scholarly journals Severe Decompression Illness: Case Report, Prehospital Recognition, and Regional Transport Considerations

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Julie Estrada ◽  
David Meurer ◽  
Kevin De Boer ◽  
Karl Huesgen
Keyword(s):  
Early Recognition ◽  
Multiorgan Failure ◽  
Tertiary Care ◽  
Pulmonary Arteries ◽  
Kidney Injury ◽  
Decompression Illness ◽  
Arterial Blood Gas ◽  
Head Ct ◽  
Arterial Blood ◽  
Prehospital Emergency

A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system. No abnormality was seen on head CT and the patient had normal mental status. Prehospital nonrebreather oxygen therapy was changed to continuous positive airway pressure (CPAP) upon ED arrival, and the patient was intubated prior to transfer to a hyperbaric facility. However, within 24 hours the patient was found to have multiorgan failure, diffuse cerebral edema, and brain death despite no further episodes of hypotension or hypoxia. No intracranial gas was seen on repeat head CT. Our case demonstrates the importance of early recognition of decompression illness by EMS personnel, consideration of ground versus flight transportation of these patients to the nearest hyperbaric center, and the possible use of prehospital CPAP as an alternative to enhance oxygenation.

scholarly journals COVID-19 and Multiorgan Dysfunction Syndrome

2021 ◽  
Author(s):  
Jitendra D. Lakhani ◽  
Sajni Kapadia ◽  
Rohit Choradiya ◽  
Roop Preet Gill ◽  
Som J. Lakhani
Keyword(s):  
Organ Failure ◽  
Kidney Injury ◽  
Glycemic Variability ◽  
Multiple Organ ◽  
Organ Support ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Treatment Support ◽  
Laboratory Investigations ◽  
Hospital Acquired

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS.As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians.

scholarly journals A study of Acute Liver Failure in adults in a tertiary care hospital

2019 ◽  
Vol 5 (6) ◽  
pp. 204-207
Author(s):  
Dr. Mohini Singh ◽  
◽  
Dr. Srilakshmi Sathiyaseelan ◽  
Devarasetty Shashank ◽  
Dr. S.R. Ramakrishnan ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Arterial Blood ◽  
Function Test

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

P18 Plasma-lyte 148 vs 0.9% saline for fluid resuscition in children: electrolytic and clinical outcomes

2018 ◽  
Vol 103 (2) ◽  
pp. e1.22-e1 ◽  
Author(s):  
Wignell Andrew ◽  
Davies Patrick
Keyword(s):  
Clinical Outcomes ◽  
Kidney Injury ◽  
Fluid Volume ◽  
Lower Percentage ◽  
Clinical Effects ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Significant Difference ◽  
Resuscitation Fluid ◽  
Plasma Chloride

AimsCrystalloid fluid boluses are a mainstay of treatment in unwell children, with the traditional fluid of choice being 0.9% saline (NS). However, the use of NS has been associated with an increase in plasma chloride levels and acidosis, leading to kidney injury and other detrimental clinical effects. Plasma-Lyte 148 (PLA) is a balanced, physiological, crystalloid intravenous fluid, which is both calcium-free and isotonic. Its use in place of NS for fluid resuscitation may circumvent hyperchloraemic metabolic acidosis. In May 2015 our hospital altered its standard resuscitation fluid from NS to PLA. We aimed to compare the effect of fluid boluses of NS to those of PLA in children.MethodsAll patients admitted in the 18 month periods before and after the change from NS to PLA, and receiving a fluid bolus in the first 24 hours of admission, were included. Post-surgical patients and those who had undergone haemofiltration were excluded. Arterial blood gas and creatinine values for up to 5 days after bolus fluid administration were examined. Patients were stratified according to the total resuscitation volume (ml/kg), then split into categories determined by the balance of PLA vs. NS.The primary outcome was plasma chloride. Secondary outcomes included blood pH and percentage change in creatinine. Clinical outcomes were length of ventilation and length of PICU stay.Results126 patients were included in the analysis. Patients receiving NS boluses tended to have a higher maximum chloride, higher average chloride, lower pH and higher percentage creatinine increase than those given PLA. Subgroup analysis showed a statistically significant difference in average serum chloride for the 61–90 ml/kg group {PLA 105.59±1.29 vs NS 111.29±2.1 mmol/L; difference: −6.21 [95% confidence interval (CI)−9.55,–2.87]}. Patients who received PLA tended to have a higher pH than those receiving NS. A statistically significant difference was seen in the 10–30 ml/kg group [PLA 7.42±0.49 vs NS 7.33±0.65; difference: 0.0913 (95% CI: −0.18 to −0.02)].Significant differences were not seen in the clinical outcomes of length of stay or ventilationConclusionPLA as a resuscitation fluid is significantly associated with a more physiological plasma chloride and pH across several resuscitation fluid volume categories, when compared to NS. The trends in the other fluid volume categories are in line with these findings, but are not statistically significant. There was also a trend towards patients receiving PLA having a lower percentage rise in creatinine than those who received saline. These results were consistent over all weight and age categories.

scholarly journals 1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S540-S540
Author(s):  
Bhavana Surapareddy ◽  
Muralidhar Varma ◽  
Shashidhar V
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Early Recognition ◽  
Care Center ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Significant Difference ◽  
Serum Bicarbonate Level

Abstract Background Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis Methods This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis. Results A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%) Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75) Conclusion Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI Disclosures All authors: No reported disclosures.

scholarly journals Electrocardiographic features of hyperkalemia during acute kidney injury in a patient with pacemaker

2018 ◽  
Vol 12 (2) ◽  
pp. 145
Author(s):  
Alfonso Sforza ◽  
Federica De Pisapia ◽  
Giuliano De Stefano ◽  
Antonio Gaspardini ◽  
Maria Immacolata Arnone ◽  
...  
Keyword(s):  
Cardiac Activity ◽  
Kidney Injury ◽  
Blood Gas Analysis ◽  
Sine Wave ◽  
Gas Analysis ◽  
Acute Confusional State ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
History Of

We describe a case of a 79-year-old man with pacemaker who presented to the Emergency Department due to asthenia and acute confusional state. He had a history of atrial fibrillation, anemia and colostomy and he was on treatment with diuretics. The electrocardiogram (ECG) showed pacemaker-induced ventricular activity, QRS complexes excessively wide with sine-wave appearance, tall and peaked T waves, without electrically evident atrial activity. Potassium concentration on arterial blood gas analysis was 8.8 mmol/L. ECG abnormalities disappeared after therapy with calcium chloride and spontaneous cardiac activity reappeared.

A Clinical Study on Acute Kidney Injury in Cirrhotic Patients

2021 ◽  
Vol 8 (8) ◽  
pp. 420-424
Author(s):  
Sathish Obalanarasimhaiah ◽  
Kiran Shankar ◽  
Balakrishna Nanjundappa Setty ◽  
Gnanendra Dibbadahalli Mariyanna ◽  
Nagesh Nayakarahalli Swamigowda ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Acute Kidney Injury ◽  
Portal Hypertension ◽  
Hospital Admission ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Care Hospital ◽  
Age Group ◽  
Arterial Blood

BACKGROUND The increased propensity for acute kidney injury (AKI) in patients with cirrhosis stems from haemodynamic abnormalities typical for patients with cirrhosis and ascites. 15 which is due to development of portal hypertension and portosystemic collaterals with splanchnic and systemic vasodilatation, resulting in decrease in effective arterial blood volume with increase in renin angiotensin-aldosterone system (RAAS), sympathetic nervous system and non-osmotic release of antidiuretic hormone causing sodium retention, increased intravascular volume, and a hyperdynamic circulatory state, 16 complemented with increased production of nitric oxide which is considered the main cause of vasodilatation in cirrhosis. Mechanism of renal dysfunction in cirrhosis includes portal hypertension & its accompanying haemodynamic abnormalities15 leading to increased synthesis of endogenous vasodilatory compounds such as nitric oxide leading to vasodilatation in splanchnic & systemic arterial systems ultimately leading to activation of reninangiotensinogen–aldosterone system causing compensatory renal vasoconstriction & hypo-perfusion resulting into renal failure. We wanted to study the clinical profile of patients with AKI who presented to a tertiary care hospital in Bangalore. METHODS Ninety-four patients of either gender admitted in the department of gastroenterology at a tertiary care hospital with age > 18 years with either diagnosed or newly diagnosed case of cirrhosis of liver (including both compensated & decompensated cases) admitted with acute kidney injury diagnosed according to International Club of Ascites Classification were enrolled in this study. The sample size was based on number of eligible patients admitted to tertiary care hospital during the study period. Details of the study were explained to them and consent was taken either from the patient or their attender. RESULTS Most patients were in the age group > 60 yrs. with 32 male patients (45.07 %) in the age group of 40 - 60 years & 13 female patients (56.52 %) in the age group of > 60 yrs. 78.7 % of patients developed AKI before hospital admission i.e., at community level; whereas 21.3 % of patients developed AKI after hospital admission i.e., they had normal creatinine level on admission. CONCLUSIONS Pre renal AKI was the most common cause of AKI followed by hepatorenal syndrome & acute tubular necrosis (ATN) comprising 52.1 %, 28.7 % & 19.1 % respectively. KEYWORDS AKI, Cirrhosis, ATN

scholarly journals Severe Hypertriglyceridaemia Leading to Factitious Hypobicarbonataemia

2021 ◽  
Author(s):  
Sasmit Roy ◽  
Mohammed Ashraf ◽  
Satbyul Sophia Kang ◽  
Raul Ayala ◽  
Sreedhar Adapa
Keyword(s):  
Laboratory Finding ◽  
Kidney Injury ◽  
Blood Gas Analysis ◽  
Blood Chemistry ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Large Molecules ◽  
Arterial Blood ◽  
Lipid Panel ◽  
Arterial Blood Gas Analysis

Anion gap metabolic acidosis is a laboratory finding commonly encountered in patients with sepsis, diabetic ketoacidosis, acute kidney injury and toxic alcohol ingestion. Serum blood chemistry assessment detects this abnormality. However, this can be falsely low in situations of high triglyceride levels due to lipid interference with measurement of the bicarbonate levels and through volume displacement by these large molecules. Arterial blood gas analysis and a lipid panel are required to confirm accurate bicarbonate levels. Clinicians handling acid-base disorders in hospitalized patients need to be aware of this spurious laboratory value to avoid unnecessary tests and to determine accurate total bicarbonate levels.

Respiratory assessment and care

2020 ◽  
pp. 13-55
Author(s):  
Daren Briscoe
Keyword(s):  
Respiratory Function ◽  
Respiratory Symptoms ◽  
Early Recognition ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Support Mechanisms ◽  
Respiratory Conditions

Respiratory conditions are a common complication for the acutely ill patient. Early recognition of the onset of a respiratory crisis is fundamental to prevent further deterioration of the acutely ill patient. This chapter provides a discussion of the respiratory system and the physiological mechanisms which control respiratory function with a useful overview of common respiratory symptoms. The principles of arterial blood gas analysis, respiratory support mechanisms, and tracheostomy care precedes a discussion of three commonly encountered respiratory disorders; asthma, COPD, and pneumonia, with focus upon nursing and medical support to support patients with these acute illnesses. A large proportion of emergency admissions to acute care wards are due to these diseases and thus a good understanding of the assessment and management of these conditions is essential.

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