shock is generally conceptualized as a state of pathological immune hyperactivity. Consequently, decades of work on immunomodulation in sepsis have focused on immunosuppressive medications (e.g. steroid, TNF-inhibitors, IL-1 inhibitors). Although most of these interventions haven’t worked, steroid offers some benefits and IL-1 receptor antagonism shows promise for a subset of patients.1 The natural […]
Get ready for ADRENAL
Historically, emphasis has rested on the distinction between noninvasive versus invasive BP (e.g., cuff pressure vs. radial arterial pressure). Attention focused on whether noninvasive oscillometric BP monitoring is adequate. Meanwhile, it has been assumed that all invasive BP measurement sites are created equal.
Introduction 0 The utility of steroids in sepsis has been debated passionately for decades. There is hope that steroids might improve mortality, but also fear that they could increase infectious complications. Practice varies widely. What does the data truly indicate? 0 Four misconceptions and one truth 0 Misconception #1: Stress-dose steroids decrease mortality 0 This […]
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