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Successful Prolonged Resuscitation of Ventricular Fibrillation Arrest in a Patient With Acute Myocardial Infarction 1例急性心肌梗死患者心室颤动骤停的成功延长复苏
ICU director Pub Date : 2013-05-01 DOI: 10.1177/1944451613480813
Elie Harmouche, S. Kiblawi, Z. Ghazzal, G. A. Dagher
{"title":"Successful Prolonged Resuscitation of Ventricular Fibrillation Arrest in a Patient With Acute Myocardial Infarction","authors":"Elie Harmouche, S. Kiblawi, Z. Ghazzal, G. A. Dagher","doi":"10.1177/1944451613480813","DOIUrl":"https://doi.org/10.1177/1944451613480813","url":null,"abstract":"A 67-year-old man presented to the emergency department with symptoms of acute myocardial infarction. Electrocardiogram showed ST segment elevations in leads II, III, and AVF. While waiting for cardiac catheterization, he developed prolonged ventricular fibrillation lasting for 69 minutes, throughout which he was resuscitated as per the 2010 Advanced Cardiac Life Support protocol. The patient was transferred to the catheterization lab while undergoing active resuscitation, where a stent was placed in his right coronary artery. He was neurologically intact postcatheterization and discharged home on the sixth day of admission.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"132-135"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613480813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Toward a Better Etomidate 迈向更好的依托咪酯
ICU director Pub Date : 2013-04-23 DOI: 10.1177/1944451613485090
Joseph F. Cotten, D. Raines
{"title":"Toward a Better Etomidate","authors":"Joseph F. Cotten, D. Raines","doi":"10.1177/1944451613485090","DOIUrl":"https://doi.org/10.1177/1944451613485090","url":null,"abstract":"More than 45 years after its development, etomidate still sees widespread use as a hypnotic agent for single-dose sedation of critically ill and hemodynamically unstable patients. Potent and prolonged inhibition of cortisol synthesis by etomidate, even following single-dose administration, is controversial and a legitimate concern for clinicians. This article will briefly review etomidate pharmacology. It will also discuss some recent basic science and translational studies that have yielded several novel and clinically promising etomidate analogues designed to circumvent etomidate adrenal suppression.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"25 1","pages":"115-120"},"PeriodicalIF":0.0,"publicationDate":"2013-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613485090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65898102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adult Extracorporeal Membrane Oxygenation: An Update for Intensivists 成人体外膜氧合:强化医生的最新进展
ICU director Pub Date : 2013-04-04 DOI: 10.1177/1944451613480814
Aaron E. Barry, M. Brzezinski
{"title":"Adult Extracorporeal Membrane Oxygenation: An Update for Intensivists","authors":"Aaron E. Barry, M. Brzezinski","doi":"10.1177/1944451613480814","DOIUrl":"https://doi.org/10.1177/1944451613480814","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO), sometimes used interchangeably with extracorporeal life support, is a therapy that artificially supports pulmonary and/or cardiac organ systems. Venous blood is continuously withdrawn from a patient and passed across a membrane that can support both oxygenation and removal of carbon dioxide; blood is then reinfused back into the patient via venous or arterial access. A pump in the circuit can augment cardiac output, if necessary. Initial treatment with ECMO had discouraging outcomes, but recent experience with acute respiratory distress syndrome and the H1N1 influenza A pandemic in 2009 have led to a resurgence in popularity and additional research into this technique. At this time, treatment with ECMO is limited to highly specialized centers with well-trained practitioners. ECMO continues to be used primarily as a salvage technique in severe critical illness. This review will discuss the indications, complications, and types of ECMO. A guide to the clinical use...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"107-114"},"PeriodicalIF":0.0,"publicationDate":"2013-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613480814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Prolonged Refractory Hypotension Secondary to Amlodipine Overdose A Therapeutic Challenge 氨氯地平过量继发的长期难治性低血压:治疗挑战
ICU director Pub Date : 2013-03-20 DOI: 10.1177/1944451613481383
S. Kambali, R. Alalawi, K. Nugent
{"title":"Prolonged Refractory Hypotension Secondary to Amlodipine Overdose A Therapeutic Challenge","authors":"S. Kambali, R. Alalawi, K. Nugent","doi":"10.1177/1944451613481383","DOIUrl":"https://doi.org/10.1177/1944451613481383","url":null,"abstract":"Calcium channel blocker overdose is one of the leading causes of overdose death among cardiovascular medications. We present a patient with the highest reported dose of amlodipine ingestion in combination pill. She was asymptomatic initially and soon became hypotensive and obtunded. She was intubated for airway protection, gastric lavage was done, and activated charcoal was given. She was resuscitated with 4L 0.9% normal saline, calcium chloride, glucagon, insulin, and glucose infusions. Her hypotension worsened necessitating use of norepinephrine 200 µg/min, phenylephrine 200 µg/min, dopamine 50 µg/kg/min, and vasopressin 0.06 U/min concurrently. She continued to improve and was weaned off vasopressors and mechanical ventilation. Few cases of extremely high-dose ingestion have been reported. Patients may be normotensive but rapidly progress to shock depending on ingested dose. High doses are associated with shock, bradycardia, pulmonary edema, renal failure, and heart failure. The primary goal is to main...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"136-142"},"PeriodicalIF":0.0,"publicationDate":"2013-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613481383","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
A Preliminary Investigation on the Acceptance and Feasibility of Acupuncture in the Intensive Care Unit 针灸术在重症监护病房接受度及可行性的初步调查
ICU director Pub Date : 2013-03-01 DOI: 10.1177/1944451612472700
E. Yeh, J. Mirocha, Anna Brantman, Xiuling Ma, Yi Qiao, C. Merz, H. Jones
{"title":"A Preliminary Investigation on the Acceptance and Feasibility of Acupuncture in the Intensive Care Unit","authors":"E. Yeh, J. Mirocha, Anna Brantman, Xiuling Ma, Yi Qiao, C. Merz, H. Jones","doi":"10.1177/1944451612472700","DOIUrl":"https://doi.org/10.1177/1944451612472700","url":null,"abstract":"Objective . Acupuncture has been shown to decrease opioid requirements and respiratory distress in selected patients, and it may be helpful as an adjunctive therapy to sedatives and analgesics in the ICU. This pre- liminary study investigated the acceptance and feasibil- ity of acupuncture in the ICU. Design . Forty-eight patients in a 12-bed medical - surgical ICU at Cedars-Sinai Medical Center who met eligibility criteria were offered the opportu- nity to receive free-of-charge daily acupuncture treatments during their time in the ICU. Primary endpoints were per- centage of patients offered acupuncture who accepted treat- ment, the percentage of eligible days acupunc- ture therapy was received, and the incidence of adverse events related to acupuncture treatment. Main Results . Of the 48 patients who were eligible and offered acupuncture therapy, 20 (41%) patients enrolled in the study with an average age of 56 years (range = 18-91 years). The median and aver- age number of days which patients received acu- puncture was 2 and 3, respectively (range = 0-11 days), and a majority of patients (13/20) received acupuncture for each of the days for which they were eligible. One patient reported dizziness, which resolved spontaneously and was not associ- ated with hemodynamic changes. No other adverse effects occurred in a total of 64 acupuncture treat- ments. Conclusions . This preliminary study demon- strates that acupuncture therapy in the ICU is a fea- sible treatment modality. Further clinical trials are warranted to determine the effi cacy of acupuncture therapy as an adjunct to sedative and analgesics in critically ill patients.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"177 1","pages":"82-87"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612472700","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Integration of Cardiology and Cardiac Surgery in the Cardiovascular Intensive Unit Formation of a Multidisciplinary Approach on the Path to Building a High-Reliability Organization 心脏科与心外科在心血管重症监护室的整合形成多学科途径构建高可靠性组织
ICU director Pub Date : 2013-03-01 DOI: 10.1177/1944451612472505
Chad E. Wagner, J. Fredi, J. Mcpherson, C. Parmley
{"title":"Integration of Cardiology and Cardiac Surgery in the Cardiovascular Intensive Unit Formation of a Multidisciplinary Approach on the Path to Building a High-Reliability Organization","authors":"Chad E. Wagner, J. Fredi, J. Mcpherson, C. Parmley","doi":"10.1177/1944451612472505","DOIUrl":"https://doi.org/10.1177/1944451612472505","url":null,"abstract":"Background. In 2006, the Vanderbilt Heart and Vascular Institute significantly expanded its clinical operations, in part through the acquisition of cardiology, cardiac surgical, and vascular surgic...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"7 1","pages":"76-81"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612472505","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Improving Diagnostic Data Communication Processes for Better Patient Care and Hospital Efficiency 改进诊断数据通信流程，提高患者护理和医院效率
ICU director Pub Date : 2013-03-01 DOI: 10.1177/1944451613477455
C. Balmforth
{"title":"Improving Diagnostic Data Communication Processes for Better Patient Care and Hospital Efficiency","authors":"C. Balmforth","doi":"10.1177/1944451613477455","DOIUrl":"https://doi.org/10.1177/1944451613477455","url":null,"abstract":"When physicians order tests, the ability to ensure that they and their patients see the results in a timely manner can have a dramatic effect on patient care and satisfaction. Not only are delays inefficient for practitioners and health care organizations, but they can also be dangerous for patients. Relying on traditional delivery methods and recordkeeping practices no longer satisfies the demands of today’s regulatory requirements or of modern health care standards. Technology solutions available today can enable test results or alerts to be delivered quickly and completely to mobile or other communications devices. In most instances, complete test and image detail can be provided. The practitioner can then order treatment, initiate further consultations or tests, and even approve patient discharges from wherever he or she may be located. These systems also create a comprehensive audit trail, tracking receipt of test results and the response to the information. This article will discuss recent developme...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"28 1","pages":"53-61"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613477455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Cardiovascular Collapse in Anaphylaxis Successfully Treated With Vasopressin: Case Report and Review of Mechanism 抗利尿激素成功治疗过敏反应中的心血管衰竭:病例报告及机制回顾
ICU director Pub Date : 2013-02-25 DOI: 10.1177/1944451613477659
P. Weott
{"title":"Cardiovascular Collapse in Anaphylaxis Successfully Treated With Vasopressin: Case Report and Review of Mechanism","authors":"P. Weott","doi":"10.1177/1944451613477659","DOIUrl":"https://doi.org/10.1177/1944451613477659","url":null,"abstract":"In this report, we describe the case of a 52-year-old man who suffered a severe anaphylactic reaction in the operating room that was unresponsive to epinephrine. After an uneventful induction and intubation, he received antibiotics and was placed in the prone position. His blood pressure began to decline and despite escalating doses of phenylephrine, ephedrine, and then epinephrine, his pressure continued to deteriorate and became unobtainable. When all other resuscitative measures failed, a single dose of vasopressin 20 units was given intravenously; the patient had an immediate response with dramatic reversal of the cardiovascular collapse. He was then stabilized, transferred to the ICU, and subsequently discharged home without neurologic sequelae. In this article, we review the signs and symptoms of anaphylaxis seen in patients under anesthesia and consider the pathophysiologic mechanisms of the reaction that support the use of vasopressin.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"88-92"},"PeriodicalIF":0.0,"publicationDate":"2013-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613477659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Platelet Function Analysis Using PFA-100 Tests in Patients With Acute Gastrointestinal Bleeding: 急性消化道出血患者血小板功能的PFA-100检测分析
ICU director Pub Date : 2013-02-14 DOI: 10.1177/1944451612474037
Catherine Jones, R. Alalawi, Susan Doctolero, K. Nugent
{"title":"Platelet Function Analysis Using PFA-100 Tests in Patients With Acute Gastrointestinal Bleeding:","authors":"Catherine Jones, R. Alalawi, Susan Doctolero, K. Nugent","doi":"10.1177/1944451612474037","DOIUrl":"https://doi.org/10.1177/1944451612474037","url":null,"abstract":"Aim. To investigate platelet function in patients with acute gastrointestinal bleeding. Methods. We prospectively studied platelet function using the PFA-100 test in a convenience sample of patients with gastrointestinal bleeding admitted to the medical ICU from July 2010 to August 2011. Patients on warfarin or heparin were excluded. Results. In all, 41 patients (30 men) participated in the study. The mean age was 55 years (range 25-74 years). Most patients (31/41) presented with blood in their stools as at least one of their presenting symptoms. Fourteen of the 41 patients were on aspirin, 4 on nonsteroidal anti- inflammatory drugs, and 5 on clopidogrel or other antiplatelet drugs. The average hemoglobin was 9.2 g/dL (range 5.1-16.1 g/dL). The average platelet count was 170 kU/L (range 41-496 kU/L). The average international normalized ratio was 1.37(range 1.01-2.08). Analysis of platelet function was performed in 9 patients (22%). These patients had closure times which ranged from 98 to >300 seconds wit...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"72-75"},"PeriodicalIF":0.0,"publicationDate":"2013-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612474037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Health Perceptions and Behavior Changes in Survivors of the Acute Respiratory Distress Syndrome 急性呼吸窘迫综合征幸存者的健康认知和行为改变
ICU director Pub Date : 2013-02-13 DOI: 10.1177/1944451613475662
K. Almoosa, L. Goldenhar, E. Rubin, Mona Hanania
{"title":"Health Perceptions and Behavior Changes in Survivors of the Acute Respiratory Distress Syndrome","authors":"K. Almoosa, L. Goldenhar, E. Rubin, Mona Hanania","doi":"10.1177/1944451613475662","DOIUrl":"https://doi.org/10.1177/1944451613475662","url":null,"abstract":"Purpose. Improvements in the management of the acute respiratory distress syndrome (ARDS) have led to an increasing number of survivors who experience chronic adverse effects. Whether these survivo...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"65-71"},"PeriodicalIF":0.0,"publicationDate":"2013-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613475662","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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