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Patient Transfer
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
There is increasing evidence of the harm of over ventilation and oxygenation (hyperoxia). Evidence from the management of acute respiratory distress syndrome (ARDS) has clearly demonstrated the benefits of low tidal volume (Vt) (<6 mL/kg) based on ideal body weight and peak pressures below 30 cmH2O.21 It is worth noting that ideal body weight starts to plateau in males at around 100 kg and in females at 70 kg depending on which calculation is used.22 There is also evidence of benefit of lung-protective ventilation in other cohorts: a recent meta-analysis of intraoperative patients found a reduction in post-operative pneumonia if a low Vt (<8 mL/kg) and moderate to high PEEP > or equal to 5 cmH2O were used.23
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
There are multiple different factors that can impede optimal wound healing. These include wound infections which disturb the wound architecture and deter fibroblast-led healing. Also, poor oxygenation to the area which can occur from several different causes such as anaemia, respiratory illness, obesity and smoking. Important elements such as vitamin C, A and B6 are all important in collagen production. Finally, certain disease states actively work against adequate wound repair, which include diabetes and corticosteroid use.
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Acutely, patients presenting in AF required a detailed assessment to evaluate clinical status and deterioration risk. Triggering factors such as sepsis, anaemia, pulmonary embolism, electrolyte imbalance or hypoxaemia should be considered and addressed. Supplemental oxygenation may be necessary to maintain target oxygen saturation, treating hypoxaemia. Serum electrolytes should be replaced to keep within normal range, as they play a role in cardiac rhythm stability. Many patients present in AF with a tachycardia; NICE (2014) and ESC (2016b) have developed guidance, suggesting two essential treatment approaches: Rate control.Rhythm control.
Neutrophil extracellular traps promote cancer-associated inflammation and myocardial stress
Published in OncoImmunology, 2022
J. Cedervall, M. Herre, A. Dragomir, F. Rabelo-Melo, A. Svensson, C. Thålin, A. Rosell, V. Hjalmar, H. Wallén, H. Lindman, G. Pejler, E. Hagström, M. Hultström, A. Larsson, AK. Olsson
Echocardiography did not detect reduced function of the myocardium in PyMT+ mice compared to healthy littermates. However, increased cardiac output, myocardial hypertrophy and a trend toward higher heart rate was detected in PyMT+ mice. A possible explanation for the increased cardiac ouput could be an increased metabolic activity due to the tumor burden. Another potential explanation is reduced peripheral oxygenation. In support of the latter is our previous findings of reduced vascular perfusion of kidney and heart in PyMT+ mice compared to healthy littermates, which was reverted upon removal of NETs by DNase I treatment.19 Interestingly, a very recent study (published during revision of this manuscript) reports that NETs can cause immunothrombosis in the small vessels of the myocardium, leading to cardiac hypertrophy and dysfunction in a mouse model of angiotensin II-cardiomyopathy.60 DNase I treatment for 3 days did not affect the functional parameters measured by echocardiography in our study. It is, however, not unlikely that changes at the level of gene transcription are detected earlier and that a longer treatment period would be needed to alter functional parameters.
Quantification of Dermal Microcirculatory Changes after Topical Administration of Capsaicin: A Randomized Placebo-Controlled Study in 46 Subjects
Published in Journal of Investigative Surgery, 2022
Ruth Christine Schäfer, Anna Sohn, Anabel Kersten, Amro Amr, Manuel Held, Andrea Wenger
The percentage change in oxygenation levels after capsaicin incubation measured at points P1, P2 and P3 was compared to preincubation levels and visualized three dimensionally in Figure 1. Oxygenation at 2 mm depth showed a peak 30 min after incubation of 162% (SD 20%) compared to baseline and returned to preincubation level after 75–90 min. The increase at P1 was significant with a p-value 0.000 remaining significant until 90 min after incubation with p = 0.004. The deep measurement at 8 mm showed a significant peak of oxygenation at 144% (SD 9%) 30 min after incubation with significant values 15 (p = 0.00) to 60 (p = 0.022) minutes after incubation. A significant increase in oxygenation at P2 was apparent after 15 mins (p = 0.005) to 60 (p = 0.034) while at P3 the increase showed to be significant only after 30 min (p = 0.008). The measurements at 8 mm depth revealed significant increases of oxygenation at P1 after 15 (p = 0.000) to 60 (p = 0.022) minutes.
Acute chest syndrome of sickle cell disease: genetics, risk factors, prognosis, and management
Published in Expert Review of Hematology, 2022
Elizabeth S. Klings, Martin H. Steinberg
In addition to history and physical examination and the usual vital signs, assessment of oxygenation via pulse oximetry and/or arterial blood gas sampling is essential, particularly in adults. All patients with a clinical suspicion for ACS should have complete blood counts, reticulocyte count, renal and liver function testing and, depending on the clinical status, blood type and hold or crossmatch for possible transfusion. Blood cultures and other microbiologic workup for viral and atypical organisms can help guide the choice of antimicrobials that are nearly always given even in the absence of proven bacterial infection [52]. In adult patients, brain natriuretic peptide or N-terminal-pro brain natriuretic peptide levels are increased in both acute congestive heart failure and pulmonary embolism. Chest radiography is key to the diagnosis. The new infiltrate must involve at least one segment of a lobe to be diagnostic. Sometimes, radiologic evidence of atelectasis and linear scarring will be present; this is not consistent with a diagnosis of ACS yet might be responsible for some or all the observed hypoxia.