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Environmental Injuries
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Soo Jung Kim, Alexander V. Nguyen
Management: Burn management depends on severity and location. Patients with severe burns and burns on the face, hands, and genitalia should be referred to a burn unit. Less severe burns can be managed by the immediate cold application, not opening vesicles or blebs of second-degree burns, thoroughly cleaning wounds, and keeping the area moist for optimal healing. Critical care includes evaluation of respiratory status, resuscitation with fluids, assessing for secondary infection, nutritional support, and pain control.
Intensive Care Management of Major Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Following major trauma, patients who survive the initial insult and resuscitation are commonly admitted to a critical care area for either level 2 (monitoring) or level 3 (organ support). Unfortunately, once in critical care they may develop infective complications and multiple organ failure.
Pressure Wounds
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Patient acuity itself can be a barrier to implementing pressure injury prevention strategies in the critical care population. Though the skin is the largest organ in the body, it is not routinely a high care priority. Lifesaving interventions necessary to treat the patient's condition take precedence [6]. Patient factors such as age, past medical history, nutrition and sensory and mobility issues increase the risk. The critical care admitting diagnosis can include organ failure, sepsis, trauma and other diagnoses with hemodynamic instability compounding the risk. Critical care interventions routinely include the use of medical devices such as endotracheal tubes and other respiratory devices, cervical collars and other immobilization devices, tubes, and catheters. The estimated pooled incidence of adult and pediatric medical device related pressure injury is reported as 12% [7]. Prevention measures to mitigate risk associated with medical devices are a key continuing need.
Risk of severe COVID-19 in patients with inflammatory rheumatic diseases treated with immunosuppressive therapy in Scotland
Published in Scandinavian Journal of Rheumatology, 2023
PM McKeigue, D Porter, RJ Hollick, SH Ralston, DA McAllister, HM Colhoun
The targeted DMARDs list comprised 4633 individuals: the diagnostic category was rheumatoid arthritis in 2702, psoriatic arthritis or other seronegative arthropathy in 1765, connective tissue disorder in 141, and other conditions in 25. Of the 4633 individuals on the list, 433 had been diagnosed with COVID-19 by 22 November 2021. Of these 433 cases, 58 were hospitalized within 14 days, seven entered critical care within 21 days, and 14 were fatal within 28 days. Of the 4633, 2527 (55%) had been added by PHS to the shielding list based on criteria suggested by the British Society for Rheumatology (BSR) (10). Of those added to the shielding list, 43 (1.7%) were hospitalized with COVID-19, compared with 15 (0.7%) of those not added. The algorithm used by PHS to identify those eligible for shielding thus discriminated between low-risk and high-risk patients.
Evaluation of medical emergency team activations in patients with limitations-of-medical-therapy: A retrospective cohort study
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Rami M. Zibdawi, Linda Carroll, R.T. Noel Gibney, David McKinlay, Satbir Kullar, Sean M. Bagshaw
The primary exposure was a baseline GOC designation for patients at the time of MET activation. The primary outcome was in-hospital mortality, defined as the number of deaths in patients with a MET activation that occurred during the index hospitalization and was reported as a proportion. Secondary outcomes included: post-MET ICU admission, hospital length of stay (LOS), duration of MET activation, post-MET disposition and hospital discharge disposition. We further evaluated interventions undertaken during MET activations for patients designated as GOC: M1 or below. These were broadly classified as 1) resuscitative: defined by use of CPR or ACLS; 2) critical care-based: defined as interventions that cannot be sustainably provided outside of an ICU setting (eg, insertion of an arterial line, use of intravenous vasoactive or antiarrhythmic medications, intubation and use of invasive mechanical ventilation; use of noninvasive ventilation); or 3) ward-based: defined as all other interventions (eg, use of supplemental oxygen; obtaining intravenous access; administration of intravenous fluids; administration of antimicrobials, etc).
Understanding the genetic basis of immune responses to fungal infection
Published in Expert Review of Anti-infective Therapy, 2022
Samuel M. Gonçalves, Cristina Cunha, Agostinho Carvalho
Recent advances in critical care medicine have significantly improved the clinical outcome of several life-threatening conditions. Owing to the inherent immune dysfunction caused by medical interventions such as hematopoietic stem-cell or solid organ transplantation, chemotherapy, and use of broad-spectrum antibacterial or immunomodulatory therapies, the incidence of fungal infections is rising [1]. Clinical and epidemiological studies have also recently revealed an expanding frequency of severe fungal infections among critically ill patients that occur in the context of viral pneumonia, e.g. influenza and COVID-19 [2,3]. Endemic fungal infections also pose a significant health threat in selected geographical areas, mainly due to environmental changes, population growth, and increasing rates of HIV infection [4]. Despite the global burden of fungal infections associated with high mortality rates and health-care costs, and the emergence of antifungal resistance [5], no fungal vaccines have been approved to date [6]. There is, therefore, an urgent need to further elucidate the pathogenetic mechanisms that predispose individuals to infection and foster the development of more effective diagnostic and therapeutic measures for fungal infections.