approach to the critically ill patient

... Approach to the Patient: Acute Febrile Illness A physician must have a consistent approach to acutely ill patients Even before the history is elicited and a physical ... a febrile patient can be a harbinger of critical illness History Presenting symptoms are frequently nonspecific Detailed questions should be asked about the onset and duration of symptoms and ... infection, diabetes, malignancy, and chemotherapy all predispose to specific infections and frequently to increased severity The patient should be questioned about factors that might help identify a nidus...

Ngày tải lên: 07/07/2014, 04:20

... bacilli Surgical evaluation is 72 essential If a Ceftriaxone (2 penicilling q24h) or oxacillinsensitive strain is isolated, those agents are superior to vancomycin (penicillin, mU q4h; or oxacillin, ... discontinued Erythroder Group A Vancomycin If ma: toxic shock Streptococcus, (1 g q12h) plus penicillin- syndrome oxacillin- Staphylococcus a or 29, 130 toxigenic bacteria should be debrided; IV immunoglobuli ... A Penicillin (2 Urgent Streptococcus, mU q4h) plus surgical mixed evaluation 19, 130 is substituted for penicillin while culture data are pending Clostridial myonecrosis Clostridi Penicillin (2...

Ngày tải lên: 07/07/2014, 04:20

... patients succumb to sepsis at 58 times the rate of the general population; 50–70% of cases occur within the first years after splenectomy, with a mortality rate of up to 80%, but the increased risk ... encapsulated bacteria cause the majority of infections Adults, who are more likely to have antibody to these organisms, are at lower risk than children Streptococcus pneumoniae is the most common isolate, ... streptococci can present as intractable hypotension and multiorgan failure Treatment can usually be initiated empirically on the basis of the presentation (Table 265-3) Adjunctive therapy with either...

Ngày tải lên: 07/07/2014, 04:20

... of patients have skin findings Blanching macules develop initially on the wrists and ankles and then spread over the legs and trunk The lesions become hemorrhagic and are frequently petechial The ... petechial The rash spreads to palms and soles later in the course The centripetal spread is a classic feature of RMSF However, 10–15% of patients with RMSF never develop a rash The patient can be hypotensive ... Asia, and southern Europe Patients have fever, flu-like symptoms, and an inoculation eschar at the site of the tick bite A maculopapular rash develops within 1–7 days, involving the palms and...

Ngày tải lên: 07/07/2014, 04:20

... onset of malaise, chills, fever, and hypotension The patient develops bullous or hemorrhagic skin lesions, usually on the lower extremities, and 75% of patients have leg pain The mortality rate ... or mucosal portals of entry for the organism can be ascertained when a careful history is taken Colonization rather than overt infection of the vagina or a postoperative wound, for example, is ... streptococcal TSS Viral Hemorrhagic Fevers Viral hemorrhagic fevers (Chaps 189 and 190) are zoonotic illnesses caused by viruses that reside in either animal reservoirs or arthropod vectors These...

Ngày tải lên: 07/07/2014, 04:20

... and then progresses to ptosis, proptosis, ophthalmoplegia, and papilledema The mortality rate is as high as 30% Septic thrombosis of the superior sagittal sinus spreads from the ethmoid or maxillary ... instability Rapid recognition of the toxic patient with central neurologic signs is crucial to improvement of the dismal prognosis of these entities Subdural empyema arises from the paranasal sinus in ... cases Microaerophilic streptococci and staphylococci are the predominant etiologic organisms The patient is toxic, with fever, headache, and nuchal rigidity Of all patients, 75% have focal signs...

Ngày tải lên: 07/07/2014, 04:20

... Staphylococci are the most common etiologic agents This diagnosis must immediately be considered in patients with a history of antecedent back pain and new neurologic symptoms Almost 60% of patients have ... abuse; recent spinal trauma, surgery, or epidural anesthesia; and other comorbid conditions, such as HIV infection The thoracic or lumbar spine is the most common location; cervical spine infections ... entity should be urgently considered if patients who have recently traveled to areas endemic for malaria present with a febrile illness and lethargy or other neurologic signs Fulminant malaria...

Ngày tải lên: 07/07/2014, 04:20

... admission to intensive care units The most important task of the physician is to distinguish these patients from other infected febrile patients who will not progress to fulminant disease The alert ... illness, and lower respiratory tract symptoms Watery diarrhea may develop and may precede respiratory symptoms Dyspnea develops a median of days after the onset of symptoms and can progress to ... should be considered in patients with severe respiratory tract illness, particularly if they have been exposed to poultry To date, human -to- human transmission is rare Patients present with high...

Ngày tải lên: 07/07/2014, 04:20

... to the endothelium is increased, especially in septic patients, potentially leading to microcirculatory impairment and tissue hypoxia [13] Tolerance to anemia in healthy subjects and in the critically ... critically ill patient Tolerance to anemia is highly dependent on the volume status of the patient, physiological reserve, and the dynamics of the anemia (for example, chronic, such as the anemia ... potassium, release of proinflammatory cytokines) These stored RBCs also have an increased tendency to adhere to endothelium and could promote vasoconstriction; the stored RBCs act as a “sink” for...

Ngày tải lên: 20/06/2014, 23:20

... placement of the tracheal cannula It remains unclear whether this was related to the level of procedural experience in the individuals performing the procedures or due to other factors These observations ... coworkers, like other authors in the past, did not report findings in the patients who received surgical tracheostomy or were left intubated during the period while study patients were assigned to percutaneous ... manner will be able to gather further scientific evidence regarding the risks and benefits of different techniques for percutaneous dilatation tracheostomy In addition, such studies should try to...

Ngày tải lên: 12/08/2014, 20:20

... 428 Although the findings reported by Van den Berghe and coworkers are impressive, some concern arose regarding the applicability of these results to other types of patients Of the patients studied, ... hours, whereas the ICU stay extended up to 71 days, with a median of days Insulin was administered to only 9% of the patients during the 48-hour period of observation In addition, patients received ... insulin therapy in the critically ill: Insulin dose versus glycemic control Crit Care Med 2003, 31:359366 Finney SJ, Zekveld C, Elia A, Evans TW: Glucose control and mortality in critically ill patients...

Ngày tải lên: 12/08/2014, 20:20

... substantial elimination of cytokines because of the low cut-off point of their membranes The use of high cut-off hemofilters is a new and effective approach to cytokine removal, but it has potentially ... (CVVH) These solutes seem to be primarily involved in the systemic inflammatory response syndrome, which characterizes the sepsis syndrome, and their efficient removal may thus be beneficial [9] These ... These therapies are not selective in removing specific mediators (pro- and anti-inflammatory mediators are equally removed) and, consequently, their role is not completely understood and their...

Ngày tải lên: 12/08/2014, 23:22

... important to stress that the diagnosis of adrenal insufficiency in critically ill patients should not be made on the basis of laboratory criteria alone Competing interests The author declares that they ... relevant in most critically ill patients, there may be groups of patients in whom this diagnosis may be important Available online http://ccforum.com/content/10/6/175 This would include patients with ... well as patients with liver disease, head injury, pancreatitis, and burns, among others At this time the diagnosis of adrenal insufficiency in these patients may best be made based on the free...

Ngày tải lên: 13/08/2014, 03:20

... we await the availability of near-continuous glucose monitoring devices, we advise clinicians to compute both HGI and GPI (per patient) , because these indicators compensate for each other’s weaknesses ... Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients N Engl J Med 2001, 345:1359-1367 Van den Berghe G, Wilmer ... normoglycaemia throughout the ICU stay leads to lower ICU mortality and morbidity, in both adult and paediatric ICU patients Second, the use of future reliable near-continuous glucose sensors will permit appropriate...

Ngày tải lên: 13/08/2014, 11:23

Ngày tải lên: 13/08/2014, 20:21

... additional parameters once the patient is admitted to the ICU Although studies have examined its application in the ED, these studies are limited to the nonsurgical patient population The Mainz Emergency ... either are limited to their original design (which is prognosticate to outcome based only on the first 24 hours in the ICU) or need to be recalibrated to include physiologic parameters in the ... been the limiting factor to a better definition of sepsis [55], the addition of lactate in the triaging of patients with a suspected infection may allow ED physicians to identify normotensive patients...

Ngày tải lên: 12/08/2014, 22:21

... patients [11] With this approach, approximately 50% of the patients were diagnosed with invasive aspergillosis and in the other 50% the isolation was considered colonization [1] These diagnoses were ... Álvarez-Lerma F, Nolla-Salas J, Iruretagoyena JR, Barcenilla F: Isolation of Aspergillus spp from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome Crit Care ... early, given the high mortality of this infection but the availability of new and active agents Obviously, this and other strategies need to be validated in large cohorts of critically ill patients...

Ngày tải lên: 12/08/2014, 23:22

... monitoring of midazolam in critically ill patients Pharmacotherapy 2007, 27:389-398 Ely EW, Margolin R , Francis J, et al.: Evaluation of delirium in critically ill patients: validation of the ... physicians, nurses and respiratory therapists Recommendation A conservative approach of less sedation does not appear to cause harm in critically ill mechanically ventilated patients This is an important ... sedation in critically ill patients This approach of using analgesia alone and avoiding sedation, unless necessary, has been the standard of care in the author’s ICU in Denmark since 1999 Another strength...

Ngày tải lên: 14/08/2014, 07:21

... contributions AMD was the co-contributor to study design, the acquisition, analysis and interpretation of the data and drafting the manuscript MH was the cocontributor to study conception and ... not to be the case future studies should, arguably, focus on critically ill patients with ‘stress hyperglycaemia’ rather than those with pre-existing type-2 diabetes The effect of GLP-1 in other ... compared to insulin glargine [7] For the above reasons GLP-1 is a potentially attractive therapeutic option for the management of hyperglycaemia in the substantial number of critically ill patients...

Ngày tải lên: 14/08/2014, 07:21

... included the patients who were transferred from one room to another For the sensitivity analyses, we assigned patients to either the window or nonwindow group on the basis of whether they were in ... shifts for the nurses (7 AM to AM and PM to PM), when visitors were asked to leave the unit We excluded all readmissions to the ICU during the same hospital stay A small subset, 121 patients (13.3%), ... (15.4%) 0.05 (0.8%) (0.0%) 0.22 All (6 to 12) (5 to 12) 0.75 (5 to 10) (4 to 9) 0.05 Survived (6 to 12) (6 to 13) 0.80 (5 to 10) (4 to 9) 0.07 Died 4.5 (1 to 6) (2 to 6) 0.44 NA NA 0.32 Of those with...

Ngày tải lên: 14/08/2014, 07:21