Critical care clinics
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Critical care clinics · Apr 2022
Review Case ReportsCommon Presentations of Rare Drug Reactions and Atypical Presentations of Common Drug Reactions in the Intensive Care Unit.
Adverse drug events (ADRs) are a significant source of iatrogenic injury that may be challenging to diagnose and treat. Patient outcomes range from mild symptoms to death. Critically ill children are at unique risk for ADR development because of age-dependent pharmacokinetic differences and off-label prescribing.
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Wheezing is a common finding across patients of all age groups presenting to the emergency department and being hospitalized for respiratory distress, with most patients responding to standard therapeutics and having readily apparent diagnoses of asthma or bronchiolitis. We describe several clinical entities that may present with wheezing and respiratory distress, calling attention to the broad differential that may masquerade as asthma or bronchiolitis, and potentially lead to misdiagnosis, delayed diagnosis, or inappropriate treatment.
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Critical care clinics · Apr 2022
ReviewRapid Exome and Genome Sequencing in the Intensive Care Unit.
Rapid genomic sequencing has become a powerful diagnostic tool for critically ill children. Accumulated data support clinical utility. ⋯ Cost savings to health care institutions are not only the result of reduced sequencing charges (which have paralleled advances in sequencing technology), but also and more specifically have impact on diagnosis-specific medical management and reduced length of hospitalization. The use of genomic sequencing in critical care is still primarily limited to academic centers but will ultimately become the wider-spread standard of care for select patients.
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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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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.