Critical care clinics
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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
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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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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Acute kidney injury (AKI) is one of the most important complications of critical illness and a significant public health concern. AKI is commonly associated with sepsis, cardiac dysfunction, and exposure to nephrotoxic medication; however, less common causes of AKI can lead to devastating patient outcomes when the underlying diagnosis is missed or delayed. These uncommon causes of AKI fall into 3 large categories: structural, immune mediated, and microvascular, including various types of thrombotic microangiopathy. Kidney imaging, urine studies, and serum hemolytic studies should be a routine part of the evaluation of AKI among critically ill patients.
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The focus of this narrative review is the differential diagnosis of disease involving the peripheral or lower motor neuron component of the neurology of breathing. The clinical context is limited to those conditions leading to admission to the intensive care unit with a time course often described as acute or of rapid onset, meaning within days to weeks. However, the article also reviews those underlying inherited or congenital conditions that may have gone unnoticed until fulminant deterioration with respiratory failure.