Critical care clinics
-
The US Department of Homeland Security, and other state and federal agencies, continues to express concern over the potential use of radioactive isotopes as a weapon of terror. Few emergency medicine and critical care physicians are familiar with the care and treatment of an accidentally or intentionally irradiated patient who is contaminated externally or internally. ⋯ Preparation for patient receipt and emergency care, followed by definitive diagnosis using biodosimetry is also presented. Therapeutic measures continue to evolve for externally and internally exposed victims, including those with combined injuries caused by burns and trauma.
-
This article reviews the epidemiology, pathophysiology, and clinical management of patients with suspected or confirmed viral hemorrhagic fever infection. The focus is on clinical management based on case series from naturally occuring outbreaks of viral hemorrhagic fever infection as well as imported cases of viral hemorrhagic fever encountered in industrialized nations. The potential risk of bioterrorism involving these agents is discussed as well as emergency department and critical care management of isolated cases or larger outbreaks. Important aspects of management, including recognition of infected patients, isolation and decontamination procedures, as well as available vaccines and therapies are emphasized.
-
Coagulation problems are very common in intensive care patients. It is important to recognize potential problems, perform a rapid assessment, and start therapy. ⋯ This review outlines a set of often catastrophic coagulation problems, which may present both thrombotic and bleeding challenges. These include heparin induced thrombocytopenia, thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation.
-
Critical care clinics · Jul 2005
ReviewEmerging off-label uses for recombinant activated factor VII: grading the evidence.
Recombinant activated factor VII (rFVIIa) is currently licensed in the United States for treatment of bleeding episodes in patients with deficiencies of factor VIII (FVIII) or IX (FIX) who are refractory to factor replacement because of circulating inhibitors. A 1999 report of its successful use to stop what was deemed to be lethal hemorrhage after an abdominal gunshot wound in a young soldier without pre-existing coagulopathy has prompted exploration of other uses for rFVIIa. The virtual explosion of proposed uses of rFVIIa raises issues not only regarding our understanding of the coagulation system, but also regarding its efficacy, cost-effectiveness, and safety.
-
Critical care clinics · Jul 2005
ReviewDoes disseminated intravascular coagulation lead to multiple organ failure?
Microvascular dysfunction with its associated impaired regional oxygen transport and use is believed to be the final common pathway in the development of multiple organ failure. The precise mechanisms underlying this dysfunction, however, are uncertain. Activation of the coagulation system is a key feature in the pathogenesis of sepsis, but whether it is also the cause of multiple organ failure is unclear. This article discusses the evidence for and against a key role for disseminated intravascular coagulation in the pathogenesis of multiple organ failure.