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Crush syndrome often occurs after severe crush injury caused by disasters or accidents, and is associated with high mortality and poor prognosis. Cardiovascular complications, such as cardiac arrest, hypovolemic shock, and hyperkalemia-related cardiac dysfunction, are the primary causes of on-site death in crush syndrome. Prehospital evaluation, together with timely and correct treatment, is of great benefit to crush syndrome patients, which is difficult in most cases due to limited conditions. Based on current data and studies, early fluid resuscitation remains the most important on-site treatment for crush syndrome. Novel solutions and drugs used in fluid resuscitation have been investigated for their effectiveness and benefits. Several drugs have proven effective for the prevention or treatment of cardiovascular complications in crush syndrome, such as hypovolemic shock, hyperkalemia-induced cardiac complications, myocardial ischemia/reperfusion injury, ventricular dysfunction, and coagulation disorder experimentally. Moreover, these drugs are beneficial for other complications of crush syndrome, such as renal dysfunction. In this review, we will summarize the existing on-site treatments for crush syndrome and discuss the potential pharmacological interventions for cardiovascular complications to provide clues for clinical therapy of crush syndrome. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of uroabdomen secondary to spontaneous bladder rupture in a dog with dystocia. Case Summary: A 2‐year‐old intact female Boston Terrier was referred for prolonged labor of 72 hours. At presentation, the dog had delivered 8 puppies at home, with the last pup being stillborn. The dog was in hypovolemic shock and had free abdominal effusion. Abdominal radiographs showed no evidence of remaining fetuses. Abdominal fluid analysis revealed a fluid potassium that was 1.8 times higher than the peripheral blood potassium. Retrograde positive contrast cystography identified leakage of contrast into the abdomen, consistent with uroabdomen secondary to bladder rupture. Bloodwork abnormalities included a mild monocytic leukocytosis with a left shift, moderate azotemia, mild hyperbilirubinemia, mild increase of alkaline phosphatase activity, moderate hyponatremia, and moderate hypochloremia. The dog was resuscitated with IV fluids and received IV antimicrobials out of concerns for septic peritonitis and sepsis. An exploratory laparotomy revealed a moderate volume abdominal effusion, uterine enlargement with no identifiable fetuses, and a small rupture of the urinary bladder wall apex. The bladder wall defect was repaired, and the dog underwent an ovariohysterectomy. Perioperative systemic hypotension was treated with a norepinephrine constant rate infusion and resolved within 24 hours. The dog was discharged 5 days later. The combined peritoneal fluid and uterine fluid culture and sensitivity testing revealed Enterococcus spp. and Staphylococcus pseudintermedius, both susceptible to amoxicillin/clavulanic acid and enrofloxacin. Bladder wall histopathology revealed severe mural congestion, edema, and hemorrhage, without evidence of neoplasia, cystitis, or urolithiasis. Unique Information Provided: This is the first case report of a dog with uroabdomen secondary to a bladder wall rupture associated with dystocia. Early recognition of this rare phenomenon and vigilance in treatment is essential for a good prognosis and outcome. [ABSTRACT FROM AUTHOR]

Abstract Introduction The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information. Aimof this study The study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h. Patients & methods The current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure 100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin). Results Among 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) ( p-value 38.5 has a sensitivity of 80.0% and Specificity of 85.71% with AUC 0.971 and a good 95% CI (0.938 – 1.0), which means that IVCci of 38.6% or more can indicate fluid responsiveness. We also found that IVCci 1 h (after fluid resuscitation) at cut-off point > 28.6 has a sensitivity of 80.0% and Specificity of 75% with AUC 0.886 and good 95% CI (0.803 – 0.968), which means that IVCci of 28.5% or less can indicate fluid unresponsiveness after 1st hour of resuscitation. We found no statistically significant difference between repleted and non-repleted cases regarding fluid requirement and amount of blood transfusion at 1st hour of resuscitation (p-value = 0.104). Conclusion Repeated bedside ultrasonography of IVCD, and IVCci before and after the first hour of resuscitation could be an excellent reliable invasive tool that can be used in estimating the First 24 h of fluid requirement in Major blunt trauma patients and assessment of fluid status.

Abstract To treat hypovolemic shock, fluid infusion or blood transfusion is essential to address insufficient volume. Much controversy surrounds resuscitation in hypovolemic shock. We aimed to identify the ideal fluid combination for treating hypovolemic shock-induced swine model, analyzing bioelectrical impedance and hemodynamics. Fifteen female three-way crossbred pigs were divided into three different groups. The three resuscitation fluids were (1) balanced crystalloid, (2) balanced crystalloid + 5% dextrose water, and (3) balanced crystalloid + 20% albumin. The experiment was divided into three phases and conducted sequentially: (1) controlled hemorrhage (1 L bleeding, 60 min), (2) resuscitation phase 1 (1 L fluid infusion, 60 min), and (3) resuscitation phase 2 (1 L fluid infusion, 60 min). Bioelectrical impedance analysis was implemented with a segmental multifrequency bioelectrical impedance analyzer. A total of 61 impedance measurements were assessed for each pig at six different frequencies in five segments of the pig. Pulse rate (PR), mean arterial pressure (MAP), stroke volume (SV), and stroke volume variation (SVV) were measured using a minimally invasive hemodynamic monitoring device. The three-dimensional graph showed a curved pattern when infused with 1 L of balanced crystalloid + 1 L of 5% dextrose water and 1.6 L of balanced crystalloid + 400 ml of 20% albumin. The 1M impedance increased in all groups during the controlled hemorrhage, and continuously decreased from fluid infusion to the end of the experiment. Only balanced crystalloid + 20% albumin significantly restored MAP and SV to the same level as the start of the experiment after the end of fluid infusion. There were no significant differences in MAP and SV from the time of recovery to the initial value of 1M impedance to the end of fluid infusion in all groups. The change and the recovery of hemodynamic indices such as MAP and SV coincide with the change and the recovery of 1M impedance. Using balanced crystalloid mixed with 20% albumin in hypovolemic shock-induced swine model may be helpful in securing hemodynamic stability, compared with balanced crystalloid single administration.

Introduction: The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information. Aimof this study: The study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h. Patients & methods: The current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure < 90/60 mmHg or a more than 30% decrease from the baseline systolic pressure, heart rate > 100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin). Results: Among 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) (p-value < 0.05) and DIVC Max (on arrival) (after 1 h) (p-value < 0.001). There is no statistically significant difference (p-value = 0.075) between repleted and non-repleted cases regarding DIVC Max (after 24 h).In our study, we found that IVCci0 at a cut-off point > 38.5 has a sensitivity of 80.0% and Specificity of 85.71% with AUC 0.971 and a good 95% CI (0.938 – 1.0), which means that IVCci of 38.6% or more can indicate fluid responsiveness. We also found that IVCci 1 h (after fluid resuscitation) at cut-off point > 28.6 has a sensitivity of 80.0% and Specificity of 75% with AUC 0.886 and good 95% CI (0.803 – 0.968), which means that IVCci of 28.5% or less can indicate fluid unresponsiveness after 1st hour of resuscitation. We found no statistically significant difference between repleted and non-repleted cases regarding fluid requirement and amount of blood transfusion at 1st hour of resuscitation (p-value = 0.104). Conclusion: Repeated bedside ultrasonography of IVCD, and IVCci before and after the first hour of resuscitation could be an excellent reliable invasive tool that can be used in estimating the First 24 h of fluid requirement in Major blunt trauma patients and assessment of fluid status. [ABSTRACT FROM AUTHOR]

To treat hypovolemic shock, fluid infusion or blood transfusion is essential to address insufficient volume. Much controversy surrounds resuscitation in hypovolemic shock. We aimed to identify the ideal fluid combination for treating hypovolemic shock-induced swine model, analyzing bioelectrical impedance and hemodynamics. Fifteen female three-way crossbred pigs were divided into three different groups. The three resuscitation fluids were (1) balanced crystalloid, (2) balanced crystalloid + 5% dextrose water, and (3) balanced crystalloid + 20% albumin. The experiment was divided into three phases and conducted sequentially: (1) controlled hemorrhage (1 L bleeding, 60 min), (2) resuscitation phase 1 (1 L fluid infusion, 60 min), and (3) resuscitation phase 2 (1 L fluid infusion, 60 min). Bioelectrical impedance analysis was implemented with a segmental multifrequency bioelectrical impedance analyzer. A total of 61 impedance measurements were assessed for each pig at six different frequencies in five segments of the pig. Pulse rate (PR), mean arterial pressure (MAP), stroke volume (SV), and stroke volume variation (SVV) were measured using a minimally invasive hemodynamic monitoring device. The three-dimensional graph showed a curved pattern when infused with 1 L of balanced crystalloid + 1 L of 5% dextrose water and 1.6 L of balanced crystalloid + 400 ml of 20% albumin. The 1M impedance increased in all groups during the controlled hemorrhage, and continuously decreased from fluid infusion to the end of the experiment. Only balanced crystalloid + 20% albumin significantly restored MAP and SV to the same level as the start of the experiment after the end of fluid infusion. There were no significant differences in MAP and SV from the time of recovery to the initial value of 1M impedance to the end of fluid infusion in all groups. The change and the recovery of hemodynamic indices such as MAP and SV coincide with the change and the recovery of 1M impedance. Using balanced crystalloid mixed with 20% albumin in hypovolemic shock-induced swine model may be helpful in securing hemodynamic stability, compared with balanced crystalloid single administration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Monkeypox is an emerging disease that can range from a mild condition to serious complications, which have not been fully described. CLINICAL CASE: A 32-year-old male patient, with HIV, who presented with monkeypox and abundant sudden-onset rectal bleeding and hypovolemic shock, six days after the onset of skin lesions. Colonoscopy showed a bleeding ulcer in the internal anal margin, despite this, the histopathological findings were inflammatory infiltrates and granulation tissue formation. CONCLUSIONS: The monkeypox virus seems to have a variable behavior, being more serious in people with immunocompromise; however, some symptoms can alert us to possible complications for timely intervention. [ABSTRACT FROM AUTHOR]

Hypovolemic shock is a circulatory failure, due to a loss in the effective circulating blood volume, that causes tissue hypoperfusion and hypoxia. This condition stimulates reactive oxygen species (ROS) and pro-inflammatory cytokine production in different organs and also in the central nervous system (CNS). Levosimendan, a cardioprotective inodilator, and dobutamine, a β1-adrenergic agonist, are commonly used for the treatment of hypovolemic shock, thanks to their anti-inflammatory and antioxidant effects. For this reason, we aimed at investigating levosimendan and dobutamine's neuroprotective effects in an "in vitro" model of lipopolysaccharide (LPS)-induced neuroinflammation. Human microglial cells (HMC3) were challenged with LPS (0.1 µg/mL) to induce an inflammatory phenotype and then treated with levosimendan (10 µM) or dobutamine (50 µM) for 24 h. Levosimendan and dobutamine significantly reduced the ROS levels and markedly increased Nrf2 and HO-1 protein expression in LPS-challenged cells. Levosimendan and dobutamine also decreased p-NF-κB expression and turned off the NLRP3 inflammasome together with its downstream signals, caspase-1 and IL-1β. Moreover, a reduction in TNF-α and IL-6 expression and an increase in IL-10 levels in LPS-stimulated HMC3 cells was observed following treatment. In conclusion, levosimendan and dobutamine attenuated LPS-induced neuroinflammation through NF-κB pathway inhibition and NLRP3 inflammasome activation via Nrf2/HO-1 signalling, suggesting that these drugs could represent a promising therapeutic approach for the treatment of neuroinflammation consequent to hypovolemic shock. [ABSTRACT FROM AUTHOR]

AbstractIntroductionCase summaryImagesConclusionMethylthioninium chloride is used for multiple treatment purposes and is sometimes administered through peripheral intravenous lines. We highlight the potential adverse effects of methylthioninium chloride extravasation during continuous peripheral intravenous administration.A 38-year-old woman presented to the emergency department with multifactorial hypovolemic and septic shock. She was treated with a continuous peripheral infusion of intravenous methylthioninium chloride for shock refractory to multiple vasopressors.One day after administration commenced, the patient developed blue staining of the left upper arm due to extravasation of methylthioninium chloride proximal to the site of infusion. Further images show its later spread.While reported cases of methylthioninium chloride extravasation are rare, it is our preference that methylthioninium chloride should be administered through a central line in cases of continuous infusion due to the risk of potential toxicity from extravasation. [ABSTRACT FROM AUTHOR]

Developmental anomalies of genital tract result from defective fusion and absorption of various parts of Mullerian ducts in fetal life. Rudimentary horn pregnancy (RHP) is a rare occurrence of one in 76,000 and one in 160,000. We present a case of a 24-year-old primigravida with ruptured RHP initially managed in the line of an intrauterine pregnancy with severe anemia. Hemodynamic instability made us suspect ruptured RHP and lifesaving laparotomy was performed for the same. A 1.5-liter hemoperitoneum was encountered with a right RHP. Multiple adhesions were present with necrotic tissue adherent and clumped together as tubo-ovarian mass. Resection of rudimentary horn was performed. We report this case to emphasize the need to consider rare uterine anomalies as a possibility in patients presenting with acute abdomen in early pregnancy. So, Obstetricians can consider these rare entities in differential diagnosis and management.

Abstract Background Hemorrhagic shock (HS), which causes insufficient tissue perfusion, can result in multiple organ failure (MOF) and death. This study aimed to evaluate whether doxycycline (DOX) protects cardiovascular, kidney, and liver tissue from damage in a rat model of HS. Immediately before the resuscitation, DOX (10 mg/kg; i.v.) was administered, and its protective effects were assessed 24 h later. Mean arterial pressure, renal blood flow, heart rate, vasoactive drug response, and blood markers such as urea, creatinine, AST, ALT, CPK, CPR, and NOx levels were determined. Results We showed that DOX has a significant effect on renal blood flow and on urea, creatinine, AST, ALT, CPK, and NOx. Morphologically, DOX reduced the inflammatory process in the liver tissue. Conclusions We conclude that DOX protects the liver and kidney against injury and dysfunction in a HS model and could be a strategy to reduce organ damage associated with ischemia-and-reperfusion injury.

Background: Hemorrhagic shock (HS), which causes insufficient tissue perfusion, can result in multiple organ failure (MOF) and death. This study aimed to evaluate whether doxycycline (DOX) protects cardiovascular, kidney, and liver tissue from damage in a rat model of HS. Immediately before the resuscitation, DOX (10 mg/kg; i.v.) was administered, and its protective effects were assessed 24 h later. Mean arterial pressure, renal blood flow, heart rate, vasoactive drug response, and blood markers such as urea, creatinine, AST, ALT, CPK, CPR, and NOx levels were determined. Results: We showed that DOX has a significant effect on renal blood flow and on urea, creatinine, AST, ALT, CPK, and NOx. Morphologically, DOX reduced the inflammatory process in the liver tissue. Conclusions: We conclude that DOX protects the liver and kidney against injury and dysfunction in a HS model and could be a strategy to reduce organ damage associated with ischemia-and-reperfusion injury. [ABSTRACT FROM AUTHOR]

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Hypovolemic shock is a circulatory failure, due to a loss in the effective circulating blood volume, that causes tissue hypoperfusion and hypoxia. This condition stimulates reactive oxygen species (ROS) and pro-inflammatory cytokine production in different organs and also in the central nervous system (CNS). Levosimendan, a cardioprotective inodilator, and dobutamine, a β1-adrenergic agonist, are commonly used for the treatment of hypovolemic shock, thanks to their anti-inflammatory and antioxidant effects. For this reason, we aimed at investigating levosimendan and dobutamine’s neuroprotective effects in an “in vitro” model of lipopolysaccharide (LPS)-induced neuroinflammation. Human microglial cells (HMC3) were challenged with LPS (0.1 µg/mL) to induce an inflammatory phenotype and then treated with levosimendan (10 µM) or dobutamine (50 µM) for 24 h. Levosimendan and dobutamine significantly reduced the ROS levels and markedly increased Nrf2 and HO-1 protein expression in LPS-challenged cells. Levosimendan and dobutamine also decreased p-NF-κB expression and turned off the NLRP3 inflammasome together with its downstream signals, caspase-1 and IL-1β. Moreover, a reduction in TNF-α and IL-6 expression and an increase in IL-10 levels in LPS-stimulated HMC3 cells was observed following treatment. In conclusion, levosimendan and dobutamine attenuated LPS-induced neuroinflammation through NF-κB pathway inhibition and NLRP3 inflammasome activation via Nrf2/HO-1 signalling, suggesting that these drugs could represent a promising therapeutic approach for the treatment of neuroinflammation consequent to hypovolemic shock.

Introduction: Massive hemorrhage (MH) is the second determinant of initial mortality in trauma patients. Its treatment requires aggressive resuscitation with blood or its components. New therapeutic schemes have been postulated, within which massive transfusion (MT) stands out. To analyze the initial experience with the application of the TM protocol in adult trauma patients admitted to the Emergency Department of the Hospital de Clínicas "Dr Manuel Quintela." Materials and methods: A retrospective, observational, and descriptive study was carried out at the Hospital de Clínicas in the period from 1st February 2018 to 2020. Inclusion and exclusion criteria were established. Results: If we only include patients who suffered some type of trauma, the percentage of correct activation rose to 81.6% of the cases. When evaluating the mortality associated with the use of the protocol, it was shown to be significantly lower than in those in which the protocol was used without a clear indication, with a calculated p-value of 0.009. This reflects that there is an association between the need for MT and death. An association was demonstrated between the value of the Assessment of Blood Consumption (ABC) score and death (p = 0.013). Conclusion: Decreases morbidity and mortality in patients who are candidates for MT. Organizes the work group, assigning roles and establishing therapies. Appropriate the rational use of blood components, a finite and scarce good in the world such as blood donation. [ABSTRACT FROM AUTHOR]

This paper summarized the integrated traditional Chinese and western medicine treatment and nursing management of hypovolemic shock due to recurrent gastrointestinal bleeding in a patient with abnormal coagulation function. The symptomatic treatment was carried out based on the risk assessment, and comprehensive interventions such as airway management, complication prevention, psychological intervention, dietary guidance, medication care, Chinese herbal medicine intervention were implemented during the treatment. The gastrointestinal bleeding was controlled and no adverse reaction was observed during the treatment. (总结1例凝血功能异常患者因反复消化道出血继发低血容量性休克的中西医联合用药护理经验。通过科学评估, 积极对症治疗, 同时开展呼吸道管理、并发症防治、心理干预、饮食指导、用药指导、中药干预等护理措施, 患者消化道出血停止, 且治疗期间未出现其他不良反应, 症状得到改善并顺利出院。)

Intramural pregnancy is a rare form of ectopic pregnancy. It is defined by a gestation within the uterine wall, completely surrounded by myometrium and separated from the uterine cavity and the fallopian tube. We report a rare case of intramural ectopic pregnancy. If a patient has a history of intrauterine surgery or myomectomy, the possibility of intramural pregnancy, although rare, should not be ruled out. [ABSTRACT FROM AUTHOR]

Introduction: Hypovolemic shock is diagnosed by the signs of hemodynamic instability and when the source of volume loss is obvious. Among various types, hypovolemic shock is the most common which results either from the loss of blood from hemorrhage or from the loss of plasma alone due to extravascular fluid sequestration or gastrointestinal, urinary, and insensible losses. The objective of this research was to find the use of shock index in predicting fluid resuscitation in patients with hypovolemic shock. Methods: An analytical cross-sectional study was conducted among 120 patients with hypovolemic shock visiting to the Emergency department of College of Medical Sciences and Teaching Hospital from July 2022 to September 2022. Data was collected from patients and checked for completeness, accuracy and then entered and analyzed using SPSS-20. Data was analyzed using descriptive and inferential statistical tools. P-value 50 years. Minority of the patients only required blood transfusion. Among total patients 60% of the patients were admitted in ICU, 25% of them were admitted in ward and 4.17% of them were expired. In 60% cases shock index was

Abstract Background The gut has been hypothesized to be a protagonist tissue in multiple organ dysfunction syndrome (MODS) for the past three decades. Gastric reactance (XL) is a potential perfusion marker derived from gastric impedance spectroscopy (GIS), which is an emerging tool through which living tissue can be continuously measured to determine its pathophysiological evolution. This study aimed to compare the performance of XL [positive predictive values (PPV), negative predictive values (NPV), and area under the curve (AUC)] against commonly used perfusion markers before and during hypovolemic shock in swine subjects. Methods Prospective, controlled animal trial with two groups, control group (CG) N = 5 and shock (MAP ≤ 48 mmHg) group (SG) N = 16. Comparison time points were defined as T-2 (2 h before shock), T-1 (1 h before shock), T0 (shock), T1 (1 h after shock), and T2 (2 h after shock). Shock severity was assessed through blood gases, systemic and hemodynamic variables, and via histological examination for assessing inflammation-edema and detachment in the gastric mucosa. Macroscopic assessment of the gastric mucosa was defined in five levels (0—normal mucosa, 1—stippling or epithelial hemorrhage, 2—pale mucosa, 3—violet mucosa, and 4—marmoreal mucosa). Receiver Operating Characteristic (ROC) curves of perfusion markers and XL were calculated to identify optimal cutoff values and their individual ability to predict hypovolemic shock. Results Comparison among the CG and the SG showed statistically significant differences in XL measurements at T-1, T0, T1, and T2, while lactate showed statistically significant differences until T1 and T2. Statistically significant differences were detected in mucosa class (p

The pressure exerted on the heart and blood vessels because of blood flow is considered an essential parameter for cardiovascular function. It determines sufficient blood perfusion, and transportation of nutrition, oxygen, and other essential factors to every organ. Pressure in the primary arteries near the heart and the brain is known as central blood pressure (CBP), while that in the peripheral arteries is known as peripheral blood pressure (PBP). Usually, CBP and PBP are correlated; however, various types of shocks and cardiovascular disorders interfere with their regulation and differently affect the blood flow in vital and accessory organs. Therefore, understanding blood pressure in normal and disease conditions is essential for managing shock-related cardiovascular implications and improving treatment outcomes. In this review, we have described the control systems (neural, hormonal, osmotic, and cellular) of blood pressure and their regulation in hemorrhagic/hypovolemic shock using centhaquine (Lyfaquin®) as a resuscitative agent. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic shock is the second leading cause of death for injured people and disproportionately affects low resource economies. The potential role of spatial allocation of blood banks and the unmet transfusion needs of patients are yet to be characterized. We aimed to estimate the effect of the number of blood banks in mortality due to traumatic hemorrhagic shock (THS) in Colombia. Methods: We performed a population-based cross-sectional study using secondary data from the Colombian Government: including annual reports from the Blood Bank Network, mortality, and population estimates for 2015-2016. International Classification of Disease 10th code T79.4 identified THS as the primary cause of death. A city-clustered multivariate negative binomial regression, weighted by violent deaths rate, was used to obtain incidence rate ratios (IRR) of death due to THS with 95% confidence intervals (95%CI). Results: Of the 59,030 violent deaths in Colombia in 2015-2016, 36.76% were due to THS. Only 3.13% of Colombian municipalities had a blood bank. THS incidence decreased as the number of blood banks in a city increased, and the lowest incidence was observed at ten banks (IRR:0.18, 95%CI:0.15-0.22). Receiving medical care in a city with blood banks had a more substantial impact on THS (IRR:0.85; 95%CI:0.76-0.96). Conclusion: The number of blood banks per city was associated with lower incidence of THS deaths. These findings may highlight the inequitable distribution of blood systems and their association with preventable deaths. Further studies with more focused clinical and geographical data might clarify the geographic determinants of blood products’ availability.

Background: The gut has been hypothesized to be a protagonist tissue in multiple organ dysfunction syndrome (MODS) for the past three decades. Gastric reactance (XL) is a potential perfusion marker derived from gastric impedance spectroscopy (GIS), which is an emerging tool through which living tissue can be continuously measured to determine its pathophysiological evolution. This study aimed to compare the performance of XL [positive predictive values (PPV), negative predictive values (NPV), and area under the curve (AUC)] against commonly used perfusion markers before and during hypovolemic shock in swine subjects. Methods: Prospective, controlled animal trial with two groups, control group (CG) N = 5 and shock (MAP ≤ 48 mmHg) group (SG) N = 16. Comparison time points were defined as T-2 (2 h before shock), T-1 (1 h before shock), T0 (shock), T1 (1 h after shock), and T2 (2 h after shock). Shock severity was assessed through blood gases, systemic and hemodynamic variables, and via histological examination for assessing inflammation-edema and detachment in the gastric mucosa. Macroscopic assessment of the gastric mucosa was defined in five levels (0—normal mucosa, 1—stippling or epithelial hemorrhage, 2—pale mucosa, 3—violet mucosa, and 4—marmoreal mucosa). Receiver Operating Characteristic (ROC) curves of perfusion markers and XL were calculated to identify optimal cutoff values and their individual ability to predict hypovolemic shock. Results: Comparison among the CG and the SG showed statistically significant differences in XL measurements at T-1, T0, T1, and T2, while lactate showed statistically significant differences until T1 and T2. Statistically significant differences were detected in mucosa class (p < 0.001) and in inflammation-edema in the gastric body and the fundus (p = 0.021 and p = 0.043). The performance of the minimum XL value per subject per event (XL_Min) was better (0.81 ≤ AUC ≤ 0.96, 0.93 ≤ PPV ≤ 1.00, 0.45 ≤ NPV ≤ 0.83) than maximum lactate value (Lac_Max) per subject per event (0.29 ≤ AUC ≤ 0.82, 0.82 ≤ PPV ≤ 0.91, 0.24 ≤ NPV ≤ 0.82). Cutoff values for XL_Min show progressive increases at each time point, while cutoff values for Lac_Max increase only at T2. Conclusions: XL proved to be an indirect and consistent marker of inadequate gastric mucosal perfusion, which shows significant and detectable changes before commonly used markers of global perfusion under the hypovolemic shock conditions outlined in this work. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to evaluate the accuracy of internal jugular vein (IJV) Doppler ultrasonography in predicting hypovolemic shock in polytrauma patients. Methods This prospective observational study was conducted on 75 multiple trauma patients (injury severity score >15) with a mean age of 33.00±9.57 years. IJV Doppler ultrasonography was performed in all patients with stable vital signs and a negative extended focused assessment with sonography for trauma. Jugular pulsatility index (JPI) values were calculated using the equation (Vmax-Vmin)/Vmax. Clinical and laboratory indices of hypovolemic shock were recorded at the time of admission. Patients were subsequently divided into those with hemorrhagic shock (n=36) and those without (n=39) based on the occurrence of hemorrhagic shock within 6 hours after admission. The results were compared between these groups. Results IJV Doppler ultrasound parameters (JPI, Vmin, and Vmax-Vmin) showed significant differences between the two groups. The JPI values of patients with hemorrhagic shock were significantly lower than those in the control group (0.43±0.21 vs. 0.78±0.24, P

Resumen: El abordaje y manejo de pacientes críticamente enfermos representa uno de los temas más versátiles en la medicina de urgencias. Los pacientes con cirrosis hepática tienen características inherentes a su enfermedad que pueden condicionar modificaciones en el tratamiento agudo urgente. Los cambios fisiopatológicos que ocurren en esta enfermedad ameritan la puesta en marcha de un análisis, acerca de si el manejo global de un paciente críticamente enfermo puede aplicarse a pacientes con cirrosis hepática de forma general o si se deben tratar de una manera especial. A través de una revisión de la literatura médica se exploró la información disponible y se sintetizó la evidencia de forma narrativa respecto de lo encontrado acerca del manejo especial que requieren los estos pacientes, seleccionando las descompensaciones urgentes más representativas dentro de la enfermedad crónica. Abstract: The approach to and management of critically ill patients is one of the most versatile themes in emergency medicine. Patients with cirrhosis of the liver have characteristics that are inherent to their disease that can condition modification in acute emergency treatment. Pathophysiologic changes that occur in cirrhosis merit the implementation of an analysis as to whether the overall management of a critically ill patient can generally be applied to patients with cirrhosis of the liver or if they should be treated in a special manner. Through a review of the medical literature, the available information was examined, and the evidence found on the special management required by those patients was narratively synthesized, selecting the most representative decompensations within chronic disease that require emergency treatment.

[Display omitted] Hemorrhagic shock (HS), a leading cause of preventable death, is characterized by severe blood loss and inadequate tissue perfusion. Reoxygenation of ischemic tissues exacerbates organ damage through ischemia–reperfusion injury. SUMOylation has been shown to protect neurons after stroke and is upregulated in response to cellular stress. However, the role of SUMOylation in organ protection after HS is unknown. This study aimed to investigate SUMOylation-mediated organ protection following HS. Male Wistar rats were subjected to HS (blood pressure of 40 ± 2 mmHg, for 90 min) followed by reperfusion. Blood, kidney, and liver samples were collected at various time points after reperfusion to assess organ damage and investigate the profile of SUMO1 and SUMO2/3 conjugation. In addition, human kidney cells (HK-2), treated with the SUMOylation inhibitor TAK-981 or overexpressing SUMO proteins, were subjected to oxygen and glucose deprivation to investigate the role of SUMOylation in hypoxia/reoxygenation injury. The animals presented progressive multiorgan dysfunction, except for the renal system, which showed improvement over time. Compared to the liver, the kidneys displayed distinct patterns in terms of oxidative stress, apoptosis activation, and tissue damage. The global level of SUMO2/3 in renal tissue was also distinct, suggesting a differential role. Pharmacological inhibition of SUMOylation reduced cell viability after hypoxia-reoxygenation damage, while overexpression of SUMO1 or SUMO2 protected the cells. These findings suggest that SUMOylation might play a critical role in cellular protection during ischemia–reperfusion injury in the kidneys, a role not observed in the liver. This difference potentially explains the renal resilience observed in HS animals when compared to other systems. [ABSTRACT FROM AUTHOR]

Objective: Our objective is to demonstrate the interest of thinking about Cerebral salt wasting syndrome (CSW) in front of hyponatremia with severe hypovolemia after a brain injury, and at the same time the interest to differentiate between Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Cerebral salt wasting syndrome (CSW) as two etiologies to be evoked in front of a hyponatremia with brain injury.Case report: We report the case of a 63-year-old patient with a recent history of hemorrhagic stroke admitted for severe hypovolemic shock in whom the investigations find a very deep hypotonic hyponatremia secondary to a cerebral salt wasting syndrome successfully treated with fludrocortisone.Discussion: CWS is characterized by hypotonic hyponatremia associated with cerebral associated with hypovolemia, the difficulty of the diagnosis is explained by the points of convergences with SIADH which is also presented with hyponatremia. The treatment is based on filling with saline, if the symptoms are severe, hypertonic saline has its place. Fludrocortisone has proven its effectiveness in the correction of refractory hyponatremia in CWS.Conclusion: It is essential to differentiate between hyponatremia in CWS and hyponatremia in SIADH because the medical care is categorically different.

The objective: to assess the information value of proadrenomedullin (PAM), once measured upon admission to ICU in predicting mortality and differential diagnosis of septic and hypovolemic shock.Subjects and Methods. A prospective cohort retrospective study was carried out. 134 patients in a state of shock were included in the study. Of these, 125 patients had septic shock; 9 ‒ hypovolemic one. The diagnosis of septic shock was established according to the Sepsis-3 criteria. To compare hypovolemic and septic shock, blood levels of proadrenomedullin (PAM), procalcitonin (PCT) and lactate were tested in 9 patients with obvious hypovolemic shock. Samples (venous blood) were collected within 24 hours from the moment the vasopressors began to be used in ICU or by the ambulance team (EMS).Results. The ROC analysis showed comparable predictive value with APACHE II, SOFA and lactate scales in patients with septic shock with cut-off > 4.23 nmol/L. The range of PAM values in patients with septic shock was Me 4.56 (2.9‒6.7) in patients with hypovolemic shock – Me 0.6 (0.1‒1.4).Conclusion. Proadrenomedullin can be used for differential diagnosis of septic shock and hypovolemic shock. Blood levels greater than 2.9 nmol/L are of absolute value for the diagnosis of septic shock. Procalcitonin is inferior to PAM within the range of 1.0–6.45 ng/ml. PAM unlike SCT is a statistically significant predictor of global outcome in septic shock along with lactate and scales. But such scales as SOFA and ARACНE-II are more laborious in comparison with testing proadrenomedullin blood level.

In forensic medical practice, when diagnosing the cause of death from blood loss, it is often necessary to solve questions related to the etiology of loss of circulating blood volume (CBV), the degree and severity of the injury, as well as its role in thanatogenesis and the duration of the terminal (agonal) period. When investigating the cases of death from acute blood loss, the authorities often ask forensic experts to solve issues related to the possibility of performing active targeted actions by the dying person, as well as to assess the timeliness of medical care and the actions of medical personnel. The solution of these issues is often difficult for experts, and it is associated with both objective and subjective reasons. For example, in cases where the circumstances of death are unknown, or there are no medical documents, or they do not contain sufficient information, without which it is impossible to conduct a retrospective clinical and anatomical analysis for the purpose of differential diagnosis between hemolytic shock and post-hemorrhagic anemia. The article deals with the use of new methodological approaches in postmortem morphological diagnostics of blood loss by the rate of its development and its role in thanatogenesis, in forensic medical practice. For example, a particular forensic expertise (case study) shows that the application of two new methods allowed to solve the issues for the investigator related to the cause of death and duration of dying from blood loss. Experts knowledge of new methodological approaches to the forensic diagnosis of acute blood loss will help law enforcement authorities to counteract crimes against the life of citizens, as well as to development the measures to improve the methods for prevention and reduction of mortality from traumatic injuries with blood loss.

Purpose Acute massive pancreaticoduodenal artery (PDA) hemorrhage represents an urgent condition. Here, we report our experience in transcatheter arterial embolization (TAE) using N-butyl-2 cyanoacrylate (NBCA) Glubran® 2 for this condition. Methods A retrospective study of 10 consecutive patients (mean, 55.2 ± 15.9 years; range, 27–74 years) was conducted from April 2015 to April 2021. The data, including baseline characteristics, control of active PDA hemorrhage (the technical and clinical outcomes), volumes of Glubran 2, and related complications, were collected from medical archives. Technical success was defined as complete occlusion of bleeding vessels on the final arteriogram. Clinical success was defined as the sustained resolution of symptoms or signs of PDA hemorrhage without the need for repeat endovascular or surgical treatment after TAE. Safety was evaluated based on the occurrence of complications. Results Glubran 2 was empirically used for six patients (6/10) with PDA hemorrhage without pseudoaneurysm (PSA), and a combination of Glubran 2 and microcoils (n = 13) was used for four patients (4/10) with PSA. The concentration ratios were 1:2–1:4 mixtures of Glubran 2 and ethiodized oil, and the median total volume injected was 1.1 ml (range, 0.7–1.6 ml). Technical success based on 10 episodes of TAEs was 100% (10/10). Early rebleeding did not occur, and repeat TAE was not necessary. Clinical success was 100% (10/10). No nontarget embolization or embolization-related complications occurred. Two patients (2/10) experienced minor complications of postembolization syndrome. During a median follow-up time of 3 months, no recurrent hemorrhage was recorded. Conclusion Urgent TAE with the use of NBCA Glubran 2 plays an important role in controlling massive PDA hemorrhage. It is minimally invasive, effective, relatively safe, and likely to reduce the need for immediate traditional surgery. The condition with PSA may determine the microcoils employed.

BackgroundThe 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.MethodsDescriptive 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.ResultsFifty-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

Introduction: Retained placenta is considered as one of the important causes of postpartum hemorrhage (primary and secondary). It may lead to complications such as renal failure and shock. Objective: To determine the occurrence of acute renal failure and hypovolemic shock in patients of retained placenta. Outcome measure: Frequency of ARF and hypovolemic shock. Study design: Cross sectional study. Setting: Department of Obstetrics and Gynecology Shaikh Zaid Women Hospital Larkana Subjects: Patients with age group (18-40 years) admitted in labor room were included. Women with renal stone or infections, receiving nephrotoxic drugs and pre-eclampsia were excluded. Methods: Patients meeting the inclusion criteria will be included after written informed consent. A detailed history and examination were done. Patients were labeled as suffering from hypovolemic shock, if they have pulse rate >100 and systolic BP<100mmHg in presence of any one Cold peripheries, Decrease capillary retiling (<3 sec). Patients were suffering from ARF, if she has loss of renal function i.e., elevated (about baseline which is 10-40 mg/dl) and creatinine (about baseline which is 0.4-1.6 mg/dl) along with oliguria (i.e., 24hrs U.O.P <400ml). The analysis of data was done with the use of SPSS version 10. Results: The mean age of included participants is 29.8±5 years. From 307 patients, primiparity accounted for 117 (38%), parity 2-3 for 135 (44%) and parity 4-5 for 55 (18%) cases. The systolic blood pressure of 145 (47.2%) patients was <100 mmHg and in 162 (52.8%) patients was >100 mmHg. A total of 299 (97.4%) patients has urine output of >400 ml in 24 hours and 8 (2.6%) cases have urine output of <400 ml in 24 hours. Of 307 patients 10 (3.2%) had acute renal failure and 69 (22.5%) had shock. Conclusions: From this study, it was observed that the frequency of ARF and hypovolemic shock is high in patients with retained placenta. [ABSTRACT FROM AUTHOR]

Shock is a life-threatening pathophysiologic state referring to inadequate organ perfusion, which can progress to end-organ dysfunction and eventually, multiple organ failure and death. The diagnosis of shock is clinical, necessitating good understanding of the underlying etiology, pathophysiology, as well as the clinical, biochemical, and hemodynamic manifestations of the various presentations of shock. This article describes an approach to shock, highlighting the important initial actions, pertinent clinical findings, and the four main types of shock, and offers an overview of the inotropes and vasopressors used in the intensive care setting. A case study and additional figures are included to supplement the presented concepts. [ABSTRACT FROM AUTHOR]

Crush syndrome often occurs after severe crush injury caused by disasters or accidents, and is associated with high mortality and poor prognosis. Cardiovascular complications, such as cardiac arrest, hypovolemic shock, and hyperkalemia-related cardiac dysfunction, are the primary causes of on-site death in crush syndrome. Prehospital evaluation, together with timely and correct treatment, is of great benefit to crush syndrome patients, which is difficult in most cases due to limited conditions. Based on current data and studies, early fluid resuscitation remains the most important on-site treatment for crush syndrome. Novel solutions and drugs used in fluid resuscitation have been investigated for their effectiveness and benefits. Several drugs have proven effective for the prevention or treatment of cardiovascular complications in crush syndrome, such as hypovolemic shock, hyperkalemia-induced cardiac complications, myocardial ischemia/reperfusion injury, ventricular dysfunction, and coagulation disorder experimentally. Moreover, these drugs are beneficial for other complications of crush syndrome, such as renal dysfunction. In this review, we will summarize the existing on-site treatments for crush syndrome and discuss the potential pharmacological interventions for cardiovascular complications to provide clues for clinical therapy of crush syndrome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Tan, Yang and Yu.)

Abstract Background Several fatal medical complications have been associated with alcohol withdrawal, such as seizure, cardiac arrhythmia, and takotsubo cardiomyopathy. However, there have been no reports on hypovolemic shock during alcohol withdrawal, although two physical signs of alcohol withdrawal, i.e., diaphoresis and fever, can lead to hypovolemia and its medical consequences. Case presentation We describe a patient with alcohol use disorder who exhibited hypovolemic shock and its associated acute renal failure during alcohol withdrawal with severe diaphoresis and fever even though he had consumed almost the full amount of food he was offered. Given his excessive diaphoresis and fever that were related to alcohol withdrawal, his water intake was insufficient. Infusion with extracellular fluid resolved all these medical issues. Conclusions The increased adrenergic activity associated with alcohol withdrawal might substantially increase a patient’s water-intake requirement through diaphoresis and fever and may cause severe hypovolemia and its associated medical complications.

Although ovarian cancer is the second most common gynecological cancer, it is the most common gynecological malignancy that causes death. Approximately 75% of the patients are diagnosed at an advanced stage, and high-grade serous-type ovarian cancer is detected in most of these patients. The final pathology result in our case was high-grade serous ovarian carcinoma. Our patient, 39 years old, applied to our emergency department with complaints of inability to urinate for three days and new onset abdominal pain. We were consulted because of detection of an 11 cm solid mass and globe vesicle in the pelvic region detected on the computed tomography (CT) taken in the emergency department. The patient's initial hemoglobin value was 11.2 g/dL and the beta-human chorionic gonadotropin (B-HCG) value was negative. During the follow-up, the patient's hemoglobin values were 9.2 and then decreased to 8.6, 8.1, and 6.5 g/dL after which hypotensive shock developed in the patient. The patient was taken for an emergency laparotomy. Intra-operatively, 1500 mL of intra-abdominal hemorrhagic fluid and diffuse tumor fragments were observed. In the right adnexal area, approximately 11 cm of ruptured tumor tissue, which may originate from the ovary or uterus, was observed. It was observed that the Douglas pouch and uterine, internal iliac, and some parts of the external iliac arteries were extensively invaded by the tumor and active bleeding occurred. Total Abdominal Hysterectomy + Bilateral Salpingo-Oopherectomy (TAH+BSO) was performed on the patient. Additional surgical intervention could not be performed because the patient had extensive vascular tumor invasion, heavy bleeding, and was in hypotensive shock. Six anti-bleeding sponges were placed on intra-abdominal bleeding areas. In addition, packing was applied to the patient by placing four sterile compresses and soft drains inside the abdomen. Tranexamic acid was administered to the patient, and six units of red blood cell suspension and four units of fresh frozen plasma were transfused. The patient was transferred by ambulance to a higher institution, which is a gynecological oncology center, for follow-up, treatment, and complementary surgery. In this case, we aimed to draw attention to a rare case of ovarian malignancy rupture and hypotensive shock. [ABSTRACT FROM AUTHOR]

Rationale: Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal (GI) bleeding. GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock. Patient’s Concern: A 33-year-old man with confusion and hypotension (blood pressure: 70/40 mmHg and pulse rate: 140/min) was brought by emergency medical services from home to the emergency department without any companion. The patient was in undifferentiated shock. His hypotension was assessed with inferior vena cava (IVC) size and collapsibility, and rapid ultrasound in shock and hypotension (RUSH) protocol was used to investigate the cause of his shock. Following the RUSH protocol when scanning the IVC, parts of the stomach were seen in its vicinity and suspended heterogeneous particles were observed in the fluid. After seeing these particles, we suspected GI bleeding. Diagnosis: Endoscopy confirmed GI bleeding. Interventions: After placing an orogastric tube and suction, about 2 L of coffee-ground fluid with clots was removed. We started intravenous proton-pump inhibitors 80 mg bolus, followed by a continuous infusion of 8 mg/h. The patient received about 2 L of normal saline and 2 units of packed red blood cells to correct his hypotension. Outcomes: After being admitted to the GI ward and treated for three days, the patient was discharged from the hospital with a hemoglobin level of 11 g/dL and continued to have an outpatient follow-up at the clinic. Lessons: The use of gastric ultrasound in conjunction with the RUSH protocol can help to diagnose undifferentiated hypotensive shock. The components of the RUSH exam are the heart (H), IVC (I), Morrison’s/FAST abdominal views with the aorta (MA), and pulmonary and pipes scanning (P), and can be memorized with the mnemonic: HI-MAP. We would like to introduce a new mnemonic: Hi-MAPS, adding stomach (S) to the RUSH protocol in undifferentiated hypotension and shock to evaluate upper GI bleeding.

The liver can be damaged from an impact (such as in a car accident) or from penetrating trauma (such as a stab or gunshot wound). Liver lesions range from relatively small collections of blood (hematomas) to large deep lacerations. Since the liver is supplied with many large blood vessels, the main problem following a liver injury is severe bleeding. Almost all bleeding from a liver injury occurs in the abdominal cavity. Spontaneous rupture of the liver is a rare occurrence. This is often associated with underlying pathological conditions (pregnant women with HELLP syndrome, liver pathologies such as adenoma, hepatic lymphoma, hepatocellular carcinoma HCC, macronodular cirrhosis, hemangioma, metastatic tumors and peliosis hepatis) or following traumatic insults. The authors report a rare case of spontaneous rupture of the liver that occurred in a 72-year-old man without underlying pathologies predisposing this condition, in the absence of evident traumatic lesions in the abdominal area and with a near- negative pathological history of trauma (falls, road accidents, etc.).