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Respiratory
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Such patients require appropriate oxygenation with a pO2 aim of >8 kPa, and oxygen saturations between 94% and 98%. In view of sepsis, fluid resuscitation is paramount. As patients are likely to be immobile, venous thromboprophylaxis is key, with low-molecular-weight heparin. The initial chest X-ray should be repeated within 3 days if there has been no improvement in the clinical picture. Antibiotics are of course the mainstay form of treatment and are prescribed in accordance with the CURB-65 criteria (confusion, urea >7 mmol/L, respiratory rate >30 breaths/min, BP systolic <90 mmHg and/or diastolic <60 mmHg, age >65). Low severity, CURB-65 0–1: amoxicillinModerate severity, CURB-65 2: amoxicillin plus clarithromycin, or benzylpenicillin plus clarithromycinHigh severity, CURB-65 3–5: co-amoxiclav plus clarithromycin, typically intravenouslyAntibiotics are typically continued for up to 7 days in low- or moderate-severity cases and for up to 7–10 days for high severity.
Case 2
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
Consider IV vasopressor therapy – where adequate perfusion is not restored with IV fluid resuscitation. Noradrenaline is the preferred drug, as it is less likely to cause tachycardia (exacerbating hypotension) than dopamine and adrenaline
Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Once the need for fluid resuscitation has been identified, the following steps should be initiated: Give a fluid bolus of 500mL of crystalloid (containing sodium in the range 130–154mmol/L) over less than 15 minutes.Reassess the patient, using the ABCDE approach.If the patient still requires fluid resuscitation and has currently been given <2000mL of fluid, then another 250–500mL of crystalloid should be given and the patient reassessed. If 2000mL has already been given, expert advice needs to be sought.
Trends and recent developments in pharmacotherapy of acute pancreatitis
Published in Postgraduate Medicine, 2023
Juliana Hey-Hadavi, Prasad Velisetty, Swapnali Mhatre
Ringer’s lactate is recommended for initial fluid resuscitation in AP. Goal-directed IV fluid therapy with initial use of 5–10 ml/kg/h fluid is employed until resuscitation goals are achieved [41]. The preferred approach to assess the response to fluid resuscitation is based on one or more of the following: 1) fluid resuscitation response can be either as noninvasive clinical targets of heart rate <120/min, mean arterial pressure between 65 and 85 mmHg, and urinary output >0.5 to 1 mL; 2) invasive clinical targets of stroke volume variation, and intrathoracic blood volume determination; and 3) biochemical targets of hematocrit 35%–44% [40]. Importantly, early aggressive IV hydration should be provided to all patients except for those with cardiovascular and/or renal comorbidities [39].
COVID-19 infection and severe rhabdomyolysis
Published in Baylor University Medical Center Proceedings, 2021
Vishal Patel, Bashar Alzghoul, Saminder Singh Kalra
The case presented here is important in multiple aspects. First, COVID-19 can often present with nonspecific symptoms and therefore a high degree of vigilance is required to identify such cases. The patient had minimal respiratory symptoms during his primary care physician’s visit, and the possibility of COVID-19 infection was overlooked. Second, the management of severe rhabdomyolysis and COVID-19 can be challenging. In general, patients with severe rhabdomyolysis should receive aggressive fluid resuscitation to prevent acute kidney injury or to prevent further damage to an already compromised kidney, such as in our case. However, liberal fluid resuscitation may result in volume overload and worsen oxygenation, especially in patients with acute respiratory distress syndrome, and underresuscitation may lead to worsening renal function. Therefore, we suggest cautious fluid resuscitation while being vigilant about the urine output and oxygen requirement, as well as frequent physical examination to detect early signs of fluid overload.
Pulmonary complications of acute pancreatitis
Published in Expert Review of Respiratory Medicine, 2020
Hariharan Iyer, Anshuman Elhence, Saurabh Mittal, Karan Madan, Pramod Kumar Garg
Patients who have preexisting lung diseases can be affected either due to local complications like ascites or due to superimposed pleuro-pulmonary complications. Development of ascites due to AP can lead to basilar atelectasis. Patients with underlying chronic obstructive pulmonary disease can have hypoxia and hypercapnia due to inherent ventilation-perfusion (V/Q) mismatch. The development of atelectasis can further aggravate the V/Q mismatch and worsen hypoxia. Also, in patients with restrictive thoracic diseases like interstitial lung disease, there is a poor functional lung reserve. The development of complications like atelectasis or lung consolidation compromises the ventilation and leads to the rapid development of respiratory failure. In the presence of pulmonary hypertension, either primary or secondary, as a consequence of lung disease, fluid resuscitation should be guarded, else it may increase the risk of fluid overload and respiratory failure. In our opinion, this group of patients needs rigorous, intensive care monitoring. The patients may develop an exacerbation of their underlying pulmonary condition due to AP and require appropriate management.