Critical care clinics
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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.
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Critical care clinics · Apr 2022
ReviewGenetic Defects that Predispose to Serious Viral Infections.
Viral immunity is a complex, multistep process involving both the innate and adaptive immune systems. Genetic defects in the immune system known as primary immune deficiency disorders (PIDDs) can result in viral infections that are severe, recurrent, or recalcitrant to therapy. These infections can lead to respiratory tract disease and pneumonitis, skin disease, and disseminated viral syndromes that affect multiple organs and even the brain. This review will provide a brief overview of immunity to viruses, an overview of PIDDs that result in significant viral susceptibility, as well as a diagnostic approach to these infections with a focus on defects that are severe and may require intensivist care.
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Critical care clinics · Apr 2022
ReviewZebras Seize the Day: Rare Causes of Status Epilepticus Across the Continuum of Critical Care.
Status epilepticus (SE) is a common neurologic emergency and is associated with a high risk of morbidity and mortality. The management of SE in the intensive care unit centers on stabilization and treatment, as well as identifying and treating the underlying etiology. Numerous etiologies of SE are amenable to treatment, including certain genetic and metabolic disorders, autoimmune encephalitis and other inflammatory disorders, intracranial infections, and toxic/metabolic derangements. This article highlights rare but important causes of SE across the continuum of care from neonates to adults.