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Shock is the state of insufficient blood flow to the tissues of the body as a result of problems with the circulatory system. Initial symptoms of shock may include weakness, fast heart rate, fast breathing, sweating, anxiety, and increased thirst. This may be followed by confusion, unconsciousness, or cardiac arrest, as complications worsen.
Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.
Septic shock is a potentially fatal medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defines septic shock as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by requiring a vasopressor to maintain a mean arterial pressure of 65 mm Hg or greater and having serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%.
In immunology, systemic inflammatory response syndrome (SIRS) is an inflammatory state affecting the whole body. It is the body's response to an infectious or noninfectious insult. Although the definition of SIRS refers to it as an "inflammatory" response, it actually has pro- and anti-inflammatory components.
Stress hyperglycemia is a medical term referring to transient elevation of the blood glucose due to the stress of illness. It usually resolves spontaneously, but must be distinguished from various forms of diabetes mellitus.
Terlipressin, sold under the brand name Terlivaz among others, is an analogue of vasopressin used as a vasoactive drug in the management of low blood pressure. It has been found to be effective when norepinephrine does not help. Terlipressin is a vasopressin receptor agonist.
Distributive shock is a medical condition in which abnormal distribution of blood flow in the smallest blood vessels results in inadequate supply of blood to the body's tissues and organs. It is one of four categories of shock, a condition where there is not enough oxygen-carrying blood to meet the metabolic needs of the cells which make up the body's tissues and organs. Distributive shock is different from the other three categories of shock in that it occurs even though the output of the heart is at or above a normal level. The most common cause is sepsis leading to a type of distributive shock called septic shock, a condition that can be fatal.
The sequential organ failure assessment score, previously known as the sepsis-related organ failure assessment score, is used to track a person's status during the stay in an intensive care unit (ICU) to determine the extent of a person's organ function or rate of failure. The score is based on six different scores, one each for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems.
Etomidate is a short-acting intravenous anaesthetic agent used for the induction of general anaesthesia and sedation for short procedures such as reduction of dislocated joints, tracheal intubation, cardioversion and electroconvulsive therapy. It was developed at Janssen Pharmaceutica in 1964 and was introduced as an intravenous agent in 1972 in Europe and in 1983 in the United States.
Critical Care Medicine is a peer-reviewed monthly medical journal in the field of intensive care medicine. The journal was established in 1973 with William C. Shoemaker as the founding editor. It is the official publication of the Society of Critical Care Medicine and is published by Lippincott Williams & Wilkins. The journal's editor-in-chief is Timothy G. Buchman.
A banana bag is a bag of IV fluids containing vitamins and minerals. The bags typically contain thiamine, folic acid, and magnesium sulfate, and are usually used to correct nutritional deficiencies or chemical imbalances in the human body. The solution has a yellow color, hence the term "banana bag".
Hydroxyethyl starch (HES/HAES), sold under the brand name Voluven among others, is a nonionic starch derivative, used as a volume expander in intravenous therapy. The use of HES on critically ill patients is associated with an increased risk of death and kidney problems.
The Surviving Sepsis Campaign (SSC) is a global initiative to bring together professional organizations in reducing mortality from sepsis. The purpose of the SSC is to create an international collaborative effort to improve the treatment of sepsis and reduce the high mortality rate associated with the condition. The Surviving Sepsis Campaign and the Institute for Healthcare Improvement have teamed up to achieve a 25 percent reduction in sepsis mortality by 2009. The guidelines were updated in 2016 and again in 2021.
Early goal-directed therapy was introduced by Emanuel P. Rivers in The New England Journal of Medicine in 2001 and is a technique used in critical care medicine involving intensive monitoring and aggressive management of perioperative hemodynamics in patients with a high risk of morbidity and mortality. In cardiac surgery, goal-directed therapy has proved effective when commenced after surgery. The combination of GDT and Point-of-Care Testing has demonstrated a marked decrease in mortality for patients undergoing congenital heart surgery. Furthermore, a reduction in morbidity and mortality has been associated with GDT techniques when used in conjunction with an electronic medical record.
Critical illness–related corticosteroid insufficiency is a form of adrenal insufficiency in critically ill patients who have blood corticosteroid levels which are inadequate for the severe stress response they experience. Combined with decreased glucocorticoid receptor sensitivity and tissue response to corticosteroids, this adrenal insufficiency constitutes a negative prognostic factor for intensive care patients.
A pediatric intensive care unit, usually abbreviated to PICU, is an area within a hospital specializing in the care of critically ill infants, children, teenagers, and young adults aged 0–21. A PICU is typically directed by one or more pediatric intensivists or PICU consultants and staffed by doctors, nurses, and respiratory therapists who are specially trained and experienced in pediatric intensive care. The unit may also have nurse practitioners, physician assistants, physiotherapists, social workers, child life specialists, and clerks on staff, although this varies widely depending on geographic location. The ratio of professionals to patients is generally higher than in other areas of the hospital, reflecting the acuity of PICU patients and the risk of life-threatening complications. Complex technology and equipment is often in use, particularly mechanical ventilators and patient monitoring systems. Consequently, PICUs have a larger operating budget than many other departments within the hospital.
Emanuel Rivers is a physician born and raised in River Rouge, Michigan which is a suburb of Detroit, MI. He is board certified in emergency medicine, internal medicine and critical care medicine. Rivers has published extensively in the field of shock, sepsis and resuscitation.
Calcium channel blocker toxicity is the taking of too much of the medications known as calcium channel blockers (CCBs), either by accident or on purpose. This often causes a slow heart rate and low blood pressure. This can progress to the heart stopping altogether. Some CCBs can also cause a fast heart rate as a result of the low blood pressure. Other symptoms may include nausea, vomiting, sleepiness, and shortness of breath. Symptoms usually occur in the first six hours but with some forms of the medication may not start until 24 after hours.
Norepinephrine, also known as noradrenaline, is a medication used to treat people with very low blood pressure. It is the typical medication used in sepsis if low blood pressure does not improve following intravenous fluids. It is the same molecule as the hormone and neurotransmitter norepinephrine. It is given by slow injection into a vein.
Vasopressin infusions are in use for septic shock patients not responding to fluid resuscitation or infusions of catecholamines to increase the blood pressure while sparing the use of catecholamines. These argipressins have much shorter elimination half-life than synthetic non-arginine vasopresines with much longer elimination half-life of many hours. Further, argipressins act on V1a, V1b, and V2 receptors which consequently lead to higher eGFR and lower vascular resistance in the lungs. A number of injectable arginine vasopressins are in clinical use in the United States and the European Union. Pitressin among others, is a medication most commonly used in the treatment of frequent urination, increased thirst, and dehydration such as that resulting from diabetes insipidus, which causes increased and diluted urine. It is used to treat abdominal distension following some surgeries, and in stomach roentgenography. Vasopressin is a hormone that affects the kidneys and reduces urine flow.
References
- ↑ R. Phillip, Dellinger; Mitchell M., Levy; Jean M., Carlet; Julian, Bion; Margaret M., Parker; Roman, Jaeschke; Konrad, Reinhart; Derek C., Angus; Christian, Brun-Buisson; Richard, Beale; et al. (1 January 2008). Buchanan, Timothy G.; Tosta, Sophie M.; Retford, Lynn; Goldberg, Jill; Less, Sarah; Drake, Madison; Maslove, David M.; Deutschmann, Clifford S.; Prough, Donald S. (eds.). "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008". Critical Care Medicine . Society of Critical Care Medicine/Lippincott Williams & Wilkins. 36 (1): 296–327. doi:10.1097/01.ccm.0000298158.12101.41. ISSN 0090-3493. LCCN 73647665. OCLC 772657699. PMID 18158437. S2CID 220581728. Archived from the original on 16 June 2020 – via PubMed.
- ↑ Rhodes, Andrew; Evans, Laura E.; Alhazzani, Waleed; Levy, Mitchell M.; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E.; Sprung, Charles L.; Nunnally, Mark E.; et al. (1 March 2017). Buchanan, Timothy G.; Tosta, Sophie M.; Retford, Lynn; Goldberg, Jill; Less, Sarah; Drake, Madison; Maslove, David M.; Deutschmann, Clifford S.; Prough, Donald S. (eds.). "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016". Critical Care Medicine . Society of Critical Care Medicine/Lippincott Williams & Wilkins. 45 (3): 486–452. doi:10.1097/CCM.0000000000002255. ISSN 0090-3493. LCCN 73647665. OCLC 772657699. PMID 28098591. S2CID 52827184. Archived from the original on 1 February 2020. Retrieved 22 June 2021.
- ↑ "Home « The UK Sepsis Trust The UK Sepsis Trust". sepsistrust.org. Retrieved 2014-04-22.
- ↑ Daniels, Ron; Nutbeam, Tim; McNamara, Georgina; Galvin, Clare (2011). Godlee, Fiona; Abbasi, Kamran; Bloom, Theodora; Loder, Elizabeth; Coombes, Rebecca; Dobson, Juliet; Kmietowicz, Zosia; Simpson, Paul; Tonks, Alison; Moberly, Tom; et al. (eds.). "The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study". Emergency Medicine Journal. London, England, United Kingdom of Great Britain: BMJ Publishing Group Ltd/British Medical Association. 28 (6): 507–512. doi:10.1136/emj.2010.095067. ISSN 1472-0213. JSTOR 09598138. LCCN 97640199. OCLC 32595642. PMID 21036796. S2CID 26693613. Archived from the original on 2 June 2018.