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Shock in Trauma Patients
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Jeetinder Kaur Makkar, Mandeep Tundak
Arterial blood gas estimation – Normal pH is 7.4. Acidosis can be diagnosed if the base excess is less than –6 mmol/L. Higher mortality and morbidity were observed if the base deficit exceeded –6 mmol/L. Serum lactate > 4 mmol/L is an additional indicator of acidosis.
Diabetes
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
In addition to an assessment of airway, breathing and circulation, a bedside capillary test of blood sugar and ketones should be undertaken, although it should be noted that blood glucose levels may not necessarily be high23. Urine also needs to be tested for ketones and leukocytes. Significant ketones in the urine or from capillary blood are diagnostic for DKA. An arterial blood gas is indicated. Low bicarbonate, arterial pH ≤ 7.30 and an elevated base deficit are indicative of DKA24. In addition, a range of laboratory-based tests will be ordered: full blood count, renal function tests including electrolytes, septic screen, blood sugar and plasma ketones. To ascertain the cause of DKA all possible sites of infection (chest X-ray, urine microscopy, blood culture, wound swabs) need to be assessed. Other causes such as hyperemesis, noncompliance with medication and corticosteroid administration should be considered27,28. The woman is at risk of cardiac arrythmias due the electrolyte imbalance and therefore continuous cardiac monitoring is indicated. Rapid fluid replacement with crystalloids is required to correct dehydration, and IV insulin therapy is indicated to lower blood glucose. IV insulin therapy not only corrects the hyperglycaemia but also inhibits further production of keto acids. However, insulin administration can be problematic if the potassium levels are low. Potassium levels need to be checked and corrected immediately as hypokalaemia (low potassium) may cause fatal cardiac arrhythmias24.
Respiratory disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
If the patient is breathless or has reduced oxygen saturation, an analysis of arterial blood gases should be performed. Profound hypoxia out of proportion to the CXR findings should alert the clinician to the possibility of Pneumocystis infection.
Staphylococcus-induced proliferative glomerulonephritis and cerebral hemorrhage – fatal complications in a young female with postpartum cardiomyopathy and an implanted left ventricular assist device: a case report and review of the literature
Published in Acta Chirurgica Belgica, 2022
Carmen Elena Opris, Horatiu Suciu, Laura Banias, Cosmin Marian Banceu, Cosmin Opris, Marius Harpa, Mihaela Ispas, Simona Gurzu
Blood analysis revealed anemia (hematocrit 19%, hemoglobin 6.2 g/L, red blood cells 2.26 × 109/µL), normal leukocyte count (7880/µL), and normal platelet (PLT) count (290,000/µL). The anticoagulation treatment was effective, with an international normalized ratio (INR) of 2.22, a prothrombin time (PT) of 28.7 s, and a PT% of 31.7. Serum levels of thyroid hormones were also within the normal range: thyroid stimulating hormone (TSH) of 3.65 µUI/mL (normal range 0.27–4.20 µUI/mL) and FT4 of 1.34 ng/dL (normal range 0.82–1.77 ng/dL). The serum level of C-reactive protein was increased to 1.25 mg/dL (normal range < 0.5 mg/dL) and the erythrocyte sedimentation rate (ESR) was 28 mm/h. Arterial blood gas examination was normal. Urine analysis was positive for Escherichia coli. The blood culture was positive for methicillin-resistant Staphylococcus aureus (MRSA) (Table 1).
Acute epiglottitis is a rare clinical presentation of coronavirus disease 2019: a case report
Published in Infectious Diseases, 2022
Burak Gezer, Hakan Karabagli, Mert Sahinoglu, Ahmet Selim Karagoz
A 58-year-old woman presented to the neurosurgery outpatient clinic with headache and abnormal gait. Neurological examination showed ataxia. Magnetic resonance imaging revealed a heterogeneously enhancing tumour 3 × 3 cm in diameter with extensive peripheral edoema in the right temporal lobe. Since she had a history of cancer, a metastasis was suspected. She had not had any risky contact or previous COVID-19 and was hospitalised for surgical treatment. On postoperative day 6, she was scheduled for discharge but developed acute-onset respiratory distress, supraclavicular and intercostal withdrawal, and stridor. She had tachycardia, hypertension, and low oxygen saturation (85% in room air). Neurological examination was normal. An arterial blood gas analysis showed pH, 7.46, oxygen saturation 89.3%, partial pressure of carbon dioxide 37.9 mmHg and partial pressure of oxygen 60.9 mmHg. White blood cell count was 6,400/µL, C-reactive protein 35.4 mg/L and procalcitonin <0.05 µg/L. The ear, nose, and throat and chest disease departments were consulted. No specific findings of COVID-19 pneumonia were found on chest computed tomography. A SARS-CoV-2 polymerase chain reaction (PCR) test was recommended. Bronchoscopy showed finding consisten with acute epiglottitis. The SARS-CoV-2 PCR was positive. Neck computed tomography showed near-total airway obstruction due to severe edoema of the epiglottis and periepiglottis (Figure 1).
Elderly People with Dementia Admitted for COVID-19: How Different are They?
Published in Experimental Aging Research, 2022
Noel Roig-Marín, Pablo Roig-Rico
With regard to blood tests carried out at the Emergency Department (Table 5), patients with dementia presented greater leukocytosis, greater neutrophilia, greater number of platelets, higher levels of urea and CRP in a statistically significant way compared to patients without dementia. In contrast, patients without dementia had significantly higher LDH levels and significantly lower sodium values. Likewise, patients having dementia presented greater hypoalbuminemia. These laboratory changes could be due to the age and comorbidity of these patients. In an arterial blood gas test, no notable differences were observed (Table 5A). Hypoalbuminemia was related to a large effect size and its corrected p-value was significant. Leukocytosis, neutrophilia, platelets, sodium, and CRP were associated with a medium effect size and their corrected p-value was significant too. However, urea was considered to have a small effect size and its corrected p-value was no longer statistically significant. LDH was associated with a medium effect size, but its corrected p-value was also not significant (Table 5B).