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Clinical Cases and Images: ClinicalCases.org: Prerenal Acute Renal Failure due to Volume Depletion

This is a good practical case and very useful for new clinicians. For any clinician:No foley catheter unless oliguric, anuric, obstructed since any catheter is a foreign body and increases infection risk.Rehydrate if U/A has high spec gavity, mucous membranes dry, or if BUN is >30 times the creatinine as in this case. Even CHF pts get dry if not in heart failure. If in doubt, do CXR, BNPT, listen for crackles.Start with 250cc IVF if BNPT not less than 150 or give carefully while checking lung bases posteriorly after each bolus along with pulse ox, etc as above. Half of pts in acute renal failure are septic. Look for and eliminate source such as pneumonia, foreign body, pyelonephritis, joint infections. May be afebrile/ low temp or low WBCs with sepsis. Do cultures, check lactate ASAP to detect sepsis BEFORE the BP drops. Lactic acid "the troponin of sepsis." If septic, give a lot of fluids (up to 10 liters often) since capillary leak syndrome will lead to severe hypotension. If septic expect edema to develop with IV boluses yet be aware pt is intravascularly depleted. No pressors without fluids "pressors are not your friend" as per lecturers on Surviving Sepsis campaign.  
clinicalcases.org
about 4 years ago
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Prerenal Acute Renal Failure with High FENa (Fractional Excretion of Sodium)

Very good case in showing a frequently overlooked issue of diuretics. Remember, there is almost never a reason to give both fluids and diuretics...make up your mind. IV fluids are the #1 method to try in oliguric pts NOT Lasix.Do not agree with Foley cath placement if patient is able to urinate and can check creatinine to know pt is improving. Any catheter is a foreign body and increases infection risk.It is also very uncomfortable for patients.Not sure why U/S of kidney needed right away either unless the patient has chronic kidney disease or does not improve with fluids.Unnecessary tests add to the expense of healthcare which all of us pay for. This increases insurance costs, medicaid costs, etc so much it can put companies (and gov't in the future?) out of business.  
clinicalcases.org
about 4 years ago
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40

Shock: Lesson 2 - Distinguishing Shock Types (Hypovolemic/Distributive/Cardiogenic/Obstructive)

How to use physical exam (e.g. JVP, ultrasound, passive leg raise, and extremity temp) to identify the subtype of shock. Disadvantages of PA catheters are al...  
youtube.com
about 4 years ago
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Replacing a peripheral venous catheter when clinically indicated versus routine replacement | Cochrane

Most hospital patients receive fluids or medications via an intravenous catheter at some time during their hospital stay. An intravenous catheter (also called an IV drip or intravenous cannula) is a short, hollow tube placed in the vein to allow administration of medications, fluids or nutrients directly into the bloodstream. These catheters are often replaced every three to four days to try to prevent irritation of the vein or infection of the blood. However, the procedure may cause discomfort to patients and is quite costly.  
cochrane.org
about 4 years ago
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Respiratory tract infection associated with seizures

A two year old girl presented to her local hospital with breathing difficulties. She was diagnosed with virus induced wheeze. On day one of admission she deteriorated and developed respiratory failure, which required ventilatory support and transfer to our paediatric intensive care unit. Figure 1⇓ shows her chest radiograph on arrival. A multiplex polymerase chain reaction (PCR) panel performed on respiratory secretions identified a micro-organism. She was successfully extubated to nasal cannula oxygen two days later and transferred to a paediatric ward. Four hours after transfer she had a prolonged tonic-clonic convulsion. Owing to profound respiratory depression after two doses of lorazepam she required re-intubation and transfer back to the paediatric intensive care unit.  
feeds.bmj.com
almost 4 years ago
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Respiratory tract infection associated with seizures

A two year old girl presented to her local hospital with breathing difficulties. She was diagnosed with virus induced wheeze. On day one of admission she deteriorated and developed respiratory failure, which required ventilatory support and transfer to our paediatric intensive care unit. Figure 1⇓ shows her chest radiograph on arrival. A multiplex polymerase chain reaction (PCR) panel performed on respiratory secretions identified a micro-organism. She was successfully extubated to nasal cannula oxygen two days later and transferred to a paediatric ward. Four hours after transfer she had a prolonged tonic-clonic convulsion. Owing to profound respiratory depression after two doses of lorazepam she required re-intubation and transfer back to the paediatric intensive care unit.  
feeds.bmj.com
almost 4 years ago
Sinaiem dark
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guidewire-shock

An AICD (automatic implantable cardioverter-defibrillator) is inserted into either subclavian vein, through the SVC and into the heart. While placing a central line catheter with Seldinger technique, the metal guidewire may contact the ICD leads and create sufficient “noisy artifact” to induce an inappropriate shock. [1]  
sinaiem.org
almost 4 years ago
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Catheter Directed Thrombolysis: The Magic Bullet for Submassive Pulmonary Embolism? - R.E.B.E.L. EM - Emergency Medicine Blog

This post is a review of The Seattle II Study: Ultrasound-Facilitated, Catheter-Directed, Low-Dose Thrombolysis of Submassive and Massive PEs  
rebelem.com
almost 4 years ago
Logo h rgb
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high-flow-o2-in-the-er

High Flow O2 Thanks to Dr. Htaik for the write-up of this post Thanks to Dr. Gaieski for heading our new blog-series which focuses on critical care Questions In hypoxemic respiratory failure, is intubation required in more than 10% of cases? Does NIPPV deliver significantly higher FIO2 than high-flow nasal cannula? Is High-Flow Nasal Cannula…  
tjuhem.wordpress.com
almost 4 years ago
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Respiratory tract infection associated with seizures

A two year old girl presented to her local hospital with breathing difficulties. She was diagnosed with virus induced wheeze. On day one of admission she deteriorated and developed respiratory failure, which required ventilatory support and transfer to our paediatric intensive care unit. Figure 1⇓ shows her chest radiograph on arrival. A multiplex polymerase chain reaction (PCR) panel performed on respiratory secretions identified a micro-organism. She was successfully extubated to nasal cannula oxygen two days later and transferred to a paediatric ward. Four hours after transfer she had a prolonged tonic-clonic convulsion. Owing to profound respiratory depression after two doses of lorazepam she required re-intubation and transfer back to the paediatric intensive care unit.  
feeds.bmj.com
almost 4 years ago
Preview
0
0

Respiratory tract infection associated with seizures

A two year old girl presented to her local hospital with breathing difficulties. She was diagnosed with virus induced wheeze. On day one of admission she deteriorated and developed respiratory failure, which required ventilatory support and transfer to our paediatric intensive care unit. Figure 1⇓ shows her chest radiograph on arrival. A multiplex polymerase chain reaction (PCR) panel performed on respiratory secretions identified a micro-organism. She was successfully extubated to nasal cannula oxygen two days later and transferred to a paediatric ward. Four hours after transfer she had a prolonged tonic-clonic convulsion. Owing to profound respiratory depression after two doses of lorazepam she required re-intubation and transfer back to the paediatric intensive care unit.  
feeds.bmj.com
almost 4 years ago
Preview
0
0

Respiratory tract infection associated with seizures

A two year old girl presented to her local hospital with breathing difficulties. She was diagnosed with virus induced wheeze. On day one of admission she deteriorated and developed respiratory failure, which required ventilatory support and transfer to our paediatric intensive care unit. Figure 1⇓ shows her chest radiograph on arrival. A multiplex polymerase chain reaction (PCR) panel performed on respiratory secretions identified a micro-organism. She was successfully extubated to nasal cannula oxygen two days later and transferred to a paediatric ward. Four hours after transfer she had a prolonged tonic-clonic convulsion. Owing to profound respiratory depression after two doses of lorazepam she required re-intubation and transfer back to the paediatric intensive care unit.  
feeds.bmj.com
almost 4 years ago
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Hyperglycemia and Catheter-Associated Bloodstream Infections

Should blood glucose be controlled before placing central lines in criticall ill children?  
medscape.com
almost 4 years ago
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Nosocomial Bacteremia Secondary to Urinary Catheters

Are male patients at higher risk than females for catheter-associated bacteremia?  
medscape.com
almost 4 years ago
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Pulmonary Artery Catheters: PAC traps for young snake charmers - Intensive Care Network

An interesting radiology case demonstrating one of the complications of using a Pulmonary Artery Catheter.  
intensivecarenetwork.com
almost 4 years ago
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Partial as Good as Whole-Breast Irradiation -- Clear Result

A technique of temporary implanting of catheters to deliver radiotherapy for 4 to 5 days was as effective as whole-breast irradiation for 5 weeks.  
medscape.com
almost 4 years ago
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RenovoCath for Targeted Fluid Delivery Into Peripheral Vasculature Cleared in Europe |

RenovoRx, a Los Altos, California firm, received the CE Mark to introduce its RenovoCath catheter in Europe. The device allows for targeted infusion of flu  
medgadget.com
almost 4 years ago
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ER-REBOA Catheter for Emergency Occlusion of Aorta FDA Cleared |

Pryor Medical Devices, a company with offices in Arvada, CO and Boerne, TX, won FDA clearance for its ER-REBOA catheter. The device is used to occlude larg  
medgadget.com
almost 4 years ago
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Intrathecal baclofen for treating spasticity in children with cerebral palsy | Cochrane

Spasticity, which is an increase in muscle tone, is the most common difficulty with movement seen in children with cerebral palsy. Baclofen is a medication which acts on receptors in the brain and spinal cord to reduce abnormal muscle tone. It has been used as an oral medication for many years. The disadvantages of oral administration are that only a small amount of the medication crosses the blood-brain barrier before it can exert an effect, and that the dose is limited by the unwanted effect of excessive sedation. The administration of baclofen into the fluid surrounding the spinal cord overcomes these problems. This treatment is called intrathecal baclofen therapy and it is administered via a pump placed under the skin connected to a catheter which enters the membranes covering the spinal cord to deliver the baclofen directly into the fluid surrounding the spinal cord and brain.  
cochrane.org
almost 4 years ago
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PICC Dwell Time Not Tied to Infections in Infants

Clinicians need not routinely replace uninfected peripherally inserted central catheters to prevent infection in infants, but should remove tunneled catheters before week 7 if no longer needed.  
medscape.com
almost 4 years ago