August 2008 - Critical Care and Shock

An Unusual Presentation of Staphylococcal Induced Paravertebral Myositis Causing Septic Shock

J. O’Leary 24/08/2008

Background: Paravertebral myositis is uncommon, and this case highlights a number of important therapeutic and diagnostic considerations. We discuss the role of appropriate antimicrobial therapy and the potential dilemma regarding the use of immunoglobulin in the septic patient. The key elements of treatment are early recognition, and the early initiation of appropriate antibiotics, typically a Î²-lactamase resistant anti-staphylococcal agent and clindamycin.

Asynchronous Independent Lung Ventilation in the Management of Bronchopleural Fistula

Rudolph L. Koch 24/08/2008

Ventilation of lungs with parenchymal injury which can be caused by either disease or trauma has always been a diffi cult task for both respiratory therapists and physicians. There have been great many advances made in mechanical ventilators and ventilator modes over last decade. This has included the introduction of modes such as High Frequency Oscillator Ventilation (HFOV) [1] and Airway Pressure Release Ventilation (APRV).

Measurement of Central Venous Pressure via the Femoral Route in Abdominal Compartment Syndrome

Gavin M. Joynt 24/08/2008

Introduction: Femoral vein catheterization provides an alternative route of access to central veins, is technically easy and relatively safe. There is good evidence of a general agreement between intrathoracic central venous pressure (CVP) and CVP measured in the iliofemoral veins or inferior vena cava in critically ill patients. This agreement is not well documented when intra-abdominal pressure is raised.

Diltiazem versus Amiodarone for New-Onset Atrial Arrhythmias in Non-Cardiac Post Surgical Patients: A Cohort Study

Anthony T. Gerlach 24/08/2008

Objective: To evaluate safety and efficacy of diltiazem versus amiodarone for conversion of atrial arrhythmias in non-cardiac post-surgical critically ill patients.
Design: A cohort study of non-cardiac post surgical patients admitted to the surgical intensive care unit with new-onset atrial tachyarrhythmias which were treated by protocol. In the first year patients were treated with diltiazem, and amiodarone was used in
the second year.

Fat Embolism Syndrome

Gavin M. Joynt 24/08/2008

The classical syndrome of fat embolism is characterized by the triad of respiratory failure, neurologic dysfunction and the presence of a petechial rash. Fat embolism syndrome (FES) occurs most commonly following orthopedic trauma, particularly fractures of the pelvis or long bones, however non-traumatic fat embolism has also been known to occur on rare occasions. Because no definitive consensus on diagnostic criteria exist, the accurate assessment of incidence, comparative research and outcome assessment is difficult.

Information Exchange in Critical Care for a Better Future

Simon Nanlohy 24/08/2008

In the year 2008, knowledge and technology develop continually in every field of our lives, and, with no exception, in critical care medicine as well. This continuous growth is implicit in our daily activities. We could not imagine our lives today without it. Nowadays, as health care professionals, we surely do not want a fever to last for one week before we can make a diagnosis of typhoid fever for our patients. We can use some simple tests instead and institute prompt therapy.