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1
Tanaka, Sébastien, and Jacques Duranteau. Management of acute non-cardiogenic pulmonary oedema. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0165.
Full textAbstract:
Severe capillary leak is an important factor in the pathogenesis of organ dysfunction following inflammatory syndromes such as sepsis-induced acute lung injury and acute respiratory distress syndrome (ARDS). Various interventions, such as a conservative fluid strategy, albumin, and diuretics are designed to maintain an adequate intravascular colloid osmotic pressure, reduce capillary leak and reduce extravascular water. Of these, only a conservative, rather than liberal fluid strategy is currently recommended. Preclinical studies in ARDS and sepsis suggest that preventing microvascular leak may represent a viable therapeutic approach to prevent or ameliorate organ dysfunction. The challenge is to now go further with carefully designed clinical trials.
2
Ware, Lorraine B. Pathophysiology of acute respiratory distress syndrome. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0108.
Full textAbstract:
The acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure characterized by the acute onset of non-cardiogenic pulmonary oedema due to increased lung endothelial and alveolar epithelial permeability. Common predisposing clinical conditions include sepsis, pneumonia, severe traumatic injury, and aspiration of gastric contents. Environmental factors, such as alcohol abuse and cigarette smoke exposure may increase the risk of developing ARDS in those at risk. Pathologically, ARDS is characterized by diffuse alveolar damage with neutrophilic alveolitis, haemorrhage, hyaline membrane formation, and pulmonary oedema. A variety of cellular and molecular mechanisms contribute to the pathophysiology of ARDS, including exuberant inflammation, neutrophil recruitment and activation, oxidant injury, endothelial activation and injury, lung epithelial injury and/or necrosis, and activation of coagulation in the airspace. Mechanical ventilation can exacerbate lung inflammation and injury, particularly if delivered with high tidal volumes and/or pressures. Resolution of ARDS is complex and requires coordinated activation of multiple resolution pathways that include alveolar epithelial repair, clearance of pulmonary oedema through active ion transport, apoptosis, and clearance of intra-alveolar neutrophils, resolution of inflammation and fibrinolysis of fibrin-rich hyaline membranes. In some patients, activation of profibrotic pathways leads to significant lung fibrosis with resultant prolonged respiratory failure and failure of resolution.
3
Rahimi, Kazem. Acute heart failure. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0091.
Full textAbstract:
Heart failure is a clinical syndrome characterized by an inadequate cardiac output for the needs of the body in the absence of low filling pressures, and reflects abnormal cardiac structure or function. Although various definitions for acute heart failure (AHF) exist, here AHF is defined as new-onset heart failure or an acute exacerbation of chronic heart failure, requiring urgent therapy. Patients with AHF typically have clinical features of organ hypoperfusion, with or without pulmonary and peripheral oedema.
4
Jolly, Elaine, Andrew Fry, and Afzal Chaudhry, eds. Acute medical emergencies and practical procedures. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199230457.003.0001.
Full textAbstract:
Chapter 1 covers the basic science and clinical topics relating to acute medical emergencies and practical procedures which trainees are required to learn as part of their basic training and demonstrate in the MRCP. It covers cardiorespiratory arrest, shock, acute coronary syndromes, tachycardia, bradycardia, hypertensive emergencies, pulmonary oedema, acute asthma, massive pulmonary embolism, acute upper gastrointestinal haemorrhage, acute kidney injury, coma, traumatic brain injury, status epilepticus, adrenal crisis, thyroid emergencies, acute poisoning, and burns.
5
McAuley, Danny F., and Thelma Rose Craig. Measurement of extravascular lung water in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0140.
Full textAbstract:
The accumulation of fluid in the interstitium and alveolar space is known as extravascular lung water (EVLW). EVLW is associated with increased morbidity and mortality in critically ill patients and is elevated in patients with cardiogenic pulmonary oedema, acute lung injury (ALI), and the acute respiratory distress syndrome (ARDS). Pulmonary oedema is a consequence of increased pulmonary capillary hydrostatic pressure and/or an increased capillary permeability. The quantity of pulmonary oedema fluid is dependent on the balance of fluid formation and clearance, and this contributes to the overall dynamic net lung fluid balance. Measurement of EVLW is therefore an indirect surrogate measurement of the alveolar epithelial and endothelial damage in ALI/ARDS. The single indicator transpulmonary thermodilution technique is an available bedside technique to measure EVLW.
6
Lee, Jae Myeong, and Michael R. Pinsky. Cardiovascular interactions in respiratory failure. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0087.
Full textAbstract:
Acute respiratory failure not only impairs gas exchange, but also stresses cardiovascular reserve by increasing the need for increased cardiac output (CO) to sustain O2 delivery in the face of hypoxaemia, increased O2 demand by the increased work of breathing and inefficient gas exchange, and increased right ventricular afterload due to lung collapse via hypoxic pulmonary vasoconstriction. Mechanical ventilation, though often reversing these processes by lung recruitment and improved arterial oxygenation, may also decrease CO by increasing right atrial pressure by either increasing intrathoracic pressure or lung over-distention by excess positive end-expiratory pressure or inadequate expiratory time causing acute cor pulmonale. Finally, spontaneous negative swings in intrathoracic pressure also increase venous return and impede left ventricular ejection thus increasing intrathoracic blood volume and often precipitating or worsening hydrostatic pulmonary oedema. Positive-pressure breathing has the opposite effects.
7
Lancellotti, Patrizio, and Bernard Cosyns. Critically Ill Patients. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713623.003.0012.
Full textAbstract:
Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioners. It can provide important information throughout the whole patient pathway. This chapter details the role of lung ultrasound and 2D echocardiography and colour Doppler for a variety of critical acute care conditions. These include acute cardiogenic pulmonary oedema, acute dyspnoea, and acute lung injury. More general information on how to perform a lung ultrasound, specific problems in ventilated patients and echocardiographic examination in cardiorespiratory arrest and focused echocardiography protocols are also discussed.
8
Martin, Daniel S., and Michael P. W. Grocott. Pathophysiology and management of altitude-related disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0350.
Full textAbstract:
Acute high-altitude related illnesses include acute mountain sickness (AMS), high altitude pulmonary oedema (HAPO) and high altitude cerebral oedema (HACO). AMS is characterized by headache, lack of appetite, poor sleep, lethargy, and fatigue. AMS is a common, generally benign, self-limiting condition if managed with rest, no ascent, and symptomatic treatment. Descent is indicated in severe cases. HACO and HAPO are rare, but serious conditions that should be considered life-threatening medical emergencies. HACO is characterized by the presence of neurological signs (including confusion) at altitude, commonly in the presence of headache. HAPO is characterized by breathlessness and signs of respiratory distress at altitude, particularly accompanying exercise. Management of HACO and HAPO involves urgent descent, supplemental oxygen (cylinder, concentrator, or portable hyperbaric chamber) if available, and specific treatment with dexamethasone (HACO) or nifedipine (HAPO). Slow controlled ascent (adequate acclimatization) is the best prophylaxis against the acute high-altitude-related illnesses. Acetazolamide is an effective prophylaxis against AMS.
9
Farmer, Brenna M., and Neal Flomenbaum. Management of salicylate poisoning. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0317.
Full textAbstract:
Salicylates are weak acids that work as neurotoxins. The goal of management is to keep salicylates out of the brain and enhance elimination. Acute salicylate toxicity manifests as tinnitus, nausea, vomiting, and hyperventilation in a patient who takes a single large ingestion. Chronic salicylate toxicity is associated with long-term use, has a more insidious onset, and symptoms tend to be less severe, resulting in delayed diagnosis. It is more commonly seen in elderly patients. Therapeutic interventions for toxicity include gastrointestinal decontamination, serum and urine alkalinization, and haemodialysis. Mechanical ventilation may lead to clinical deterioration and death in a salicylate-poisoned patient due to worsening acidosis from respiratory failure. This results in severe acidosis, cerebral oedema, pulmonary oedema, and cardiac arrest.
10
Spoletini, Giulia, and Nicholas S. Hill. Non-invasive positive-pressure ventilation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0090.
Full textAbstract:
Non-invasive ventilation (NIV) has been increasingly used over the past decades to avoid endotracheal intubation (ETI) in critical care settings. In selected patients with acute respiratory failure, NIV improves the overall clinical status more rapidly than standard oxygen therapy, avoids ETI and its complications, reduces length of hospital stay, and improves survival. NIV is primarily indicated in respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema and associated with immunocompromised states. Weaker evidence supports its use in other forms of acute hypercapnic and hypoxaemic respiratory failure. Candidates for NIV should be carefully selected taking into consideration the risk factors for NIV failure. Patients on NIV who are unstable or have risk factors for NIV failure should be monitored in an intensive or intermediate care units by experienced personnel to avoid delay when intubation is needed. Stable NIV patients can be monitored on regular wards.
11
McIndoe, Andrew. Anaesthetic emergencies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198719410.003.0036.
Full textAbstract:
This chapter discusses anaesthetic emergencies. It begins with a description of adult basic life support and advanced life support. It goes on to describe the management of acute problems, including narrow and broad complex tachycardia, severe hypo- or hypertension, severe hypoxia, laryngospasm, air/gas embolism, gastric aspiration, status asthmaticus, pulmonary oedema, failed intubation, the cannot-intubate-cannot-ventilate scenario, malignant hyperthermia anaphylaxis, intra-arterial injection, and unsuccessful reversal of neuromuscular blockade. It concludes with the management of paediatric emergencies, including paediatric advanced life support, ventricular fibrillation or tachycardia, neonatal resuscitation, the collapsed septic child, paediatric major trauma, acute severe asthma, and anaphylaxis, as well as with a discussion of paediatric drug doses and equipment.
12
McIndoe, Andrew. Anaesthetic emergencies. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198719410.003.0036_update_001.
Full textAbstract:
This chapter discusses anaesthetic emergencies. It begins with a description of adult basic life support and advanced life support. It goes on to describe the management of acute problems, including narrow and broad complex tachycardia, severe hypo- or hypertension, severe hypoxia, laryngospasm, air/gas embolism, gastric aspiration, status asthmaticus, pulmonary oedema, failed intubation, the cannot-intubate-cannot-ventilate scenario, malignant hyperthermia anaphylaxis, intra-arterial injection, and unsuccessful reversal of neuromuscular blockade. It concludes with the management of paediatric emergencies, including paediatric advanced life support, ventricular fibrillation or tachycardia, neonatal resuscitation, the collapsed septic child, paediatric major trauma, acute severe asthma, and anaphylaxis, as well as with a discussion of paediatric drug doses and equipment.
13
Flachskampf, Frank A., Pavlos Myrianthefs, Ruxandra Beyer, and Pavlos M. Myrianthefs. Echocardiography and thoracic ultrasound. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0020.
Full textAbstract:
For the emergency management of cardiovascular disorders, echocardiography and thoracic ultrasound are indispensable imaging techniques at the bedside. In the intensive care environment, crucial questions, such as left and right ventricular function, valvular heart disease, volume status, aortic disease, cardiac infection, pleural effusion, pulmonary oedema, pneumothorax, and many others, can be sufficiently and reliably answered by using these techniques; in fact, it is almost impossible to manage patients with acute severe haemodynamic impairment reasonably well without a prompt and repeated access to echocardiography. This is confirmed by the prominent place that echocardiography has in the guideline-based diagnosis and treatment of all major cardiovascular emergencies, from acute heart failure to the acute coronary syndrome to pulmonary embolism, etc. Moreover, it is the ideal tool to follow the patient, since repeat examinations pose no risk to the patient and demand relatively little logistics and resources. To benefit from the wealth of information that echocardiography and thoracic ultrasound can provide, modern equipment (including a transoesophageal probe) and systematic training of echocardiographers must be ensured. The availability of prompt and experienced echocardiography and thoracic ultrasound services at all times is fundamental for sound contemporary cardiovascular intensive care.
14
Flachskampf, Frank A., Pavlos Myrianthefs, Ruxandra Beyer, and Pavlos M. Myrianthefs. Echocardiography and thoracic ultrasound. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0020_update_001.
Full textAbstract:
For the emergency management of cardiovascular disorders, echocardiography and thoracic ultrasound are indispensable imaging techniques at the bedside. In the intensive care environment, crucial questions, such as left and right ventricular function, valvular heart disease, volume status, aortic disease, cardiac infection, pleural effusion, pulmonary oedema, pneumothorax, and many others, can be sufficiently and reliably answered by using these techniques; in fact, it is almost impossible to manage patients with acute severe haemodynamic impairment reasonably well without a prompt and repeated access to echocardiography. This is confirmed by the prominent place that echocardiography has in the guideline-based diagnosis and treatment of all major cardiovascular emergencies, from acute heart failure to the acute coronary syndrome to pulmonary embolism, etc. Moreover, it is the ideal tool to follow the patient, since repeat examinations pose no risk to the patient and demand relatively little logistics and resources. To benefit from the wealth of information that echocardiography and thoracic ultrasound can provide, modern equipment (including a transoesophageal probe) and systematic training of echocardiographers must be ensured. The availability of prompt and experienced echocardiography and thoracic ultrasound services at all times is fundamental for sound contemporary cardiovascular intensive care.
15
Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0025.
Full textAbstract:
During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
16
Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_001.
Full textAbstract:
During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
17
Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_002.
Full textAbstract:
During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
18
Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_003.
Full textAbstract:
During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, immunocompromised or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure, bilevel pressure support ventilation and more recently, high flow nasal cannula. Whereas non-invasive pressure support ventilation requires a ventilator, the other two techniques are simpler and can be easily used in non-equipped areas by less experienced teams, including the pre-hospital setting. The success of non-invasive ventilation is related to an adequate timing, proper selection of patients and interfaces, close monitoring as well as the achievement of a good adaptation to patients’ demand.
19
Evans, Charlotte, Anne Creaton, Marcus Kennedy, and Terry Martin, eds. Cardiac. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198722168.003.0009.
Full textAbstract:
Retrieval of patients with cardiac emergencies makes up a large chunk of the workload of most retrieval services. Cases range from the routine to the most challenging unstable patients with complex physiology and high-level support requirements. The transfer of patients for time-critical interventions mean that the adrenaline levels of the retrieval clinician may approach those of the patient. Included are clinical and logistical considerations for patients with acute coronary syndromes, pulmonary oedema, cardiogenic shock, arrhythmias, and those requiring pacing. Aortic dissection and pulmonary embolus are also discussed in detail. With the development of smaller more portable devices the use of intra-aortic balloon pumps (IABP) and extracorporeal membrane oxygenation (ECMO) in the retrieval environment has increased. While many retrieval services routinely perform retrieval of these patients, the technology can intimidate those who do not use it regularly. The operation and key features of these devices is included.
20
Page, Piers, Asif Shah, Greg Skinner, Alan Weir, and Natasha Eagles, eds. Emergencies in Clinical Medicine. 2nd ed. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198779117.001.0001.
Full textAbstract:
Emergencies in Clinical Medicine, second edition, provides a guideline to the management of acutely unwell patients. Designed for rapid use, it explains how to arrive at a differential diagnosis and how to prevent, manage, and treat emergencies. Updated to reflect current guidelines, this second edition contains sections on new topics, such as pulmonary oedemas and the overdose patient. Designed to help young clinicians navigate the stress of emergency treatment, the book has been revised to cover the curricula for core medical training (CMT) and the acute care common stem (ACS), with key algorithms for quick reference and symbols indicating clinical severity, from life-threatening to minor.