Critical care clinics
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Pediatric acute liver failure is a rare process that results from many different diseases including toxin ingestion and drug overdose, infections, metabolic and genetic disorders, immune-mediated diseases, and ischemia. Up to 50% of children with acute liver failure will never have an underlying cause found. ⋯ Nonetheless, overall survival is approximately 50% without liver transplantation. Opportunities for improvement in the care of children with acute liver failure still exist.
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Critical care clinics · Apr 2022
ReviewUndiagnosed and Rare Diseases in Critical Care: Severe Mucocutaneous Medication Reactions.
There have been major advances in the understanding of severe cutaneous adverse reactions (SCARs). Early recognition and withdrawal of culprit medications can decrease morbidity and mortality significantly. ⋯ Physicians need to recognize SCARs early in their course, including drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis, and their mimicking conditions. This review focuses on common and rare SCARs with an emphasis on defining features, clinical and diagnostic evaluation, treatment, and long-term sequelae.
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Critical care clinics · Apr 2022
ReviewUndiagnosed and Rare Diseases in Critical Care: The Role of Diagnostic Access.
Critically ill patients with undiagnosed and rare diseases are at high risk for cognitive diagnostic errors as well as delays in diagnosis that are the result of impaired diagnostic access. Local evaluation teams dedicated to undiagnosed and rare diseases can address both the risk and actuality of diagnostic error, as well as shortfalls in diagnostic access, particularly for patients whose diminished access is a result of critical illness. Features of successful teams are discussed.
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Critical care clinics · Apr 2022
ReviewRecognition and Management Considerations of Cardiac Channelopathies in the Intensive Care Unit.
The understanding and prevalence of cardiac channelopathies has grown over time. Many patients are asymptomatic but are at risk for malignant arrhythmias during high-acuity medical admissions. Long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia are discussed with specific consideration given for the role these medical conditions play during an intensive care unit admission-for either cardiac or noncardiac reasons.
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Critical care clinics · Apr 2022
ReviewAutoimmune Encephalitis: Distinguishing Features and Specific Therapies.
Autoimmune encephalitis is characterized by subacute onset of the altered mental status that can rapidly progress to autonomic instability and refractory seizures requiring intensive care. It is mediated by autoantibodies that bind to synaptic surface proteins and alter their function. ⋯ Diagnosis, treatment, and monitoring for this devastating condition continue to evolve. Pathogenesis, diagnosis and both current and emerging therapies are reviewed.