Critical care clinics
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Shock is a state in which the cardiovascular system fails to adequately deliver required substrates to maintain end-organ perfusion, tissue homeostasis, and cellular metabolism. Rapid recognition of shock and intervention is of utmost importance to reverse the shock state. This article reviews uncommon etiologies of shock classified in the following categories: distributive, hypovolemic, cardiogenic, and dissociative shock.
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Rhabdomyolysis is a relatively common phenomenon, and most cases do not require intensive care unit level of care. Although most common causes can be easily identified, in encephalopathic or critically ill patients, symptoms can be easily missed, as can uncommon etiologies. ⋯ As the list of potential causes is large, not every possible cause for rhabdomyolysis will be discussed. This article, however, will provide a general framework to manage any patient with this muscle disease.
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Sepsis is a heterogenous and imprecise syndrome that includes multiple phenotypes, some of which are amenable to specific therapies. Developing new therapies for sepsis will require focusing on subsets of patients. ⋯ Because sepsis is common, it is easy to overlook unusual causes of organ failure and succumb to confirmation bias about the nature of an illness. Careful attention to medical and family histories, focused diagnostic testing, and subspecialty input can help identify potentially treatable diseases masquerading as typical sepsis.
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Hypertensive crisis, especially in children, is a rare condition and is defined as a sudden and abrupt elevation in blood pressure that poses a threat of rapid onset of end-organ damage. Symptomatic hypertension requires urgent and thorough evaluation and management. ⋯ This article discusses common and rare causes of severe hypertension in infancy, childhood, and adulthood. Clinical features that indicate possible serious underlying disease associated with severe and symptomatic hypertension are outlined.
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Diagnostic errors harm patients. While the underlying causes of diagnostic error and the settings in which they occur are diverse, the use of a cognitive forcing function in the form of a diagnostic time-out can mitigate the risk of diagnostic error. ⋯ Attending neonatologists and neonatology nurse practitioners reported decreased perception of the risk of diagnostic error impacting patient outcomes, relative to the perception among neonatology fellowship trainees. Future directions include addressing concerns over the perceived time investment required for a diagnostic time-out and increasing provider appreciation of the nature and impact of diagnostic error on patient outcomes.