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2.
Lancet ; 395(10235): 1517-1520, 2020 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-32311318

RESUMO

Since the outbreak of coronavirus disease 2019 (COVID-19), clinicians have tried every effort to understand the disease, and a brief portrait of its clinical features have been identified. In clinical practice, we noticed that many severe or critically ill COVID-19 patients developed typical clinical manifestations of shock, including cold extremities and weak peripheral pulses, even in the absence of overt hypotension. Understanding the mechanism of viral sepsis in COVID-19 is warranted for exploring better clinical care for these patients. With evidence collected from autopsy studies on COVID-19 and basic science research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV, we have put forward several hypotheses about SARS-CoV-2 pathogenesis after multiple rounds of discussion among basic science researchers, pathologists, and clinicians working on COVID-19. We hypothesise that a process called viral sepsis is crucial to the disease mechanism of COVID-19. Although these ideas might be proven imperfect or even wrong later, we believe they can provide inputs and guide directions for basic research at this moment.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus , Citocinas/metabolismo , Pulmão , Pandemias , Pneumonia Viral , Sepse/virologia , Autopsia , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/complicações , Estado Terminal , Endotélio , Epitélio , Humanos , Inflamação , Pulmão/imunologia , Pulmão/patologia , Macrófagos , Pneumonia Viral/complicações , Índice de Gravidade de Doença , Choque/etiologia
3.
Khirurgiia (Mosk) ; (2): 95-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105263

RESUMO

A 51-year-old severely burned woman had hospitalized at the Clinic of Thermal Injuries of the S.M. Kirov Military Medical Academy with a diagnosis: flame burn in a surface area of 40% (11%)/II-III b degrees of head, neck, trunk, limbs. Inhalation injury of moderate severity. The infusion drug of the combined action reamberin, which has a volemic and antihypoxic effect, had added to the complex antishock therapy. The presented clinical observation demonstrates the favorable course of burn shock: stopping of burn shock 28 hours after injury.


Assuntos
Queimaduras , Meglumina/análogos & derivados , Militares , Choque , Succinatos , Queimaduras/complicações , Feminino , Hidratação , Humanos , Meglumina/uso terapêutico , Pessoa de Meia-Idade , Choque/etiologia , Choque/terapia , Succinatos/uso terapêutico
4.
J Surg Res ; 245: 163-167, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419641

RESUMO

BACKGROUND: The Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. MATERIALS AND METHODS: We performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes. RESULTS: 630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9%), 3123 (1.0%) were transfused blood products, and 7115 (2.3%) underwent an urgent procedure. In class 2, 219 (1.3%) died, 387 (2.3%) were transfused, and 1575 (9.2%) underwent intervention. In class 3, 7 (22.6%) died, 10 (32.3%) were transfused, and 13 (41.9%) underwent intervention. In class 4, 15 (34.9%) died, 19 (44.2%) were transfused, and 23 (53.5%) underwent intervention. For uncategorized patients, 21,356 (7.1%) died, 15,168 (5.0%) were transfused, and 23,844 (7.9%) underwent intervention. CONCLUSIONS: Almost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1%) than patients in classes 1 and 2 (0.9% and 1.3%, respectively). Classes 3 and 4 only accounted for 0.005% and 0.007%, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock.


Assuntos
Cuidados de Suporte Avançado de Vida no Trauma/normas , Medição de Risco/métodos , Choque/classificação , Índices de Gravidade do Trauma , Ferimentos e Lesões/complicações , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Choque/diagnóstico , Choque/etiologia , Choque/mortalidade , Análise de Sobrevida , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Adulto Jovem
5.
BMC Infect Dis ; 19(1): 1014, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783809

RESUMO

BACKGROUND: Clonorchiasis, caused by Clonorchis sinensis (C. sinensis) infection, is a serious food-borne zoonotic disease that is often asymptomatic or shows only mild symptoms, which leads to delayed treatment and chronic clonorchiasis and results in various complications, such as cholelithiasis, cholangitis, cholecystitis and cholangiocarcinoma. However, acute shock caused by C. sinensis infection has not been reported. Here, for the first time, we describe a fatal case of acute shock caused by C. sinensis infection. CASE PRESENTATION: A patient with a history of eating raw or undercooked freshwater fish was hospitalized with acute shock caused by severe abdominal pain. Physical examination suggested acute abdomen with severe abdominal pain and rigidity. Computed tomography (CT) detection indicated acute cholecystitis and cholelithiasis. After cholecystectomy, several liver flukes were found in the drainage tube. Furthermore, morphological analysis and polymerase chain reaction (PCR) identified the pathogen as C. sinensis. The liver gradually restored normal function after anthelmintic therapy with praziquantel. CONCLUSIONS: In this fatal case, C. sinensis infection was the cause of acute shock, which is rarely found in the clinic environment. This report aims to increase awareness of the hazards and complications related to clonorchiasis. The PCR diagnosis method used in this report might be helpful in reducing the misdiagnosis of clonorchiasis and unnecessary cholecystectomy.


Assuntos
Clonorquíase/diagnóstico , Clonorchis sinensis/isolamento & purificação , Choque/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Animais , Clonorquíase/complicações , Clonorquíase/parasitologia , Clonorchis sinensis/genética , DNA de Protozoário/genética , DNA de Protozoário/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Choque/etiologia , Tomografia Computadorizada por Raios X
6.
Cir Cir ; 87(S1): 1-7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501621

RESUMO

Introduction: Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers a graphic representation of the formation of the coagulum, its stability and the presence of lysis. Objective: This first case of transfusion management guided by thromboelastography in Mexico and we conducted a review of the literature. Method: A metasearch search was performed (PubMed, Scielo, Medigraphic) with the words thromboelastometry, coagulopathy, transfusion medicine and the most influential works were included. Conclusions: The rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a directed and individualized management of the coagulopathy associated with bleeding.


Assuntos
Transfusão de Componentes Sanguíneos/métodos , Choque/terapia , Tromboelastografia/métodos , Tempo de Coagulação do Sangue Total/métodos , Adolescente , Afibrinogenemia/tratamento farmacológico , Afibrinogenemia/etiologia , Plaquetas/fisiologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Soluções Cristaloides/administração & dosagem , Emergências , Transfusão de Eritrócitos/métodos , Evolução Fatal , Feminino , Fibrinogênio/uso terapêutico , Humanos , México , Plasma , Choque/etiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia
7.
S Afr J Surg ; 57(3): 30-37, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392862

RESUMO

BACKGROUND: Major pancreatic injuries are complex to treat, especially when combined with vascular and other critical organ injuries. This case-matched analysis assessed the influence of associated visceral vascular injuries on outcome in pancreatic injuries. METHOD: A registered prospective database of 461 consecutive patients with pancreatic injuries was used to identify 68 patients with a Pancreatic Injury combined with a major visceral Vascular Injury (PIVI group) and were matched one-to-one by an independent blinded reviewer using a validated individual matching method to 68 similar Pancreatic Injury patients without a vascular injury (PI group). The two groups were compared using univariate and multivariate logistic regression analysis and outcome including complication rates, length of hospital stay and 90-day mortality rate was measured. RESULTS: The two groups were well matched according to surgical intervention. Mortality in the PIVI group was 41% (n = 28) compared to 13% (n = 9) in the PI alone group (p = 0.000, OR 4.5, CI 1.00-10.5). On univariate analysis the PIVI group was significantly more likely to (i) be shocked on admission, (ii) have a RTS < 7.8, (iii) require damage control laparotomy, (iv) require a blood transfusion, both in frequency and volume, (v) develop a major postoperative complication and (vi) die. On multivariate analysis, the need for damage control laparotomy was a significant variable (p = 0.015, OR 7.95, CI 1.50-42.0) for mortality. Mortality of AAST grade 1 and 2 pancreatic injuries combined with a vascular injury was 18.5% (5/27) compared to an increased mortality of 56.1% (23/41) of AAST grade 3, 4 and 5 pancreatic injuries with vascular injuries (p = 0.0026). CONCLUSION: This study confirms that pancreatic injuries associated with major visceral vascular injuries have a significantly higher complication and mortality rate than pancreatic injuries without vascular injuries and that the addition of a vascular injury with an increasing AAST grade of pancreatic injury exponentially compounds the mortality rate.


Assuntos
Pâncreas/lesões , Pâncreas/cirurgia , Sistema Porta/lesões , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/mortalidade , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Aorta/lesões , Transfusão de Sangue , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação , Masculino , Artéria Mesentérica Superior/lesões , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Artéria Renal/lesões , Veias Renais/lesões , Choque/etiologia , Artéria Esplênica/lesões , Taxa de Sobrevida , Índices de Gravidade do Trauma , Lesões do Sistema Vascular/cirurgia , Veia Cava Inferior/lesões , Adulto Jovem
8.
PLoS Med ; 16(8): e1002858, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31442221

RESUMO

BACKGROUND: Severe falciparum malaria is a medical emergency characterised by potentially lethal vital organ dysfunction. Patient fatality rates even with parenteral artesunate treatment remain high. Despite considerable research into adjuvant therapies targeting organ and tissue dysfunction, none have shown efficacy apart from renal replacement therapy. Understanding the causal contributions of clinical and laboratory abnormalities to mortality is essential for the design and evaluation of novel therapeutic interventions. METHODS AND FINDINGS: We used a structural model causal inference approach to investigate causal relationships between epidemiological, laboratory, and clinical variables in patients with severe falciparum malaria enrolled in clinical trials and their in-hospital mortality. Under this causal model, we analysed records from 9,040 hospitalised children (0-12 years, n = 5,635) and adults (n = 3,405, 12-87 years) with severe falciparum malaria from 15 countries in Africa and Asia who were studied prospectively over the past 35 years. On admission, patient covariates associated with increased in-hospital mortality were severity of acidosis (odds ratio [OR] 2.10 for a 7-mEq/L increase in base deficit [95% CI 1.93-2.28]), renal impairment (OR 1.71 for a 2-fold increase in blood urea nitrogen [95% CI 1.58, 1.86]), coma (OR 3.59 [95% CI 3.07-4.21]), seizures (OR 1.40 [95% CI 1.16-1.68]), shock (OR 1.51 [95% CI 1.14-1.99]), and presumed pulmonary oedema (OR 1.58 [95% CI 1.04-2.39]). Lower in-hospital mortality was associated with moderate anaemia (OR 0.87 for a decrease of 10 percentage points in haematocrit [95% CI 0.80-0.95]). Circulating parasite density was not associated with mortality (OR 1.02 for a 6-fold increase [95% CI 0.94-1.11]), so the pathological effects of parasitaemia appear to be mediated entirely by the downstream effects of sequestration. Treatment with an artemisinin derivative decreased mortality compared with quinine (OR 0.64 [95% CI 0.56-0.74]). These estimates were consistent across children and adults (mainly representing African and Asian patients, respectively). Using inverse probability weighting, transfusion was not estimated to be beneficial in children with admission haematocrit values between 15% and 25% (OR 0.99 [95% CI 0.97-1.02]). Except for the effects of artemisinin treatment and transfusion, causal interpretations of these estimates could be biased by unmeasured confounding from severe bacterial sepsis, immunity, and duration of illness. CONCLUSION: These data suggest that moderate anaemia is associated with a reduced risk of death in severe falciparum malaria. This is possibly a direct causal association. The severe anaemia threshold criteria for a definition of severe falciparum malaria should be reconsidered.


Assuntos
Malária Falciparum/etiologia , Acidose/parasitologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Nitrogênio da Ureia Sanguínea , Criança , Pré-Escolar , Coma/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Malária Falciparum/complicações , Malária Falciparum/mortalidade , Malária Falciparum/patologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Edema Pulmonar/etiologia , Estudos Retrospectivos , Convulsões/etiologia , Choque/etiologia , Adulto Jovem
9.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451478

RESUMO

Spontaneous splenic rupture (SSR) is a rare but potentially life-threatening entity. It can be due to neoplastic, infectious, haematological, inflammatory and metabolic causes. An iatrogenic or an idiopathic aetiology should also be considered. Depending on the degree of splenic injury and the haemodynamic status of the patient, it can be managed conservatively. A 61-year-old man presented to the emergency department with an acute abdomen, hypovolaemic shock and clotting abnormalities. However, his focused assessment with sonography for trauma showed no evidence of an aortic aneurysm, rupture or dissection. Further investigation with a CT angiogram aorta confirmed a subcapsular splenic haematoma with free fluid in the pelvis and a mass in the superior pole of the spleen. He was diagnosed with an SSR. He was initially managed non-operatively. However, his repeat CT showed an enlarging haematoma and he underwent embolisation of his splenic artery. Ultrasound-guided core biopsy of his splenic mass confirmed the diagnosis of diffuse large B-cell lymphoma. This paper will discuss the clinical presentation, differential diagnosis and management of SSR. Furthermore, it provides an important clinical lesson to maintain a high index of clinical suspicion for splenic injury in patients presenting with left upper quadrant abdominal pain radiating to the shoulder. This case also reinforces the importance of close observation and monitoring of those individuals treated conservatively for signs of clinical deterioration.


Assuntos
Abdome Agudo , Linfoma Difuso de Grandes Células B , Baço , Neoplasias Esplênicas , Ruptura Esplênica , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Testes de Coagulação Sanguínea/métodos , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Humanos , Biópsia Guiada por Imagem/métodos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/fisiopatologia , Ruptura Espontânea/terapia , Choque/diagnóstico , Choque/etiologia , Baço/diagnóstico por imagem , Baço/patologia , Baço/cirurgia , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/terapia , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologia , Ruptura Esplênica/fisiopatologia , Ruptura Esplênica/terapia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
10.
BMJ Case Rep ; 12(7)2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31300608

RESUMO

Abdominal compartment syndrome (ACS) is not rare and has a high mortality in the paediatric intensive care unit. However, there are few reports about this in the emergency department (ED). We report an 8 month-old male patient with ACS in shock associated with gastric volvulus who improved rapidly by a simple procedure in the ED. He had congenital comorbidities, including multiple cranial anomalies and was transferred because of decreased mental status. He had compensated shock with cold and mottled skin of the lower extremities, paediatric Glasgow Coma Scale of E3V5M6 and prominence of the left upper abdomen. The abdominal X-ray showed a considerably distended stomach. Soon after aspiration of gastric contents, shock and mental status improved. Physicians should consider ACS in the differential diagnosis of shock with abdominal distention. ACS may be ameliorated by gastric suction. Gastric volvulus can induce shock and decreased mental status, particularly in patients with comorbidities.


Assuntos
Abdome/patologia , Síndromes Compartimentais/diagnóstico , Choque/diagnóstico , Volvo Gástrico/terapia , Sucção/métodos , Abdome/diagnóstico por imagem , Anormalidades Múltiplas , Síndromes Compartimentais/complicações , Síndromes Compartimentais/terapia , Anormalidades Congênitas , Procedimentos Cirúrgicos do Sistema Digestório , Serviço Hospitalar de Emergência , Humanos , Lactente , Masculino , Choque/etiologia , Choque/terapia , Volvo Gástrico/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Pediatr Emerg Care ; 35(8): 575-578, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31290800

RESUMO

The differential diagnosis for patients presenting in shock can be broad, making rapid diagnosis and management challenging. We present a case of a medically complex patient with presumed septic shock, diagnosed with a large pericardial effusion with evidence of tamponade using the rapid ultrasound in shock and hypotension protocol. The point-of-care ultrasound examination allowed for more timely and definitive management.


Assuntos
Derrame Pericárdico/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito/normas , Choque/etiologia , Ultrassonografia/métodos , Adolescente , Ecocardiografia/métodos , Serviço Hospitalar de Emergência , Humanos , Masculino , Medicina de Emergência Pediátrica , Derrame Pericárdico/complicações , Derrame Pericárdico/terapia , Pericardiocentese/métodos , Choque/diagnóstico , Resultado do Tratamento
12.
Artigo em Inglês | MEDLINE | ID: mdl-31345740

RESUMO

The major cause of maternal death worldwide is postpartum hemorrhage (PPH). Early identification is the basis for adequate treatment. In addition to the visual estimation of blood loss, clinical signs could offer a more reliable representation of the cardiovascular system of the bleeding woman. However, in postpartum women, recognition of hypovolemic shock through vital signs is impaired owing to physiological cardiovascular changes in pregnancy. The Shock Index [SI] is one composite vital sign that may help in the identification of women with hypovolemic shock. Values of SI ≥ 1 in the first hour postpartum indicate cardiac decompensation, and treatment should be implemented immediately. From the diagnosis of PPH, first-line measures should ensure coordinated care actions including the availability of blood derivatives, the establishment of conditions for volume replacement, oxygen therapy, and identification and timely treatment causes of bleeding. Individualized fluid resuscitation should start with warmed crystalloids and be limited to 3.5 L.


Assuntos
Hipovolemia , Hemorragia Pós-Parto , Choque , Feminino , Humanos , Hipovolemia/etiologia , Hipovolemia/terapia , Mortalidade Materna , Período Pós-Parto , Gravidez , Choque/etiologia , Choque/terapia
13.
BMJ Case Rep ; 12(5)2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31151967

RESUMO

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.


Assuntos
Gangrena/etiologia , Doenças do Íleo/complicações , Obstrução Intestinal/etiologia , Volvo Intestinal/complicações , Doenças do Colo Sigmoide/complicações , Doença Aguda , Gangrena/cirurgia , Humanos , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Volvo Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Raras , Choque/etiologia , Doenças do Colo Sigmoide/cirurgia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(20): e15491, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096449

RESUMO

RATIONALE: Uterine rupture is a rare incidence but can lead to catastrophic maternal and fetal consequences. We still need to place a high premium on these cases. PATIENT CONCERNS: The patients all showed hemodynamic shock with complaints of serious pain in the abdomen. They all had a history of laparoscopy or hysteroscopy procedures. DIAGNOSES: Case 1 and 2 were diagnosed during surgery. Case 3 was diagnosed by an urgent abdominal ultrasonogram before surgery. INTERVENTIONS: We performed emergency surgeries for the 3 cases. OUTCOMES: Three patients all recovered well. But only the child in case 2 survived. LESSONS: It must be emphasized that pregnant women with a history of such surgeries should be aware of uterine rupture during pregnancy.


Assuntos
Histeroscopia/efeitos adversos , Laparoscopia/efeitos adversos , Choque/etiologia , Ruptura Uterina/etiologia , Útero/patologia , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Placenta Acreta/patologia , Gravidez , Gravidez Ectópica/epidemiologia , Choque/diagnóstico , Resultado do Tratamento , Ultrassonografia/métodos , Ruptura Uterina/diagnóstico por imagem , Ruptura Uterina/patologia , Útero/diagnóstico por imagem , Útero/cirurgia
17.
J Pediatr Surg ; 54(5): 984-988, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30952455

RESUMO

BACKGROUND: Studies have demonstrated the superiority of the shock index, pediatric age-adjusted (SIPA) in predicting outcomes in pediatric blunt trauma patients. However, all have utilized SIPA calculated on emergency department (ED) arrival. We sought to evaluate the utility of SIPA at the trauma scene and describe changes in SIPA from the trauma scene to the ED. METHODS: We used 2014-2016 Trauma Quality Improvement Program Data to identify blunt trauma patients 1-15 years old with an injury severity score (ISS) > 15. We calculated SIPA using vitals obtained at the trauma scene and on ED arrival. Outcome measures included ISS, transfusion within 24 h, intensive care unit (ICU), hospital length of stay (LOS), ventilator days, and mortality. RESULTS: We identified 2917 patients, and 34.2% had a persistently elevated SI from the injury scene to ED arrival, whereas 17.9% had a persistently elevated SIPA. An elevated SIPA at the trauma scene was more predictive of greater ISS, LOS, and ventilator requirements. Furthermore, a SIPA that remained abnormal was associated with greater ISS, LOS, ICU admission, mechanical ventilation, and mortality. CONCLUSIONS: Prehospital SIPA values predict worse outcomes in pediatric trauma patients, and their change over time may have greater predictive utility than a single value alone. LEVEL OF EVIDENCE: II TYPE OF STUDY: Prognosis Study.


Assuntos
Choque/diagnóstico , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/diagnóstico , Adolescente , Fatores Etários , Transfusão de Sangue , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Prognóstico , Estudos Retrospectivos , Choque/etiologia , Choque/mortalidade , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/mortalidade
18.
Leg Med (Tokyo) ; 38: 64-68, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30991227

RESUMO

Although fatal colchicine intoxications are rare and mostly related to suicidal intake or accidental overdose, other hypotheses should be considered when dealing with colchicine poisoning. We present a case of double, acute, and subacute, fatal colchicine intoxication in a married couple. The 70-year-old male victim suddenly died after vomiting and diarrhea. The next day his wife showed aggravating gastrointestinal symptoms and was hospitalized with a diagnosis of septic shock. A complete postmortem examination on the man was performed, together with histopathological analysis. Toxicological examination performed through liquid chromatography coupled to mass spectrometry revealed a colchicine blood peripheral concentration of 33 ng/mL. A few days after hospitalization, the woman showed a colchicine plasma concentration of 32 ng/mL. Despite veno-venous hemofiltration, she ultimately died of septic shock and multi-organ failure. Death scene investigation revealed that, a few days before the death of the male victim, the couple had collected wild saffron and had eaten a presumed saffron risotto. The integrated analysis of circumstantial, clinical, postmortem and toxicological data allowed to establish that the couple had died of a fatal accidental intoxication due to the ingestion of natural colchicine, mistaken for saffron. The death of the male was deemed caused by acute cardiovascular collapse induced by acute intoxication, while the female had suffered a subacute poisoning by antimitotic agent, resulting in immunosuppression and systemic infection. Toxicological analyses, promptly performed on the man for forensic purposes, directed the investigations and suggested the clinical diagnosis on the woman.


Assuntos
Antimitóticos/envenenamento , Colchicina/envenenamento , Crocus , Medicina Legal , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/patologia , Choque Séptico/etiologia , Choque Séptico/patologia , Choque/etiologia , Choque/patologia , Acidentes , Doença Aguda , Idoso , Autopsia , Colchicina/sangue , Evolução Fatal , Feminino , Humanos , Masculino , Cônjuges
19.
BMC Gastroenterol ; 19(1): 61, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023233

RESUMO

BACKGROUND: Ulcerative colitis (UC)-related post-colectomy enteritis is a very rare condition that is characterized by diffuse small-bowel mucosal inflammation following colectomy and could be very dangerous. In previously reported cases, corticosteroid therapy seemed to be the optimal choice for inducing remission; however, the patient studied herein presented with severe diarrhoea and hypovolemic shock and failed to achieve full remission with corticosteroid therapy. CASE PRESENTATION: We describe the case of a patient with severe pan-enteritis presenting with life-threatening diarrhoea complicated with hypovolemic shock and acute kidney injury after colectomy and ileal pouch anal anastomosis (IPAA) for UC; this patient was successfully treated by ileostomy closure after failing to achieve full remission with corticosteroid therapy. Next, we review other cases of post-colectomy enteritis reported in the literature and propose a flow-chart for its diagnosis and initial treatment. CONCLUSION: Post-colectomy enteritis can be dangerous, and the early awareness of this condition plays a vital role. Additionally, in patients who do not respond well to corticosteroid or immunosuppressant therapy, early closure of the ileostomy and re-establishment of the natural faecal stream could be important considerations.


Assuntos
Colite Ulcerativa/cirurgia , Enterite/etiologia , Proctocolectomia Restauradora/efeitos adversos , Lesão Renal Aguda/etiologia , Colite Ulcerativa/tratamento farmacológico , Diarreia/etiologia , Enterite/tratamento farmacológico , Enterite/cirurgia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Ileostomia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/cirurgia , Prednisona/uso terapêutico , Choque/etiologia
20.
Clin Perinatol ; 46(2): 273-290, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010560

RESUMO

There is a distinct lack of age-appropriate cardiotonic drugs, and adult derived formulations continue to be administered, without evidence-based knowledge on their dosing, safety, efficacy, and long-term effects. Dopamine remains the most commonly studied and prescribed cardiotonic drug in the neonatal intensive care unit (NICU), but evidence of its effect on endorgan perfusion still remains. Unlike adult and pediatric critical care, there are significant gaps in our knowledge on the use of various cardiotonic drugs in various forms of circulatory failure in the NICU.


Assuntos
Cardiotônicos/uso terapêutico , Hipotensão/tratamento farmacológico , Choque/tratamento farmacológico , Vasoconstritores/uso terapêutico , Corticosteroides/uso terapêutico , Asfixia Neonatal/complicações , Dobutamina/uso terapêutico , Dopamina/uso terapêutico , Cardiopatias Congênitas/complicações , Humanos , Hipotensão/etiologia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Milrinona/uso terapêutico , Sepse Neonatal/complicações , Norepinefrina/uso terapêutico , Síndrome da Persistência do Padrão de Circulação Fetal/complicações , Choque/etiologia , Simendana/uso terapêutico , Vasopressinas/uso terapêutico
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