496 results on '"hypovolemic shock"'
Search Results
452. Cholera
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Kreutner, A. Karen and Gleicher, Norbert, editor
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- 1985
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453. Hypertonic saline dextran alleviates hepatic injury in hypovolemic rats undergoing porta hepatis occlusion
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Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı., Özgüç, Halil, Tokyay, Rifat, Kahveci, Nevzat, Serdar, Zehra, Gür, Esma Sürmen, AAG-7070-2021, and AAG-7327-2021
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Male ,Hypovolemia ,Antioxidants ,Rats, Sprague-Dawley ,Lactated ringers solution ,Fluid therapy ,Ischemia ,Malondialdehyde ,Alanine transaminase ,Hypertonic saline Dextran ,Ischemia-reperfusion ,Sodium Chloride ,Hemorrhagic Shock ,Intracranial Hypertension ,Malonaldehyde ,Dextrans ,Hematology ,Glutathione ,MLCS ,MLOWN ,Reperfusion injury ,Sprague dawley rat ,Blood ,Liver ,Hemorrhagic shock ,Hypertonic saline dextran solution ,Portal vein ,Antioxidant ,Lactated Ringer's ,Blood-flow ,Resuscitation ,Sodium chloride ,Lipid peroxidation ,Ischemia-reperfusion injury ,Saline solution, hypertonic ,Trauma ,Article ,Shock, hemorrhagic ,Animals ,Critical care medicine ,Dextran ,Hemostasis ,Animal ,Vascularization ,Hypertonic saline-dextran solution ,General and internal medicine ,Hypovolemic shock ,Hepatic artery ,Cardiovascular system and cardiology ,Rats ,Hemorrhagic-shock ,Oxidative stress ,Leukocyte adhesion ,Peripheral vascular disease ,Alanine aminotransferase ,Rat ,Surgery ,Hemostatic techniques ,Neutrophil activation - Abstract
To monitor the ischemic and/or reperfusion injury after porta hepatis occlusion (Pringle maneuver) in livers subjected to hypotension, serum alanine amino transferase (ALT), liver malondialdehyde, (MIDA), and liver glutathione (GSH) levels were measured. MDA is a by-product of oxidant-induced lipid peroxidation, and GSH is an endogenous antioxidant. The effects of lactated Ringer's (LR) and hypertonic saline (7.5%)/Dextran (6%; HSD) resuscitation on liver injury, if any, was investigated. Rats in sham (S, n = 8) and five other groups (n = 8) underwent femoral artery and vein catheterization and laparotomy. The hemorrhage and ischemia (HI) group was bled 30% of their blood volume and had their porta hepatis occluded for 30 min. The HI, LR, and HSD groups underwent both hemorrhage and occlusion. Thirty minutes after hemorrhage, the LR and HSD groups received either LR (equivalent to three times the shed blood) or HSD (10 mL/kg) resuscitation over 30 min. Both LR and HSD resuscitation lowered the increased ALT and liver tissue MDA seen in the HI group. ALT was decreased from 348 +/- 93 IU/L in the HI group to 200 +/- 98 IU/L in the LR and 139 +/- 74 IU/L in the HSD groups. Liver tissue MDA was 353 +/- 22 nmol/g/tissue in the HI group and LR decreased it to 261 +/- 17 nmol/g/tissue, whereas HSD decreased it to 273 +/- 20 nmol/g/tissue. The decrease in ALT and the increase in liver GSH were more pronounced with HSD resuscitation (P < 0.05). HSD seems to be more effective than LR in decreasing the liver tissue damage produced by total hepatic inflow occlusion under hypovolemic conditions.
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- 2003
454. Inspiratory Resistance Maintains Arterial Pressure During Central Hypovolemia: Implications For Treatment Of Combat Casualties With Severe Hemorrhage
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ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX, Convertino, Victor A., Ryan, Kathy L., Richards, Caroline A., Holcomb, John B., Cooke, William H., Idris, Ahamed H., Metzger, Anja, Lurie, Keith G., Adams, Bruce D., ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX, Convertino, Victor A., Ryan, Kathy L., Richards, Caroline A., Holcomb, John B., Cooke, William H., Idris, Ahamed H., Metzger, Anja, Lurie, Keith G., and Adams, Bruce D.
- Abstract
Loss of consciousness due to central hypovolemia can occur due to sudden cardiovascular decompensation in normal individuals or hypovolemic shock in wounded patients. A variety of devices have been developed to sustain perfusion to the brain including anti-G suits worn by pilots and returning astronauts and applied to patients as shock trousers. However, all countermeasures developed to date suffer from problems that limit their utility in the field. An impedance threshold device (ITD) has recently been developed that acutely increases central blood volume by forcing the thoracic muscles to develop increased negative pressure, thus drawing venous blood from extrathoracic cavities into the heart and lungs. We review here a series of experiments that demonstrate the application of the ITD to a variety of experimental conditions, including its use to: (a) increase heart rate, stroke volume, and arterial blood pressure in normovolemia and hypovolemia; (b) increase cerebral blood flow velocity; (c) reset cardiac baroreflex function to a higher operating range for blood pressure; (d) lower intracranial pressure; and (e) reduce orthostatic symptoms. In this brief review, we present evidence that supports further consideration of using inspiratory resistance as a countermeasure against circulatory collapse associated with orthostatic instability and hemorrhagic shock., See also ADM002075., The original document contains color images.
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- 2006
455. Esophageal capnometry during hemorrhagic shock and after resuscitation in rats
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Totapally, Balagangadhar R, Fakioglu, Harun, Torbati, Dan, and Wolfsdorf, Jack
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Endpoint Determination ,Partial Pressure ,Resuscitation ,hypovolemic shock ,Acid-Base Imbalance ,Shock, Hemorrhagic ,Rats, Sprague-Dawley ,Esophagus ,hemorrhagic hypotension ,Humans ,Animals ,skin and connective tissue diseases ,sublingual capnometry ,Acid-Base Equilibrium ,tonometry ,tissue hypoxia ,capnometry ,Blood Volume Determination ,Research ,carbon dioxide ,esophageal luminal PCO2 ,Arteries ,base excess ,Rats ,base deficit ,trauma ,Commentary ,esophageal capnometry ,Wounds and Injuries ,sense organs ,Blood Gas Analysis ,Hypotension ,hemorrhage ,Biomarkers - Abstract
Background Splanchnic perfusion following hypovolemic shock is an important marker of adequate resuscitation. We tested whether the gap between esophageal partial carbon dioxide tension (PeCO2) and arterial partial carbon dioxide tension (PaCO2) is increased during graded hemorrhagic hypotension and reversed after blood reinfusion, using a fiberoptic carbon dioxide sensor. Materials and method Ten Sprague–Dawley rats were anesthetized, tracheotomized, and cannulated in one femoral artery and vein. A calibrated fiberoptic PCO2 probe was inserted into the distal third of the esophagus for determination of luminal PeCO2 during maintained anesthesia (pentobarbital 15 mg/kg per hour), normothermia (38 ± 0.5°C), and fluid balance (saline 5 ml/kg per hour). Three out of 10 rats were used to determine the limits of hemodynamic stability during gradual hemorrhage. Seven of the 10 rats were then subjected to mild and severe hemorrhage (15 and 20–25 ml/kg, respectively). Thirty minutes after severe hemorrhage, these rats were resuscitated by reinfusion of the shed blood. Arterial gas exchange, hemodynamic variables, and PeCO2 were recorded at each steady-state level of hemorrhage (at 30 and 60 min) and after resuscitation. Results The PeCO2–PaCO2 gap was significantly increased after mild and severe hemorrhage and returned to baseline (prehemorrhagic) values following blood reinfusion. Base deficit increased significantly following severe hemorrhage and remained significantly elevated after blood reinfusion. Significant correlations were found between base deficit and PeCO2–PaCO2 (P < 0.002) and PeCO2 (P < 0.022). Blood bicarbonate concentration decreased significantly following mild and severe hemorrhage, but its recovery was not complete at 60 min after blood reinfusion. Conclusion Esophageal–arterial PCO2 gap increases during graded hemorrhagic hypotension and returns to baseline value after resuscitation without complete reversal of the base deficit. These data suggest that esophageal capnometry could be used as an alternative for gastric tonometry during management of hypovolemic shock.
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- 2002
456. Isquemia e reperfusão hepática total associada ao estado de choque hemorrágico controlado: efeitos no seqüestro de neutrófilos no íleo terminal e cólon sigmóide do rato
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Fontelles, Mauro José and Mantovani, Mario
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Isquemia ,Choque Hipovolêmico ,Neutrófilos ,Ischemia ,Reperfusion ,Neutrophil ,Hypovolemic shock ,Reperfusão ,Pringle's maneuver ,Manobra de Pringle - Abstract
OBJETIVO: Estudar os efeitos da isquemia e reperfusão hepática total sobre acúmulo de neutrófilos no íleo terminal e cólon sigmóide de ratos, em condições de normalidade e submetidos ao estado de choque hemorrágico controlado. MÉTODO: 32 ratos Wistar, machos, foram divididos em quatro grupos de oito animais cada: grupo Sham, submetido aos procedimentos padrões com um período de 60 minutos de observação; grupo Choque, submetido a choque hemorrágico controlado (PAM = 40mmHg, 20min) seguido de reposição volêmica (Ringer lactato + sangue, 3:1) e reperfusão (60min); grupo Pringle, submetido à isquemia hepática total (15min.) e reperfusão (60min); grupo Total submetido a choque hemorrágico controlado (20min) seguido de reposição volêmica (Ringer lactato + sangue, 3:1), isquemia hepática (15min) e reperfusão (60min). Após o sacrifício dos animais, procedeu-se à contagem de neutrófilos nos segmentos intestinais. RESULTADOS: Na contagem de neutrófilos no íleo terminal, apenas o grupo Choque diferiu dos demais (p
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- 2002
457. Isquemia e reperfusão hepática total associada ao estado de choque hemorrágico controlado: efeitos no seqüestro de neutrófilos no pulmão do rato
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Mauro José Fontelles, Lucélia Rita Gaudino Caputo, Rosana Celestina Morandin, Elcio Shiyoiti Hirano, André Almeida Schenka, and Mario Mantovani
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Resuscitation ,Neutrófilos ,RD1-811 ,Adult male ,lcsh:Surgery ,Pringle’s maneuver ,Ischemia ,medicine ,Experimental work ,Lung ,business.industry ,Neutrophil ,Hypovolemic shock ,lcsh:RD1-811 ,Choque hipovolêmico ,Hepatic ischemia ,Isquemia ,medicine.anatomical_structure ,Anesthesia ,Shock (circulatory) ,Hemorrhagic shock ,Reperfusion ,Reperfusão ,Surgery ,medicine.symptom ,business ,Lung tissue ,Manobra de Pringle - Abstract
OBJETIVO: Estudar os efeitos da isquemia e reperfusão hepática total sobre acúmulo de neutrófilos no interstício pulmonar de ratos, em condições de normalidade e submetidos ao estado de choque hemorrágico controlado. MÉTODOS: 32 ratos Wistar, machos, foram divididos em quatro grupos de oito animais cada: grupo Sham, submetido aos procedimentos padrões com um período de 60 minutos de observação; grupo Choque, submetido a choque hemorrágico controlado (PAM = 40 mmHg, 20 min.) seguido de reposição volêmica (Ringer lactato + sangue, 3:1) e reperfusão (60 min.); grupo Pringle, submetido a isquemia hepática total (15 min.) e reperfusão (60 min.); grupo Total submetido a choque hemorrágico controlado (15 min.) seguido de reposição volêmica (Ringer lactato + sangue, 3:1) e reperfusão (60 min.). Após o sacrifício dos animais, procedeu-se à contagem de neutrófilos no interstício pulmonar. RESULTADOS: Os valores encontrados para contagem de neutrófilos no interstício pulmonar indicaram que, os animais dos grupos Pringle, Total e, também, do grupo Choque, não diferiram dos animais do grupo Sham com valores de (Sham 21,08± 14,12; Choque 35,15± 18,74; Pringle 19,78± 15,38; Total 23,90± 16,37) (p=0.253) CONCLUSÃO: Em ratos submetidos a estado de choque hemorrágico controlado associado a isquemia hepática de 15 minutos, seguida de 60 minutos de reperfusão, não ocorreu acúmulo significativo de neutrófilos no interstício pulmonar. OBJECTIVE: The purpose of this experimental work was to study the effects of total hepatic ischemia and reperfusion on the accumulation of neutrophils in the lung of rats, under normal conditions and submitted to controlled hemorrhagic shock state. METHODS: thirty two adult male Wistar rats, were divided into four groups: the Sham group, was submitted to the standard procedures for a period of 60 min. of observation; Shock group, was submitted to controlled hemorrhagic shock (PAM=40 mmHg, 20 min.) followed by volemic resuscitation (lactated Ringer’s solution + blood, 3:1) and reperfusão for 60 min.; Pringle group, was submitted to total hepatic ischemia for 15 min. and reperfusão for 60 min.; The Total group, was submitted to controlled hemorrhagic shock for 15 min. followed by volemic resuscitation (lactated Ringer’s solution + blood, 3:1) and reperfusão for 60 min.). The counting of neutrophils on the lung tissue was performed after the euthanasia of animals. RESULTS: The values found for the counting of neutrophils on the lung tissue indicate that the animals from the Pringle, Total, and Shock groups, did not differ from the Sham group, having the following values: Sham, 21,08± 14,12; Shock, 35,15± 18,74; Pringle, 19,78± 15,38; Total, 23,90± 16,37) (p=0.253). CONCLUSION: Rats submitted to controlled hemorrhagic shock state associated to total hepatic ischemia for 15 minutes, followed by 60 minutes of reperfusion, did not present significant neutrophils accumulation on the lung tissue.
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- 2002
458. Hypovolemic shock as a presenting sign of severe ovarian hyperstimulation syndrome following in vitro fertilization and embryo transfer (IVF-ET)
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Goldchmit, R., Elchalal, U., Zalel, Y., Barash, A., Borenstein, R., and Insler, V.
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- 1993
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459. Effect of verapamil on activity of Ca2+,Mg2+-dependent endonucleases in dog liver nuclei in long-term hypovolemic shock
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Kozhura, V. L., Smirnova, N. V., and Novoderzhkina, I. S.
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- 1991
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460. Fluid resuscitation after traumatic brain injury with hypovolemic shock: Still a bloody business?
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Plesnila, Nikolaus
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HEMOGLOBINS , *RESUSCITATION , *HEMORRHAGIC shock , *LABORATORY rats - Abstract
The author comments on the study by Shellington et al which investigated the effectiveness of polynitroxylated pegylated hemoglobin (PNP-Hb) for fluid resuscitation of traumatic patients with hemorrhagic shock in rats. He stresses that the strength of the study includes the use of the combined in vitro and in vivo approach, experimental technique in vivo, the experimental protocol and the use of relevant control compounds. He also cites the weak points of the study including the lack of insight into the neuroprotective mechanisms of PNP-Hb.
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- 2011
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461. hypovolemic shockの状態で搬送された産婦人科出血の2症例
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- 1999
462. Abdominal computed tomographic findings in adults with hypovolemic shock
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Michele Scialpi, Lorenzo E. Derchi, Orlando Catalano, Giandomenico Stellacci, Giuseppe Angelelli, Antonio Rotondo, and Roberto Grassi
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Resuscitation ,medicine.medical_specialty ,business.industry ,hypovolemic shock ,CT ,Computed tomographic ,Contrast medium ,Renal abnormalities ,Shock (circulatory) ,Emergency Medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,sense organs ,Radiology ,medicine.symptom ,business ,Abdominal vessels - Abstract
The clinical charts and contrast mediumenhanced computed tomographic (CT) examinations of 15 adults with a history of serious shock and resuscitation were reviewed. Several hypovolemia-related abnormalities were recognizable and were variably associated with each other. Diminished caliber of the abdominal vessels with intense vascular contrast medium enhancement and renal abnormalities were the most common findings; decreased and/or increased enhancement of the abdominal organs and other hypovolemic changes were also present.
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- 1997
463. Collaborative Strategies for Management of Obstetric Hemorrhage.
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Kennedy BB and McMurtry Baird S
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- Critical Care Nursing, Female, Humans, Hypovolemia, Obstetric Labor Complications blood, Pregnancy, Risk Factors, Uterine Hemorrhage epidemiology, Uterine Hemorrhage prevention & control, Maternal Mortality, Obstetric Labor Complications therapy, Uterine Hemorrhage therapy
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Obstetric hemorrhage is a significant cause of perinatal morbidity and mortality that requires prompt recognition and collaborative intervention to prevent poor outcomes. Medical and surgical management goals include controlling bleeding, supporting tissue oxygenation and perfusion, and monitoring for coagulopathies and complications., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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464. Understanding fluid administration approaches in children with co-morbidities and septic shock.
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Kissoon N
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- Child, Comorbidity, Humans, Resuscitation, Fluid Therapy, Shock, Septic
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- 2017
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465. Experience in the use of non-pneumatic anti-shock garment (NASG) in the management of postpartum haemorrhage with hypovolemic shock in the Fundación Valle Del Lili, Cali, Colombia.
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Escobar MF, Füchtner CE, Carvajal JA, Nieto AJ, Messa A, Escobar SS, Monroy AM, Forero AM, Casallas JD, Granados M, and Miller S
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- Adolescent, Adult, Colombia epidemiology, Emergencies, Female, Humans, Hypovolemia epidemiology, Motion Therapy, Continuous Passive instrumentation, Motion Therapy, Continuous Passive methods, Obstetric Surgical Procedures methods, Postpartum Hemorrhage epidemiology, Pregnancy, Pregnancy Outcome epidemiology, Retrospective Studies, Shock epidemiology, Young Adult, Clothing, Gravity Suits, Hypovolemia therapy, Obstetric Surgical Procedures instrumentation, Postpartum Hemorrhage therapy, Shock therapy
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Background: The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals., Methods: Descriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application., Results: Fifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour and 100% within the first 6 h; 100% had a SI < 1.0 in the first hour. The NASG was not removed until definitive control of bleeding was achieved, with an average time of use of 24 h. There were no mortalities., Conclusions: In this case series of women in severe shock, the NASG was an effective management device for the control of severe hypovolemic shock. It should be considered a first-line option for shock management.
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- 2017
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466. "Cannot ventilate, cannot intubate" situation after penetration of the tongue root through to the epipharynx by a surfboard: a case report.
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Ono Y, Kunii M, Miura T, and Shinohara K
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- Adult, Cricoid Cartilage, Critical Care, Humans, Intubation, Intratracheal methods, Male, Neck Injuries physiopathology, Thyroid Gland, Treatment Outcome, Wounds, Penetrating physiopathology, Emergency Treatment instrumentation, Emergency Treatment methods, Intubation, Intratracheal instrumentation, Neck Injuries therapy, Tongue injuries, Tracheotomy methods, Water Sports injuries, Wounds, Penetrating therapy
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Background: Surfing is an increasingly popular activity and surfing-related injuries have increased accordingly. However, to the best of our knowledge, there are no reports of penetrating upper airway injuries in surfers. We present a "cannot ventilate, cannot intubate" situation following penetrating neck injury by a surfboard fin., Case Presentation: A previously healthy 29-year-old Japanese man was swept off his board by a large wave and his left mandible, tongue root, and right epipharynx were penetrated by the surfboard fin. He presented with severe hypovolemic shock because of copious bleeding from his mouth. Direct laryngoscopy failed, as did manual ventilation, because of the exacerbated upper airway bleeding and distorted upper airway anatomy. Open cricothyrotomy was immediately performed, followed by surgical exploration, which revealed extensive ablation of his tongue root and laceration of his lingual artery. After definitive hemostasis and intensive care, he returned home with no sequelae., Conclusions: The long, semi-sharp surfboard fin created both extensive crushing upper airway lesions and a sharp vascular injury, resulting in a difficult airway. This case illustrates that surfing injuries can prompt a life-threatening airway emergency and serves as a caution for both surfers and health care professionals.
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- 2017
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467. Hypovolemic Shock and Hemoperitoneum from Spontaneous Avulsion of a Large Pedunculated Uterine Leiomyoma.
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Mizrahi DJ, Kaushik C, and Adamo R
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- Adult, Female, Hemoperitoneum surgery, Humans, Hypovolemia surgery, Leiomyoma surgery, Ligation, Rupture, Spontaneous, Tomography, X-Ray Computed, Uterine Neoplasms surgery, Hemoperitoneum diagnostic imaging, Hemoperitoneum etiology, Hypovolemia diagnostic imaging, Hypovolemia etiology, Leiomyoma complications, Leiomyoma diagnostic imaging, Uterine Neoplasms complications, Uterine Neoplasms diagnostic imaging
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Hemoperitoneum with hypovolemic shock from avulsion of a pedunculated leiomyoma is a rare but highly fatal condition that can occur spontaneously or as a result of trauma. We report a case of hemoperitoneum and hypovolemic shock secondary to a bleeding leiomyoma detected via computed tomography (CT) scan in a 39 year old premenopausal, gravida 0 female that presented with abdominal pain and became hemodynamically unstable in the emergency department. A preoperative bimanual exam revealed a mass consistent with a 20 week gestational uterus. Following fluid resuscitation, the patient underwent emergent myomectomy and ligation of the right uterine artery and was discharged home in good condition.
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- 2017
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468. Administration of recombinant erythropoietin determines increase of peripheral resistances in patients with hypovolemic shock
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Luca Siracusano, Alessandro Allegra, Anselmo Galasso, Francesco Corica, Michele Buemi, Nicola Frisina, Angela Laganà, and Carmela Aloisi
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medicine.medical_specialty ,Fatal outcome ,business.industry ,General Medicine ,Pharmacology ,Surgery ,Peripheral ,Nephrology ,Shock (circulatory) ,medicine.artery ,recombinant erythropoietin ,peripheral resistances ,hypovolemic shock ,Pulmonary artery ,Medicine ,In patient ,medicine.symptom ,business ,Recombinant erythropoietin - Published
- 1996
469. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report.
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Sermeus L, Vander Eeckt K, Ost D, and Van Den Branden M
- Abstract
Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available., Competing Interests: Statement No competing financial interests exist.
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- 2016
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470. Infective Endocarditis and Phlebotomies May Have Killed Mozart
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Simon Jong-Koo Lee
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medicine.medical_specialty ,Pediatrics ,business.industry ,Hypovolemic shock ,Review ,Phlebotomy ,medicine.disease ,Rash ,Surgery ,Shock (circulatory) ,Heart failure ,Infective endocarditis ,Internal Medicine ,Vomiting ,medicine ,Endocarditis ,Rheumatic fever ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Bloodletting - Abstract
Thirty-five year-old Amadeus Mozart died in Vienna after an acute illness that lasted only 15 days but no consensus has been reached on the cause of his death. From many letters written by his farther it is almost certain that he experienced at least three episodes of acute rheumatic fever attack in his childhood, and a relapse of rheumatic fever was suggested to have killed Mozart, although death from acute rheumatic fever is very rare in adults. His last illness was characterized by high fever, massive edema, vomiting and skin rash. His last illness can be explained by infectious endocarditis and heart failure. During his last hours, he was given phlebotomy, possibly for the third time in two weeks, and soon after he became unconscious and died. As such, phlebotomy performed on a man dehydrated by high fever and vomiting may have caused systemic shock. In summary, Mozart probably died from chronic rheumatic heart disease complicated by infective endocarditis and heart failure, and repeated phlebotomy-induced hypovolemic shock.
- Published
- 2010
471. Pulse contour analysis guided management of a case of puerperal uterine inversion and hemorrhagic shock – ‘Giving what it takes’.
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Singh, Shivinder, Kapur, A, Goyal, R, Joshi, A, and Pandith, S
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PUERPERAL disorders ,UTERINE diseases ,DIAGNOSIS of uterine diseases ,HYPOVOLEMIC anemia ,HEMORRHAGIC shock treatment ,DISEASE management ,THERAPEUTICS - Published
- 2015
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472. Omega-Conotoxin prevents the effect of adrenocorticotropin in hypovolemic shock
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Guarini, Salvatore, Bazzani, Carla, and Bertolini, Alfio
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Omega-Conotoxin ,adrenocorticotropin ,hypovolemic shock - Published
- 1992
473. Circulatory and respiratory consequences of massive hemorrhage are reversed by protoveratrines
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William Ferrari, Simonetta Tagliavini, Alfio Bertolini, and Salvatore Guarini
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Male ,Cardiac output ,hypotension ,medicine.medical_treatment ,Rat model ,Blood Pressure ,Hemorrhage ,Vagotomy ,hypovolemic shock ,respiratory depression ,protoveratrines ,Protoveratrines ,Cellular and Molecular Neuroscience ,medicine ,Animals ,Respiratory system ,Molecular Biology ,Depression (differential diagnoses) ,Pharmacology ,Carotid Body ,Chemotherapy ,business.industry ,Veratrum Alkaloids ,Rats, Inbred Strains ,Shock ,Cell Biology ,Survival Analysis ,Rats ,Shock (circulatory) ,Anesthesia ,Circulatory system ,Molecular Medicine ,Female ,Hypotension ,medicine.symptom ,business - Abstract
In a rat model of severe hypotension and respiratory depression induced by step-wise bleeding, protoveratrines cause a prompt and sustained improvement of cardiovascular and respiratory functions, both in anesthetized and in conscious animals, seemingly through a magnification of the reflex response originated by the chemoreceptors of aortic and carotid bodies. The restoration of cardiovascular function is attributable to an increase both in total peripheral resistance and cardiac output. The finding could provide the basis for a new approach to the first-aid management of massive blood losses.
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- 1990
474. Capillary leakage complicated by compartment syndrome necessitating surgery.
- Author
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Guidet, B., Guerin, B., Maury, E., Offenstadt, G., and Amstutz, P.
- Abstract
A single episode of systemic capillary leak syndrome is reported in a HIV-positive patient. The shock had necessitated the infusion of large amounts of fluid with concomitant diffuse swelling and weight gain leading to compartment syndrome of both legs. This required surgical relief. The initial high hematocrit (62%) and low serum protein concentration (48 g/l) with normal factor V (molecular weight above 300,000) concentrations are the hallmark of capillary leak when they are associated with hypovolemic shock. It must be emphasized that fluid resuscitation may worsen the muscle damage with ultimate compartment syndrome. Therefore, it appears reasonable to monitor muscular pressure during volume expansion in patients with capillary leak syndrome, severe shock and muscular swelling. [ABSTRACT FROM AUTHOR]
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- 1990
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475. Airway management in a patient with nuchal, interspinous, and flavum ligament rupture by a sickle: a case report.
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Sorimachi K, Ono Y, Kobayashi H, Watanabe K, Shinohara K, and Otani K
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- Airway Management methods, Cervical Vertebrae pathology, Humans, Ligamentum Flavum diagnostic imaging, Ligamentum Flavum surgery, Male, Middle Aged, Neck Injuries physiopathology, Psychiatric Department, Hospital, Referral and Consultation, Rupture, Shock etiology, Shock therapy, Tomography, X-Ray Computed, Treatment Outcome, Wounds, Penetrating therapy, Alcoholic Intoxication psychology, Cervical Vertebrae injuries, Intubation, Intratracheal methods, Laryngoscopy methods, Ligamentum Flavum injuries, Neck Injuries surgery, Self-Injurious Behavior psychology, Shock diagnosis, Wounds, Penetrating surgery
- Abstract
Background: Penetrating neck injury is an important trauma subset but is relatively rare, especially when involving the posterior cervical column. Rupture of the neck restraints, including the interspinous and flavum ligaments, can create serious cervical instability that requires special consideration when managing the airway. However, no detailed information regarding airway management in patients with profound posterior neck muscle laceration and direct cervical ligament disruption by an edged weapon is yet available in the literature., Case Presentation: A 63-year-old Japanese man attempted to cut off his head using a sickle after drinking a copious amount of alcohol. On admission, his posterior vertebral column was grossly exposed and the lacerated tissues were actively bleeding, resulting in severe hypovolemic shock. We used a rapid-sequence intubation technique with direct laryngoscopy while manual in-line stabilization of his head and neck was maintained by several people. Surgical exploration revealed nuchal, interspinous, and flavum ligament rupture between his fourth and fifth cervical vertebrae, but no injury to the great vessels was present. The major source of bleeding was a site of oozing from his trapezius and splenius muscles. After surgical hemostasis, wound repair, and subsequent intensive care, our patient was discharged home without any neurological sequelae., Conclusions: Deficits of the neck restraints can cause cervical spine subluxation and dislocation secondary to neck movement. Thus, the key to successful airway management in such a scenario is minimization of neck movement to prevent further neurological impairment. We successfully managed an airway using a conventional but trusted endotracheal intubation strategy in a patient with multiple traumas and a suspected spinal cord injury. This case also illustrates that, even when great vessel injury is absent, severe hypovolemic shock may occur after profound neck muscle laceration, requiring immediate surgical intervention.
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- 2016
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476. Impact of Trauma, Massive Blood Loss and Administration of Resuscitation Fluids on a Person's Blood-Alcohol Concentration and Rate of Ethanol Metabolism.
- Author
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Jones AW
- Abstract
Excessive drinking and drunkenness are tightly linked to many types of intentional and unintentional injuries involving trauma and blood loss, which often necessitate emergency medical intervention. This article considers the impact of trauma, massive blood loss, and the administration of life-saving replacement fluids on a person's blood alcohol concentration (BAC) and rate of ethanol metabolism. Both German and English language journals were reviewed and results from animal experiments, human studies, and actual victims of trauma undergoing life-saving treatment were considered. If trauma-related bleeding occurs when some ingested alcohol remains unabsorbed in the stomach, then under these circumstances continued absorption into portal venous blood is delayed, owing to altered splanchnic circulation. Hemodilution caused by administration of replacement fluids has only minimal effects on a preexisting BAC, because ethanol distributes into the total body water (TBW) compartment, which represents 50-60% of body weight. After hypovolemia there is a transfer of fluids from tissue compartments into the blood, which becomes more like plasma in composition with lower hematocrit and hemoglobin content. Unless the trauma or emergency treatment impedes hepatic blood flow, the rate of ethanol metabolism is not expected to differ from normal values, namely 0.10-0.25 g/L/h (0.01-0.025 g% per h). If ethanol is fully absorbed and distributed in all body fluids and tissues, neither massive blood loss nor administration of resuscitating fluids is expected to have any significant effect on a preexisting BAC or the rate of ethanol metabolism., Competing Interests: DISCLOSURES & DECLARATION OF CONFLICTS OF INTEREST The author, reviewers, editors, and publication staff do not report any relevant conflicts of interest
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- 2016
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477. Syndrome d’hyperperméabilité capillaire idiopathique : à propos d’un cas avec atteinte cardiaque
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Guillaume, M., Tolsma, V., Colombe, B., Bosseray, A., and Massot, C.
- Subjects
- *
VASCULAR diseases , *CAPILLARIES , *EDEMA , *CARDIOGENIC shock , *ATRIAL fibrillation , *HEART beat , *HYPOVOLEMIC anemia - Abstract
Abstract: Systemic capillary leak syndrome (SCLS) is characterized by recurrent hypovolemic shock associated with edema, hemoconcentration and paradoxal hypoprotidemia due to leakage into the interstitial space. We report a new case with cardiac involvement. A 62-year-old man had two recurrent hypovolemic shocks with SCLS''s criteria, associated twice with cardiac systolic dysfunction and atrial fibrillation. This report should enhance physician awareness of SCLS, which is a rare and severe disease, and its cardiac involvement. [Copyright &y& Elsevier]
- Published
- 2011
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478. Severe complication after termination of a second trimester cervical pregnancy
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Hanstede, Miriam M.F., van't Hof, Dirk B., van Groningen, Krijn, and de Graaf, Irene M.
- Subjects
- *
SECOND trimester of pregnancy , *ABORTION , *DURATION of pregnancy , *HYSTERECTOMY , *HEALTH outcome assessment , *HYPOVOLEMIC anemia , *PREGNANT women - Abstract
Objective: To report a supracervical hysterectomy performed after a life-threatening hemorrhage due to an attempted surgical termination at a gestational age of 18 weeks, which appeared to be a cervical pregnancy. Design: Case report. Setting: Teaching hospital. Patient(s): A 36-year-old pregnant woman, with two previous cesarean sections. Intervention(s): Supracervical hysterectomy. Main Outcome Measure(s): Not applicable. Result(s): A stable patient. Conclusion(s): By missing a cervical pregnancy in the second trimester, a life-threatening hemorrhage occurred after an attempted surgical termination. In case of failure of the conservative therapy this rare diagnosis should be considered. A supracervical hysterectomy at this gestational age is the only therapeutic option. [Copyright &y& Elsevier]
- Published
- 2008
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479. An autopsy case of sudden death due to acute gastric dilatation without rupture
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Watanabe, Satoshi, Terazawa, Koichi, Asari, Masaru, Matsubara, Kazuo, Shiono, Hiroshi, and Shimizu, Keiko
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- *
AUTOPSY , *SUDDEN death , *CAUSES of death , *FORENSIC medicine - Abstract
Abstract: We report the first autopsy case of fatal gastric dilatation without rupture. A 31-year-old woman who lived alone was found dead in her living room. Despite being very thin, she showed marked abdominal distention. Autopsy and histological findings revealed that a severely distended stomach, of which walls notably thin and displayed transmural necrosis, occupied the entire abdominal cavity. Severe congestion was observed in the intestine and cecum. Theses findings suggest that bulimia nervosa together with anorexia nervosa resulted in rapid dilation of the stomach. We conclude that the cause of death was acute circulatory failure from hypovolemic shock that occurred following compression of the inferior vena cava and superior mesenteric vein, and by loss of circulatory volume to the third space. [Copyright &y& Elsevier]
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- 2008
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480. Microcirculatory alterations in shock states.
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Hamlin SK, Parmley CL, and Hanneman SK
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- Blood Pressure, Cardiac Output, Hemodynamics physiology, Humans, Oxygen blood, Oxygen Consumption physiology, Shock, Cardiogenic therapy, Microcirculation physiology, Shock, Septic physiopathology
- Abstract
Functional components of the microcirculation provide oxygen and nutrients and remove waste products from the tissue beds of the body's organs. Shock states overwhelmingly stress functional capacity of the microcirculation, resulting in microcirculatory failure. In septic shock, inflammatory mediators contribute to hemodynamic instability. In nonseptic shock states, the microcirculation is better able to compensate for alterations in vascular resistance, cardiac output, and blood pressure. Therefore, global hemodynamic and oxygen delivery parameters are appropriate for assessing, monitoring, and guiding therapy in hypovolemic and cardiogenic shock but, alone, are inadequate for septic shock., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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481. Per-protocol effect of earlier non-pneumatic anti-shock garment application for obstetric hemorrhage.
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El Ayadi A, Gibbons L, Bergel E, Butrick E, Huong NT, Mkumba G, Kaseba C, Magwali T, Merialdi M, and Miller S
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- Clinical Protocols, Clothing, Female, First Aid instrumentation, Humans, Postpartum Hemorrhage mortality, Pregnancy, Time Factors, Zambia epidemiology, Zimbabwe epidemiology, Postpartum Hemorrhage therapy
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- 2014
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482. Vascular type Ehlers-Danlos Syndrome with fatal spontaneous rupture of a right common iliac artery dissection: case report and review of literature.
- Author
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Abayazeed A, Hayman E, Moghadamfalahi M, and Cain D
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- Adult, Diagnosis, Differential, Ehlers-Danlos Syndrome genetics, Fatal Outcome, Hemorrhage etiology, Humans, Iliac Artery diagnostic imaging, Iliac Artery surgery, Imaging, Three-Dimensional, Male, Prognosis, Recurrence, Retroperitoneal Space, Rupture, Spontaneous complications, Rupture, Spontaneous diagnostic imaging, Rupture, Spontaneous surgery, Tomography, X-Ray Computed, Ehlers-Danlos Syndrome complications, Ehlers-Danlos Syndrome pathology, Iliac Artery pathology
- Abstract
Vascular Ehlers-Danlos Syndrome (previously Ehlers-Danlos IV) is a rare autosomal dominant collagen vascular disorder caused by a 2q31 COL3A1 gene mutation encoding pro-alpha1 chain of type III collagen (in contrast to classic Ehlers-Danlos, caused by a COL5A1 mutation). The vascular type accounts for less than 4% of all Ehlers-Danlos cases and usually has a poor prognosis due to life threatening vascular ruptures and difficult, frequently unsuccessful surgical and vascular interventions. In 70% of cases, vascular rupture or dissection, gastrointestinal perforation, or organ rupture is a presenting sign. We present a case of genetically proven vascular Ehlers-Danlos with fatal recurrent retroperitoneal hemorrhages secondary to a ruptured right common iliac artery dissection in a 30-year-old male. This case highlights the need to suspect collagen vascular disorders when a young adult presents with unexplained retroperitoneal hemorrhage, even without family history of such diseases.
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- 2014
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483. Hypovolemic shock complex: does the pancreatic perfusion increase or decrease at contrast-enhanced dynamic CT?
- Author
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Higashi H, Tamada T, Kanki A, Yamamoto A, and Ito K
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Contrast Media, Female, Humans, Male, Middle Aged, Perfusion, Shock complications, Tomography, Spiral Computed, Tomography, X-Ray Computed methods, Wounds, Nonpenetrating diagnostic imaging, Young Adult, Pancreas diagnostic imaging, Radiographic Image Enhancement methods, Shock diagnostic imaging, Wounds, Nonpenetrating complications
- Abstract
Objective: The purpose of this study is to evaluate contrast enhancement effects of the pancreas at dynamic computed tomography (CT) to clarify whether pancreatic perfusion increases or decreases in severe trauma patients with hypovolemic shock., Methods: A total of 90 patients with (n=30) and without (n=60) blunt trauma and hypovolemic shock who underwent dynamic CT for abdomen was included. The measurement of CT attenuation values of the pancreas in the early phase and the late phase was performed to compare the contrast enhancement effects between patients with and without hypovolemic shock., Results: The mean CT attenuation values of the pancreas in the early phase of dynamic CT in patients with hypovolemic shock [95.4±29.1 Hounsfield units (HU)] were significantly lower (P < .001) than those in non-hypovolemic patients (136.6±17.9 HU), indicating decreased pancreatic perfusion in patients with hypovolemic shock. The mean CT attenuation values of the pancreas in the late phase of dynamic CT in patients with hypovolemic shock (95.9±17.6 HU) were significantly higher (P < .026) than those in non-hypovolemic patients (87.2±9.0 HU), indicating delayed or prolonged pancreatic enhancement in patients with hypovolemic shock., Conclusions: Decreased pancreatic perfusion in the early phase and delayed pancreatic enhancement in the late phase of contrast-enhanced dynamic CT was a common finding in patients with hypovolemic shock., (© 2014.)
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- 2014
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484. Gastric, duodenal, and pancreatic somatostatin-like immunoreactivity during hypovolemic shock
- Author
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Wiles, David, Yeginsu, Oktay, Ozden, Ali, Covington, Steve M., Rice, Janet, and Ertan, Atilla
- Published
- 1988
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485. Regional gastric mucosal blood flow in hypovolemic shock
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Starlinger, M., Jakesz, R., Bratusch-Marrain, P., and Schiessel, R.
- Published
- 1979
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486. Lifesaving intraosseous access in a patient with a massive obstetric hemorrhage.
- Author
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de Vogel J, Heydanus R, Mulders AG, Smalbraak DJ, Papatsonis DN, and Gerritse BM
- Abstract
A 42-year-old, gravida 1, para 0 woman was induced at a gestational age of 41 weeks because of post-term dates. The fourth stage of delivery was complicated by a massive hemorrhage. The uncontrollable persisting amount of blood loss led to hypovolemic shock and cardiopulmonary arrest. Lifesaving extra access was gained through an intraosseous needle in the proximal tibia. We therefore advocate including the use of an intraosseous needle as an additional route for intravascular volume replacement in case of peripartum hemorrhage.
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- 2011
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487. Infective endocarditis and phlebotomies may have killed mozart.
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Lee SJ
- Abstract
Thirty-five year-old Amadeus Mozart died in Vienna after an acute illness that lasted only 15 days but no consensus has been reached on the cause of his death. From many letters written by his farther it is almost certain that he experienced at least three episodes of acute rheumatic fever attack in his childhood, and a relapse of rheumatic fever was suggested to have killed Mozart, although death from acute rheumatic fever is very rare in adults. His last illness was characterized by high fever, massive edema, vomiting and skin rash. His last illness can be explained by infectious endocarditis and heart failure. During his last hours, he was given phlebotomy, possibly for the third time in two weeks, and soon after he became unconscious and died. As such, phlebotomy performed on a man dehydrated by high fever and vomiting may have caused systemic shock. In summary, Mozart probably died from chronic rheumatic heart disease complicated by infective endocarditis and heart failure, and repeated phlebotomy-induced hypovolemic shock.
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- 2010
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488. Physiological Mechanisms of Acute Intestinal Radiation Death
- Author
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WASHINGTON UNIV SEATTLE DEPT OF ENVIRONMENTAL HEALTH, Jackson, Kenneth L., Geraci, Joseph P., WASHINGTON UNIV SEATTLE DEPT OF ENVIRONMENTAL HEALTH, Jackson, Kenneth L., and Geraci, Joseph P.
- Abstract
The overall objective was to clarify the role of fluid and electrolyte loss, bile-duct ligation, radiation-damaged intestinal mucosa, bacterial toxemia and their interrelationships on radiation-induced gastrointestinal death. Using specific pathogen-free CD-1 male rats, this study found that endogenous enteric bacteria did not play a significant role in pure intestinal radiation death. Bile acids, per se, were shown to play little role in intestinal radiation death but that the inability of the denuded mucosa to absorb fluid and electrolytes, thereby producing hypovolemic shock was the major mechanism. Keywords: Neutron exposure; Gamma ray exposure.
- Published
- 1986
489. The Use of Hypertonic Solutions to Resuscitate Animals from Hypovolemic Shock.
- Author
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CALIFORNIA UNIV DAVIS, Holcroft,James W, CALIFORNIA UNIV DAVIS, and Holcroft,James W
- Abstract
The purpose of this contract was to evaluate small volume resuscitation of animals subjected to moderately severe hemorrhagic shock. The stimulus for this study was the observation that many soldiers who die preventable deaths after suffering injuries die from uncontrolled hemorrhagic shock. Resuscitation of soldiers in the field is difficult, in part, because of the necessity to infuse large volumes of isotonic resuscitative solutions. This proposal evaluated the use of very small volumes of hyperosmotic solutions. The proposal began by evaluating different compositions for hyperosmotic solutions and ended with an evaluation of the solution that appeared the most promising. We found that 2,400 milliosmolar sodium chloride with 6% Dextran 70 was highly effective in resuscitating animals that had lost up to 60% of their blood volume. The amount of solution necessary to restore and maintain cardiac index and blood pressure was on the order of 1/5 the amount of blood loss from the hemorrhagic insult. These solutions appear particularly promising because they are inexpensive, require no cross matching, are effective when used in small volumes, are easy to store, and should keep indefinitely as they will not support bacterial growth.
- Published
- 1986
490. The Use of Hypertonic Solutions to Resuscitate Animals from Hypovolemic Shock.
- Author
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CALIFORNIA UNIV DAVIS SCHOOL OF MEDICINE, Holcroft,James W, Kramer,George, Green,Jerry F, CALIFORNIA UNIV DAVIS SCHOOL OF MEDICINE, Holcroft,James W, Kramer,George, and Green,Jerry F
- Abstract
This report pertains to the use of hypertonic solutions to resuscitate animals from hypovolemic shock. In brief, it appears that a solution comprised of sodium chloride, with a calculated osmolality of 2,400 milliosmols/kg mixed with a dextran solution, provides good resuscitation from hemorrhagic shock in sheep. This resuscitation is longer lasting than resuscitation with equivalent volumes of normal saline. The resuscitation also seems better than when using solutions containing sodium acetate, mannitol, glucose, or sodium bicarbonate.
- Published
- 1984
491. Performance characteristics of pressure infusors.
- Author
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Zaretsky U, Heller O, and Elad D
- Abstract
Pressure infusion devices (PID) are used in trauma hospitals and in military applications to enhance rapid fluid replacement of hypovolemic shocked patients. This work presents a simple inexpensive technique for evaluation of the performance characteristics of pressure infusors. Pressure-volume and volume-time curves of pneumatic and spring-activated infusors have been derived for pressurized infusion with various output resistances. Three indices of performance are suggested for evaluation of pressure infusors: the energy to discharge fluid from the bag, efficiency index and time required to empty 50% of the bag.
- Published
- 1994
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492. Hypovolemic shock complicating nephrotic syndrome in a child
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Sumantri Ag, Anwar Mr, Rochmanadji W, Kosnadi L, and Trimulyo
- Subjects
Male ,medicine.medical_specialty ,Nephrotic Syndrome ,business.industry ,lcsh:R ,lcsh:RJ1-570 ,lcsh:Medicine ,lcsh:Pediatrics ,Shock ,medicine.disease ,Prognosis ,Shock (circulatory) ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,medicine.symptom ,hypovolemic shock ,nephrotic syndrome ,proteinuria ,hypoalbuminemia ,infection ,hypovolemia ,Intensive care medicine ,business ,Child ,Nephrotic syndrome - Abstract
The fundamental abnormality in nephrotic syndrome is the structural and electrochemical changes that have been documented to occur in the glomerular basement membrane lead to proteinuria. It is the proteinuria itself which most likely causes hypoalbuminemia and associated complications such as infections, hypercoagulability and hypovolemia. Hypovolemia may cause postural hypotension, acute renal failure, circulatory collaps or sudden death. An eleven-year-old boy was referred to the Child Health Department of Dr. Kariadi Hospital Semarang with a diagnosis of corticosteroid resistant nephrotic syndrome and acute renal failure. Physical examination showed a severely ill boy with general edema, shock, hemoconcentration, hypoalbuminemia, hypercholesterolemia, massive proteinuria and disturbed renal function. The treatment consisted of infusion of dextrose 10% followed by human plasma and furosemide to restore plasma volume and enhance urine production. Two days later he was in better condition, normovolemia, slight edema, good diuresis, but his blood pressure increased, and ophtalmologic examination supported the diagnosis of grade I hypertensive retinopathy. Intravenous clonidine and furosemide were given and were very effective. Kidney biopsy revealed minimal lesion with slight proliferation.
- Published
- 1988
493. Bombesin reverses bleeding-induced hypovolemic shock, in rats
- Author
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Alfio Bertolini, Carla Bazzani, Salvatore Guarini, and Simonetta Tagliavini
- Subjects
Male ,medicine.medical_specialty ,Hemodynamics ,Blood Pressure ,Hemorrhage ,hypovolemic shock ,Devazepide ,General Biochemistry, Genetics and Molecular Biology ,chemistry.chemical_compound ,Internal medicine ,Hypovolemia ,Heart rate ,medicine ,Animals ,Respiratory function ,General Pharmacology, Toxicology and Pharmaceutics ,Pulse ,Cholecystokinin ,Benzodiazepinones ,business.industry ,Respiration ,Bombesin ,Rats, Inbred Strains ,Shock ,General Medicine ,Rats ,Blood pressure ,Endocrinology ,chemistry ,Shock (circulatory) ,Anesthesia ,Injections, Intravenous ,Female ,medicine.symptom ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
In an experimental model of bleeding-induced hypovolemic shock causing the death of all saline-treated rats within 26 ± 4 min, the intravenous injection of bombesin (2.5, 5 or 10 μg/kg) dose-dependently restored blood pressure, pulse amplitude, heart rate and respiratory function, and improved survival rate as assessed at the end of the experiment (2 h). The effect on cardiovascular and respiratory functions was prompt (within 1–2 min) and sustained. The release of cholecystokinin seems to be the main mechanism of action, because the anti-shock effect of bombesin is largely prevented by the CCK-antagonist, L-364, 718.
- Published
- 1989
494. Positive predictive value of International Classification of Diseases, 10th revision, diagnosis codes for cardiogenic, hypovolemic, and septic shock in the Danish National Patient Registry
- Author
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Henrik Gammelager, Marie D. Lauridsen, Henrik Nielsen, Morten Schmidt, and Christian Fynbo Christiansen
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Male ,Inotrope ,Positive predictive value ,medicine.medical_specialty ,Cardiotonic Agents ,Epidemiology ,Denmark ,Shock, Cardiogenic ,Health Informatics ,Vasopressor therapy ,Inotropic therapy ,Medical Records ,Validity ,ICD-10 ,International Classification of Diseases ,Predictive Value of Tests ,Septic shock ,Internal medicine ,medicine ,Humans ,Vasoconstrictor Agents ,Registries ,Cardiogenic shock ,Aged ,Aged, 80 and over ,Inpatients ,business.industry ,Hypovolemic shock ,Shock ,Middle Aged ,medicine.disease ,Shock, Septic ,Confidence interval ,Surgery ,Shock (circulatory) ,Predictive value of tests ,Cardiology ,Female ,Diagnosis code ,medicine.symptom ,business ,Research Article - Abstract
Background Large registries are important data sources in epidemiological studies of shock, if these registries are valid. Therefore, we examined the positive predictive value (PPV) of diagnosis codes for shock, the procedure codes for inotropic/vasopressor therapy among patients with a diagnosis of shock, and the combination of a shock diagnosis and a code for inotropic/vasopressor therapy in the Danish National Patient Registry (DNPR). Methods We randomly selected 190 inpatients with an International Classification of Diseases, 10th revision (ICD-10) diagnosis of shock at Aarhus University Hospital from 2005–2012 using the DNPR; 50 patients were diagnosed with cardiogenic shock, 40 patients with hypovolemic shock, and 100 patients with septic shock. We used medical charts as the reference standard and calculated the PPV with 95% confidence intervals (CI) for overall shock and for each type of shock separately. We also examined the PPV for inotropic/vasopressor therapy and the PPV for shock when a concurrent code for inotropic/vasopressor therapy was also registered. Results The PPV was 86.1% (95% CI: 79.7–91.1) for shock overall, 93.5% (95% CI: 82.1–98.6) for cardiogenic shock, 70.6% (95% CI: 52.5–84.9) for hypovolemic shock, and 69.2% (95% CI: 57.7–79.2) for septic shock. The PPV of use of inotropes/vasopressors among shock patients was 88.9% (95% CI: 79.3–95.1). When both a shock code and a procedure code for inotropic/vasopressor therapy were used, the PPV for shock overall was 93.1% (95% CI: 84.5–97.7). ICD-10 codes for subtypes of shock and simultaneously registered use of inotropes/vasopressors provided PPVs of 96.0% (95% CI: 79.6–99.9) for cardiogenic shock, 69.2% (95% CI: 38.6–90.9) for hypovolemic shock, and 82.4% (95% CI: 65.5–93.2) for septic shock. Conclusions Overall, we found a moderately high PPV for shock in the DNPR. The PPV was highest for cardiogenic shock but lower for hypovolemic and septic shock. Combination diagnoses of shock with codes for inotropic/vasopressor therapy further increased the PPV of shock overall, and for cardiogenic and septic shock diagnoses. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0013-2) contains supplementary material, which is available to authorized users.
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495. Thoracic CT findings at hypovolemic shock
- Author
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Antonio Rotondo, Roberto Grassi, Giuseppe Angelelli, Orlando Catalano, Michele Scialpi, Rotondo, Antonio, Catalano, O, Grassi, Roberto, Scialpi, M, and Angelelli, G.
- Subjects
Adult ,Male ,Thorax ,medicine.medical_specialty ,Adolescent ,Cardiac Volume ,hypovolemic shock ,Wounds, Nonpenetrating ,medicine.artery ,Hypovolemia ,medicine ,Humans ,Thoracic aorta ,Glasgow Coma Scale ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Aorta ,Radiological and Ultrasound Technology ,Multiple Trauma ,business.industry ,CT ,Shock ,General Medicine ,Middle Aged ,Blood pressure ,Shock (circulatory) ,cardiovascular system ,Female ,Radiography, Thoracic ,Radiology ,medicine.symptom ,Tomography, X-Ray Computed ,business - Abstract
Purpose: To describe and discuss the thoracic CT features of hypovolemic shock. Material and Methods: From a group of 18 patients with signs of hypovolemia on contrast-enhanced abdominal CT, 11 were selected for our study as having also undergone a complete chest examination. Pulse rate, blood pressure, trauma score value, Glasgow coma scale value, surgical result, and final outcome were retrospectively evaluated. The CT features analyzed were: decreased cardiac volume, reduced caliber of the thoracic aorta, aortic branches and caval venous system, increased enhancement of the aorta, and increased enhancement of the pulmonary collapses/contusions. Results: All 11 subjects presented severe injuries and hemodynamic instability; 7 were stable enough to undergo surgery; only 1 of the 11 survived. Two patients showed none of the features of thoracic hypovolemia. All the other patients presented at least two signs: reduced caliber of the thoracic aorta in 7 cases; decreased volume of the cardiac chambers and increased aortic enhancement in 6; decreased caliber of the aortic vessels in 4; decreased caliber of the caval veins in 3; and increased enhancement of the pulmonary collapses/contusions in 3. Conclusions: In patients with hypovolemia, CT may show several thoracic findings in addition to abdominal ones. Knowledge of these features is important for distinguishing them from traumatic injuries.
496. Non-invasive hemodynamic monitoring in trauma patients
- Author
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Aristomenis K. Exadaktylos, Beat Schnüriger, and Matthias Kuster
- Subjects
medicine.medical_specialty ,Cardiac output ,Hemodynamics ,610 Medicine & health ,Review ,Trauma ,Internal medicine ,medicine.artery ,Heart rate ,medicine ,Intensive care medicine ,Initial care ,business.industry ,Hypovolemic shock ,Emergency department ,Gold standard (test) ,Blood pressure ,Shock (circulatory) ,Pulmonary artery ,Cardiology ,Emergency Medicine ,Surgery ,Non-invasive hemodynamic monitoring ,medicine.symptom ,business - Abstract
BACKGROUND The assessment of hemodynamic status is a crucial task in the initial evaluation of trauma patients. However, blood pressure and heart rate are often misleading, as multiple variables may impact these conventional parameters. More reliable methods such as pulmonary artery thermodilution for cardiac output measuring would be necessary, but its applicability in the Emergency Department is questionable due to their invasive nature. Non-invasive cardiac output monitoring devices may be a feasible alternative. METHODS A systematic literature review was conducted. Only studies that explicitly investigated non-invasive hemodynamic monitoring devices in trauma patients were considered. RESULTS A total of 7 studies were identified as suitable and were included into this review. These studies evaluated in a total of 1,197 trauma patients the accuracy of non-invasive hemodynamic monitoring devices by comparing measurements to pulmonary artery thermodilution, which is the gold standard for cardiac output measuring. The correlation coefficients r between the two methods ranged from 0.79 to 0.92. Bias and precision analysis ranged from -0.02 +/- 0.78 l/min/m(2) to -0.14 +/- 0.73 l/min/m(2). Additionally, data on practicality, limitations and clinical impact of the devices were collected. CONCLUSION The accuracy of non-invasive cardiac output monitoring devices in trauma patients is broadly satisfactory. As the devices can be applied very early in the shock room or even preclinically, hemodynamic shock may be recognized much earlier and therapeutic interventions could be applied more rapidly and more adequately. The devices can be used in the daily routine of a busy ED, as they are non-invasive and easy to master.
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