Perioperative Management of Patients with Sepsis and Septic Shock, Part II: Ultrasound Support for Resuscitation

Publication date: March 2020Source: Anesthesiology Clinics, Volume 38, Issue 1Author(s): Nibras Bughrara, Jose L. Diaz-Gomez, Aliaksei Pustavoitau
Source: Anesthesiology Clinics - Category: Anesthesiology Source Type: research

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Conclusions Ultrasound enables identification of specific early diaphragm atrophy that affects the majority of mechanically ventilated patients and septic shock patients. Diaphragm atrophy and pectoral muscle atrophy seem to be two unrelated processes.
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Rationale: A peripherally inserted central catheter (PICC) is typically inserted with the patient in the supine position. Here, we placed a PICC in a patient in the sitting position, in order to treat congestive heart failure. Patient concerns: A 65-year-old man was diagnosed with end-stage lung cancer. He had experienced septic shock and was medicated with continuous infusion of noradrenaline through a peripheral vein, in order to maintain sufficient blood pressure. However, indwelling peripheral venous catheters were difficult to place and maintain. Diagnosis: The patient experienced orthopnea due to congestive h...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
A PREVIOUSLY healthy 52-yr-old man was admitted to the intensive care unit for septic shock and diffuse alveolar hemorrhage caused by leptospirosis. He received high-dose norepinephrine (2.2 μg · kg−1· min−1); the heart rate was 155 beats/min, and the electrocardiogram revealed regular tachycardia with narrow QRS complexes (imageA,white arrows). A P wave (imageA, black arrows) was observed in the middle of each RR interval, and it was unclear if the rhythm was sinus tachycardia, atrial tachycardia, or atrial flutter. Transesophageal echocardiography, performed for evaluation of shock, included ...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 323rd LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Are you still ordering BNPs? Spiegel and Morgenstern do a deep dive into the litera...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Education LITFL review Source Type: blogs
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 317th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Learn to be a pediatric airway master with these fundamental moves from PEM Playbook. [M...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: LITFL review Source Type: blogs
ConclusionFCU is a valuable examination tool during early resuscitation of severe sepsis and septic shock.
Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many  institutions in the U.S. Stop the madness! Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Trauma critical care examination research and reviews Source Type: blogs
Welcome to the 104th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or ...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Airway Anaesthetics Education Emergency Medicine Emergency Medicine Update Haematology Immunology Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care Review Source Type: blogs
CONCLUSIONS: This case illustrates the potential advantages of ultrasound-guided stellate ganglion blockade for the treatment of sepsis-related digital ischemia refractory to standard therapy. PMID: 26415545 [PubMed - as supplied by publisher]
Source: Canadian Journal of Anaesthesia - Category: Anesthesiology Authors: Tags: Can J Anaesth Source Type: research
This study of 50 volunteers suggests that three commonly taught methods for finding the cricothyroid membrane (general palpation, four-finger, skin crease) are relatively inaccurate, using ultrasonography as the gold standard. I conclude:1. The landmark techniques are inaccurate for finding the CTM *and that’s okay.* Make your best guess using general palpation and if you feel nothing, use four-finger or skin crease **and then make a long vertical incision.** Once you get through the skin you are very likely to be able to feel the CTM, and even if you still can’t at that point, that’s fine too, cut to air...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Airway Education Emergency Medicine Intensive Care R&R in the FASTLANE Trauma critical care EBM literature recommendations research and reviews Source Type: blogs
More News: Anesthesia | Anesthesiology | Septic Shock | Ultrasound