Treatment of Hemothorax in the Era Of€The€Minimaly Invasive Surgery
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081999 Disseminated Intravascular Coagulation
The New England Journal of Medicine Current Concepts Systemic activation+ of coagulation DISSEMINATED INTRAVASCULAR COAGULATION Intravascular+ Depletion of platelets+ deposition of fibrin and coagulation factors MARCEL LEVI, M.D., AND HUGO TEN CATE, M.D. Thrombosis of small+ Bleeding and midsize vessels+ ISSEMINATED intravascular coagulation is and organ failure characterized by the widespread activation Dof coagulation, which results in the intravas- Figure 1. The Mechanism of Disseminated Intravascular Coag- cular formation of fibrin and ultimately thrombotic ulation. occlusion of small and midsize vessels.1-3 Intravascu- Systemic activation of coagulation leads to widespread intra- lar coagulation can also compromise the blood sup- vascular deposition of fibrin and depletion of platelets and co- agulation factors. As a result, thrombosis of small and midsize ply to organs and, in conjunction with hemodynam- vessels may occur, contributing to organ failure, and there may ic and metabolic derangements, may contribute to be severe bleeding. the failure of multiple organs. At the same time, the use and subsequent depletion of platelets and coag- ulation proteins resulting from the ongoing coagu- lation may induce severe bleeding (Fig. 1). Bleeding may be the presenting symptom in a patient with disseminated intravascular coagulation, a factor that can complicate decisions about treatment. TABLE 1. COMMON CLINICAL CONDITIONS ASSOCIATED WITH DISSEMINATED ASSOCIATED CLINICAL CONDITIONS INTRAVASCULAR COAGULATION. AND INCIDENCE Sepsis Infectious Disease Trauma Serious tissue injury Disseminated intravascular coagulation is an ac- Head injury Fat embolism quired disorder that occurs in a wide variety of clin- Cancer ical conditions, the most important of which are listed Myeloproliferative diseases in Table 1. -
Failure to Wean Caused by Cryptogenic Fibrosing Pleuritis and Bilateral Lung Trapping. Case Report*
RBTI Relato DE CASO 2007:19:4:504-508 Failure to Wean Caused by Cryptogenic Fibrosing Pleuritis and Bilateral Lung Trapping. Case Report* Falência do Desmame em Paciente com Fibrose Pleural Idiopática e Trapping Pulmonar Bilateral. Relato de Caso Elsemiek Verweel1, Jos le Noble, PhD1, Christine Groeninx-van Zoelen1, Alex Maat2, Willy Thijsse1, Patricia Gerritsen1, Jan Bakker, PhD3 RESUMO Unitermos: decorticação pleural, fibrose pleural, fibro- se pulmonar, Fibrotórax Idiopático. JUSTIFICATIVA E OBJETIVOS: Fibrose pleural idiopá- tica é uma doença rara e pode afetar ambos pulmões SUMMARY já desde uma idade precoce. O achado mais comum na fibrose pleural idiopática é uma restrição pulmonar BACKGROUND AND OBJECTIVES: Cryptogenic fi -- grave que pode levar a um quadro de falência respira- brosing pleuritis is an extremely rare disease, which tória e hipoxemia. can affect both lungs from a very young age. The most RELATO DO CASO: Paciente do sexo masculino, 26 common finding is severe lung restriction resulting in anos, internado com reagudização de insuficiência both hypoxemic and ventilatory failure. respiratória crônica e submetido à ventilação mecâni- CASE REPORT: Male patient, 26 year old with acu- ca prolongada. Após intensa investigação e uma apre- te deterioration of chronic respiratory failure. Follo- sentação clínica atípica, foi estabelecido o diagnóstico wing admission prolonged mechanical ventilation de fibrose pleural idiopática associado à fibrose pul- was necessary. An atypical clinical presentation monar. made the diagnosis difficult, but eventually cryp- CONCLUSÕES: O prognóstico de pacientes com fi- togenic fibrosing pleuritis and lung fibrosis were brose pleural idiopática é extremamente ruim, particu- established. larmente em fase avançada da doença. -
What Everyone Should Know to Stop Bleeding After an Injury
What Everyone Should Know to Stop Bleeding After an Injury THE HARTFORD CONSENSUS The Joint Committee to Increase Survival from Active Shooter and Intentional Mass Casualty Events was convened by the American College of Surgeons in response to the growing number and severity of these events. The committee met in Hartford Connecticut and has produced a number of documents with rec- ommendations. The documents represent the consensus opinion of a multi-dis- ciplinary committee involving medical groups, the military, the National Security Council, Homeland Security, the FBI, law enforcement, fire rescue, and EMS. These recommendations have become known as the Hartford Consensus. The overarching principle of the Hartford Consensus is that no one should die from uncontrolled bleeding. The Hartford Consensus recommends that all citizens learn to stop bleeding. Further information about the Hartford Consensus and bleeding control can be found on the website: Bleedingcontrol.org 2 SAVE A LIFE: What Everyone Should Know to Stop Bleeding After an Injury Authors: Peter T. Pons, MD, FACEP Lenworth Jacobs, MD, MPH, FACS Acknowledgements: The authors acknowledge the contributions of Michael Cohen and James “Brooks” Hart, CMI to the design of this manual. Some images adapted from Adam Wehrle, EMT-P and NAEMT. © 2017 American College of Surgeons CONTENTS SECTION 1 3 ■ Introduction ■ Primary Principles of Trauma Care Response ■ The ABCs of Bleeding SECTION 2 5 ■ Ensure Your Own Safety SECTION 3 6 ■ A – Alert – call 9-1-1 SECTION 4 7 ■ B – Bleeding – find the bleeding injury SECTION 5 9 ■ C – Compress – apply pressure to stop the bleeding by: ■ Covering the wound with a clean cloth and applying pressure by pushing directly on it with both hands, OR ■Using a tourniquet, OR ■ Packing (stuff) the wound with gauze or a clean cloth and then applying pressure with both hands SECTION 6 13 ■ Summary 2 SECTION 1: INTRODUCTION Welcome to the Stop the Bleed: Bleeding Control for the Injured information booklet. -
Pediatric Pulmonology
Received: 27 October 2019 | Accepted: 6 January 2020 DOI: 10.1002/ppul.24654 ORIGINAL ARTICLE: IMAGING Lung ultrasound—a new diagnostic modality in persistent tachypnea of infancy Emilia Urbankowska MD1 | Tomasz Urbankowski MD, PhD2 | Łukasz Drobczyński MD3 | Matthias Griese MD, PhD4 | Joanna Lange MD, PhD1 | Michał Brzewski MD, PhD5 | Marek Kulus MD, PhD1 | Katarzyna Krenke MD, PhD1 1Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Abstract Warsaw, Poland Lung ultrasound (LUS) has been increasingly used in diagnosing and monitoring of 2Department of Internal Medicine, various pulmonary diseases in children. The aim of the current study was to evaluate Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland its usefulness in children with persistent tachypnea of infancy (PTI). This was a 3Pediatric Radiology Department, Jan Polikarp controlled, prospective, cross‐sectional study that included children with PTI and Brudziński Pediatric Hospital, Warsaw, Poland healthy subjects. In patients with PTI, LUS was performed at baseline and then after 6 4Department of Pediatric Pneumology, Dr. von Hauner Children's Hospital, Ludwig‐ and 12 months of follow‐up. Baseline results of LUS were compared to (a) baseline Maximilians University, German Centre for high‐resolution computed tomography (HRCT) images, (b) LUS examinations in Lung Research (DZL), Munich, Germany ‐ 5Department of Pediatric Radiology, Medical control group, and (c) follow up LUS examinations. Twenty children with PTI were University of Warsaw, Warsaw, Poland enrolled. B‐lines were found in all children with PTI and in 11 (55%) control subjects ‐ Correspondence (P < .001). The total number of B lines, the maximal number of B lines in any Katarzyna Krenke, Department of Pediatric intercostal space, the distance between B‐lines, and pleural thickness were Pneumonology and Allergy, Medical University of Warsaw, Żwirki i Wigury 63A, significantly increased in children with PTI compared to controls. -
Using Tourniquets to Stop Bleeding
JAMA PATIENT PAGE | Trauma Using Tourniquets to Stop Bleeding After the April 15, 2013, Boston Marathon bombings, 27 patients with life-threatening bleeding were saved by placement of tourniquets by people at the scene. What Is a Tourniquet? Applying a tourniquet with a windlass device A tourniquet is a device that is placed around a bleeding arm or leg. Apply direct pressure 1 Place a 2-3” strip of material Tourniquets work by squeezing large blood vessels. The squeezing to the wound for about 2” from the edge helps stop blood loss. at least 15 minutes. of the wound over a long bone between the wound and the heart. Use a tourniquet only How Do I Put a Tourniquet On? when bleeding cannot be stopped and Tourniquets can be made out of any available material. For ex- is life threatening. ample, you can use a bandage, strip of cloth, or even a t-shirt. The material should be at least 2 to 3 inches wide. The material should also overlap itself. Using thin straps or material less than 2 inches wide can rip or cut the skin. Tourniquets often use a windlass device to increase tighten- 2 Insert a stick or other strong, straight ing. Inflated tourniquets (for example, those made from blood pres- item into the knot to act as a windlass. sure cuffs) can work well. But they must be carefully watched for small leaks. The injured blood vessel is not always right below the skin wound. Place the tourniquet between the injured vessel and the heart, about 2 inches from the closest wound edge. -
ER Guide to Bleeding Disorders
Bleeding disorders ER guide to bleeding disorders 1 Table of contents 4 General Guidelines 4–5 national Hemophilia Foundation guidelines 5–10 Treatment options 10 HemopHilia a Name:__________________________________________________________________________________________________ 10–11 national Hemophilia Foundation guidelines Address:________________________________________________________________________________________________ 12 dosage chart Phone:__________________________________________________________________________________________________ 14–15 Treatment products 16 HemopHilia B In case of emergency, contact: ______________________________________________________________________________ 16 national Hemophilia Foundation guidelines Relation to patient:________________________________________________________________________________________ 17 dosage chart 18 Treatment products 19 HemopHilia a or B with inHiBiTors Diagnosis: Hemophilia A: Mild Moderate Severe 20 national Hemophilia Foundation guidelines Inhibitors Inhibitors Bethesda units (if known) ____________________________________ 21 Treatment products Hemophilia B: Mild Moderate Severe 22–23 Von willeBrand disease Inhibitors Inhibitors Bethesda units (if known) ____________________________________ 23–24 national Hemophilia Foundation guidelines von Willebrand disease: Type 1 Type 2 Type 3 Platelet type 25 Treatment products 27 Bibliography Preferred product:_________________________________________________________________________________________ Dose for life-threatening -
Clinical Communications: Adults ARTICLE in PRESS
ARTICLE IN PRESS The Journal of Emergency Medicine, Vol. xx, No. x, pp. xxx, 2008 Copyright © 2008 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/08 $–see front matter doi:10.1016/j.jemermed.2007.12.023 Clinical Communications: Adults CHYLOTHORAX: A RARE COMPLICATION OF TUBE THORACOSTOMY Atikun Limsukon, MD,* Dennis Yick, MD, FCCP,†‡ and Nader Kamangar, MD, FACP, FCCP, FAASM†‡ *Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, †David Geffen School of Medicine at UCLA, Los Angeles, California, and ‡Division of Pulmonary, Critical Care and Sleep Medicine, Olive View-UCLA Medical Center, Sylmar, California Reprint Address: Atikun Limsukon, MD, 130 S.Flores St, Apt # 310, Los Angeles, CA 90048; E-mail: [email protected] e Abstract—Background: Chylothorax resulting from hiatus of the diaphragm to enter the posterior mediasti- chest tube injury to the thoracic duct is very rare and num. In the thorax, it continues cephalad in a rightward underreported. Objective: The purpose of this case report position where it lies to the right of the aorta, inclining to is to exemplify this rare but potentially significant compli- the left at approximately the level of the fifth thoracic cation of chest tube thoracostomy. Case Report: An 86- year-old woman presented with sepsis and a massive right vertebra, where it crosses over the vertebral column pleural effusion; she developed a chylous effusion with the behind the esophagus and continues in the left posterior pleural fluid triglyceride level of 158 mg/dL 2 days after a mediastinum. Entering the root of the neck, it turns traumatic chest tube insertion. -
Thrombocytopenia.Pdf
THROMBOCYTOPENIA DIFFERENTIAL DIAGNOSIS FALSELY LOW PLATELET COUNT In vitro platelet clumping caused by EDTA-dependent agglutinins Giant platelets COMMON CAUSES OF THROMBOCYTOPENIA Pregnancy (gestational thrombocytopenia, preeclampsia) Drug-induced thrombocytopenia (i.e., heparin, quinidine, quinine, and sulfonamides) Viral infections (ie. HIV, rubella, infectious mononucleosis) Hypersplenism due to chronic liver disease Dilutional (massive transfusion) OTHER CAUSES OF THROMBOCYTOPENIA Myelodysplasia Congenital thrombocytopenia Thrombotic thrombocytopenic purpura (TTP) -hemolytic-uremic syndrome (HUS) Chronic disseminated intravascular coagulation (DIC) Autoimmune diseases, such as systemic lupus erythematosus-associated lymphoproliferative disorders (CLL and NHL) Sepsis Idiopathic thrombocytopenic purpura (ITP)* DIFFERENTIAL FOR THROMBOCYTOPENIA BASED ON CLINICAL SETTING CLINICAL SETTING DIFFERENTIAL DIAGNOSES Cardiac surgery Cardiopulmonary bypass, HIT, dilutional thrombocytopenia, PTP Interventional cardiac Abciximab or other IIb/IIIa blockers, HIT procedure Sepsis syndrome DIC, ehrlichiosis, sepsis, hemophagocytosis syndrome, drug-induced, misdiagnosed TTP, mechanical ventilation, pulmonary artery catheters Pulmonary failure DIC, hantavirus pulmonary syndrome, mechanical ventilation, pulmonary artery catheters Mental status TTP, ehrlichiosis changes/seizures Renal failure TTP, Dengue, HIT, DIC, HUS Continuous hemofiltration HIT, consumption by filter and tubing Cardiac failure HIT, drug-induced, pulmonary artery catheter Post-surgery -
Ten Patient Stories Illustrating the Extraordinarily Diverse Clinical Features of Patients with Thrombotic Thrombocytopenic Purpura and Severe ADAMTS13 Deficiency
Journal of Clinical Apheresis 27:302–311 (2012) Ten Patient Stories Illustrating the Extraordinarily Diverse Clinical Features of Patients With Thrombotic Thrombocytopenic Purpura and Severe ADAMTS13 Deficiency James N. George,* Qiaofang Chen, Cassie C. Deford, and Zayd Al-Nouri Department of Biostatistics and Epidemiology, College of Public Health, Department of Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma Patients with thrombotic thrombocytopenic purpura (TTP) and severe ADAMTS13 deficiency are often consid- ered to have typical clinical features. However, our experience is that there is extraordinary diversity of the pre- senting features and the clinical courses of these patients. This diversity is illustrated by descriptions of 10 patients. The patients illustrate that ADAMTS13 activity may be normal initially but severely deficient in subse- quent episodes. Patients with established diagnoses of systemic infection as the cause of their clinical features may have undetectable ADAMTS13 activity. Patients may have a prolonged prodrome of mild symptoms with only microangiopathic hemolytic anemia and thrombocytopenia or they may have the sudden onset of critical ill- ness with multiple organ involvement. Patients may die rapidly or recover rapidly; they may require minimal treatment or extensive and prolonged treatment. Patients may have acute and severe neurologic abnormalities before microangiopathic hemolytic anemia and thrombocytopenia occur. Patients may have concurrent TTP and systemic lupus erythematosus. Patients may have hereditary ADAMTS13 deficiency as the etiology of their TTP rather than acquired autoimmune ADAMTS13 deficiency. These patients’ stories illustrate the clinical spectrum of TTP with ADAMTS13 deficiency and emphasize the difficulties of clinical diagnosis. J. Clin. -
Modern Management of Traumatic Hemothorax
rauma & f T T o re l a t a m n r e u n o t J Mahoozi, et al., J Trauma Treat 2016, 5:3 Journal of Trauma & Treatment DOI: 10.4172/2167-1222.1000326 ISSN: 2167-1222 Review Article Open Access Modern Management of Traumatic Hemothorax Hamid Reza Mahoozi, Jan Volmerig and Erich Hecker* Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany *Corresponding author: Erich Hecker, Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany, Tel: 0232349892212; Fax: 0232349892229; E-mail: [email protected] Rec date: Jun 28, 2016; Acc date: Aug 17, 2016; Pub date: Aug 19, 2016 Copyright: © 2016 Mahoozi HR. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Hemothorax is defined as a bleeding into pleural cavity. Hemothorax is a frequent manifestation of blunt chest trauma. Some authors suggested a hematocrit value more than 50% for differentiation of a hemothorax from a sanguineous pleural effusion. Hemothorax is also often associated with penetrating chest injury or chest wall blunt chest wall trauma with skeletal injury. Much less common, it may be related to pleural diseases, induced iatrogenic or develop spontaneously. In the vast majority of blunt and penetrating trauma cases, hemothoraces can be managed by relatively simple means in the course of care. Keywords: Traumatic hemothorax; Internal chest wall; Cardiac Hemodynamic response injury; Clinical manifestation; Blunt chest-wall injuries; Blunt As above mentioned the hemodynamic response is a multifactorial intrathoracic injuries; Penetrating thoracic trauma response and depends on severity of hemothorax according to its classification. -
Immune Thrombocytopenic Purpura (ITP) — Adult Conditions for Which Ivig Has an Established Therapeutic Role
Immune thrombocytopenic purpura (ITP) — adult Conditions for which IVIg has an established therapeutic role. Specific Conditions Newly Diagnosed Immune thrombocytopenic purpura (ITP) Persistent Immune thrombocytopenic purpura (ITP) Chronic Immune thrombocytopenic purpura (ITP) Evans syndrome ‐ with significant Immune thrombocytopenic purpura (ITP) ‐ adult Indication for IVIg Use Newly diagnosed ITP — initial Ig therapy ITP in pregnancy — initial Ig therapy ITP with life‐threatening haemorrhage or the potential for life‐threatening haemorrhage Newly diagnosed or persistent ITP — subsequent therapy (diagnosis <12 months) Refractory persistent or chronic ITP — splenectomy failed or contraindicated and second‐line agent unsuccessful Subsequent or ongoing treatment for ITP responders during pregnancy and the postpartum period ITP and inadequate platelet count for planned surgery HIV‐associated ITP Level of Evidence Evidence of probable benefit – more research needed (Category 2a) Description and Diagnostic Immune thrombocytopenic purpura (ITP) is a reduction in platelet count Criteria (thrombocytopenia) resulting from shortened platelet survival due to anti‐platelet antibodies, reduced platelet production due to immune induced reduced megakaryopoeisis and/or immune mediated direct platelet lysis. When counts are very low (less than 30x109/L), bleeding into the skin (purpura) and mucous membranes can occur. Bone marrow platelet production (megakaryopoiesis) is morphologically normal. In some cases, there is additional impairment of platelet function related to antibody binding to glycoproteins on the platelet surface. It is a common finding in patients with human immunodeficiency virus (HIV) disease, and while it may be found at any stage of the infection, its prevalence increases as HIV disease advances. Around 80 percent of adults with ITP have the chronic form of disease. -
Pulmonary Rehabilitation in Patients with Respiratory Disease
Kansas Journal of Medicine Pulmonary Rehabilitation Pulmonary Rehabilitation in Patients with Respiratory Disease Furqan Shoaib Siddiqi, M.D.1, Said Chaaban, M.D.2, Erin Petersen, M.S.N., A.P.R.N.3, K James Kallail, Ph.D.2, Mary Hope, B.H.S., A.R.T., R.R.T., C.P.F.T.3, Daniel Nichols, A.R.T., R.R.T., A.E.C.3 1University of Florida College of Medicine, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Jacksonville, FL 2University of Kansas School of Medicine-Wichita Department of Internal Medicine, Wichita, KS 3 Via Christi Hospital on St. Francis, Pulmonary Rehabilitation, Wichita, KS Abstract Background. Limited evidence suggests that pulmonary rehabilitation be included in the management of restrictive lung diseases. The purpose of this study was to document pulmonary rehabilitation outcomes in patients with respiratory diseases other than chronic obstructive pulmonary disease (COPD). Methods. Clinical outcomes of 31patients with respiratory diseases other than COPD and 190 patients with COPD, seen over a 35-month period, were reviewed retrospectively. Patients were evaluated for a 6-minute walk, arm curl strength, chair stand strength, the St. George’s Respiratory Questionnaire (SGRQ) total score, SGRQ symptom scores, SGRQ activity levels, and SGRQ impact of respiratory illness on the patient’s life. Outcome measures were obtained before the start of pulmonary rehabilitation and after a minimum of nine therapy visits. Results. Pre- and post-rehabilitation changes in the 6-minute walk, arm curl strength, chair stand strength, the St. George’s Respiratory Questionnaire (SGRQ) total score, SGRQ symptom scores, SGRQ activity levels, and SGRQ impact scores improved significantly for both groups.