Emergency medicine clinics of North America
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Shock is a physiologic state associated with high morbidity and mortality rates. The clinician has several tools available to evaluate volume status. ⋯ Although the search for the Holy Grail of a perfect intravascular monitor continues, we must remember the importance of early, aggressive, and goal-directed interventions for patients in shock. Finally, there is no substitute for the most important intervention-the frequent presence of the physician at the patient's bedside.
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Resuscitative ultrasonography provides rapid, repeatable, and multisystem assessment to guide diagnosis and management of critically ill patients in the emergency department (ED). Cardiac ultrasonography offers new anatomic and hemodynamic information, previously unavailable in an ED setting, whereas other applications match or exceed the speed and utility of existing tests such as chest radiograph (thoracic ultrasonography) or central venous pressure determination (inferior vena cava ultrasonography). Evolving areas of resuscitative ultrasonography include neurologic applications and transesophageal echocardiography, which promise to further enhance the role of ultrasonography in managing critical illness in the ED.
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To effectively treat an aging and increasingly complex patient population, emergency physicians and other acute-care providers must be comfortable with the use of vasopressors, inotropes, and chronotropes. These medicines are used to augment the cardiovascular function of critically ill patients. ⋯ For the emergency physician, these agents are used with the explicit goal of preserving vital organ perfusion during acute and severe illness. This article reviews the physiologic receptors targeted by such drugs, common agents used, and specific clinical indications for their use.
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Emerg. Med. Clin. North Am. · Nov 2014
ReviewEmergency Department Antimicrobial Considerations in Severe Sepsis.
Severe sepsis and septic shock are common problems in the emergency department patient population and require expert clinical skill by members of the emergency department team to maximize optimal patient outcomes. Although various guidelines have been developed for the management of these patients, issues around antimicrobial-related considerations in critically ill patients require further evidence-based attention. In this review article, important factors related to patient illness, microorganism, timing of antimicrobial administration, and source control are discussed.
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Neurotrauma continues to be a significant cause of morbidity and mortality. Prevention of primary neurologic injury is a critical public health concern. ⋯ Critical care management of the patient with neurotrauma is focused on the prevention of secondary injuries. Much research is still needed for potential neuroprotection therapies.