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Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
In shock, there is a reduction in the person’s cardiac output and significant changes occur in their vital signs. It is important to find the cause of shock and treat it quickly. Mrs Patel has a lot of drainage from her wound and changes in her vital signs. Thus, her rate of intravenous fluid administration may be increased to boost the circulating fluid volume, or a blood transfusion may be commenced (see Chapter 10).
Specific Emergency Conditions in Forced Displacement Settings
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Natalie Roberts, Halfdan Holger Knudsen, Alvin Sornum, Taha Al-Taei, Barbara Scoralick Villela, Maryam Omar, Faith Traeh, Abdulkarim Ekzayez, Clare Shortall, Eric Weerts
Shock is a life-threatening condition, defined by acute circulatory failure with multiple different causes. The initial management of shock is based on a generalised resuscitation approach, while the further specific management of the underlying insult causing shock should be taken from national and international guidelines. Early identification is crucial as initial effects are reversible. Without timely treatment, inadequate delivery of oxygen to tissues results in irreversible end organ dysfunction and potentially death.
Shock Management
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The state of shock is a temporary one—patients either improve or die. Shock can be viewed as a momentary pause on the way to death. It is during this pause that the trauma team must take the opportunity to prevent the further deterioration of the patient. Given the definition of shock, its detection is reliant upon monitoring the consequences of this pathology on certain physical signs.1 Furthermore, therapeutic intervention for shock must be aimed at restoring adequate oxygen delivery, rather than a normal blood pressure.
The pharmacotherapeutic options in patients with catecholamine-resistant vasodilatory shock
Published in Expert Review of Clinical Pharmacology, 2022
Timothy E. Albertson, James A. Chenoweth, Justin C. Lewis, Janelle V. Pugashetti, Christian E. Sandrock, Brian M. Morrissey
General classifications of shock include hypovolemic, cardiogenic, obstructive, and distributive shock. One of the most common types of circulatory shock is distributive or vasodilatory shock (VS). Classically, distributive, or VS is characterized by normal or increased cardiac output (CO) and a low systemic vascular resistance (SVR), leading to hypotension, organ hypoperfusion, inadequate delivery and utilization of oxygen, metabolic acidosis, and eventually organ failure. Causes of VS include vasoplegic syndrome after anesthesia or cardiopulmonary bypass (CPB), infection-related septic shock, severe adrenal insufficiency leading to shock, neurogenic shock, and allergin-induced or anaphylactic shock. Multiple mechanisms of shock may be coincidental. An example would be in severe sepsis, where VS can be coupled with cardiogenic shock either from a preexisting cardiomyopathy or from an infection-related cardiac effect.
Echis coloratus envenomation in children: a retrospective case series
Published in Clinical Toxicology, 2022
Miguel Glatstein, Liat Lerman, Dvir Gatt, Dennis Scolnik, Ayelet Rimon, Christopher Hoyte, Isaac Iazar
Echis coloratus is the second most common cause of venomous snakebite in Israel and the most common dangerous snakebite in the southern Negev desert of Israel. Thus, whenever a child from these geographical areas presents to the emergency department with a snakebite and coagulopathy, envenomation by this snake is suspected [12]. The differential diagnosis of other locally endemic venomous snakes (Vipera palastinae, Cerastes vipera, Cerastes gasperettii, Cerastes cerastes and Pseudocerastes fieldi) is important because different antivenoms exist and should be considered. We have admitted children with envenomation by all of these snakes (data not shown). All had the typical appearance and clinical presentation of snake envenomation with severe local pain, gradual swelling and edema of the affected limb towards the trunk, and sometimes necrosis at the bite site. Systemic signs included tachycardia, abdominal pain and vomiting, hypotension and even signs of hypovolemic shock. Thrombocytopenia and prolonged PT and PTT were common. However, none other than Echis coloratus envenomation presented with “non-clotting” coagulation blood tests (VICC).
Echocardiography in a critical care unit: a contemporary review
Published in Expert Review of Cardiovascular Therapy, 2022
Muhammad Mohsin, Muhammad Umar Farooq, Waheed Akhtar, Waqar Mustafa, Tanzeel Ur Rehman, Jahanzeb Malik, Taimoor Zahid
Shock can be a potentially life-threatening condition because it causes circulatory system failure leading to inadequate oxygen delivery to the body. The mortality associated with shock ranges between 15% and 56%. Four types of underlying mechanism are defined in the above manuscript which are responsible for pathophysiology of shock. Echocardiography is a portable, noninvasive, and inexpensive imaging modality that can be rapidly performed and interpreted in CCUs. These characteristics make echocardiography an important tool for the management of shock. A RACE assessment using 2D and M-mode echocardiography can promptly give an etiological diagnosis of sub-type of shock for a tentative line of treatment. A RACE should be performed immediately in a collapsed patient followed by a comprehensive echocardiographic assessment after stabilization.