Journal of intensive care medicine
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J Intensive Care Med · Mar 2007
Review Case ReportsAcute adrenal insufficiency after a single dose of etomidate.
Acute adrenocortical insufficiency is a critical care emergency characterized by hemodynamic instability, lethargy, and cardiovascular collapse. Acute adrenal insufficiency has many etiologies, from rapid withdrawal of exogenous glucocorticoids to adrenocortical destruction to poor adrenal reserve after administration of steroid synthesis inhibitors. ⋯ A case is presented of acute adrenocortical insufficiency and crisis after a standard induction dose of etomidate. Acute adrenal insufficiency should be suspected in intensive care unit patients who have undergone general anesthesia with etomidate induction and present with hypotension refractory to standard vasopressor administration.
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The practice of platelet transfusion in the intensive care unit varies, and liberal use may not be associated with improved outcome. This study reviewed the medical records of 117 patients with moderate-to-severe thrombocytopenia and without active bleeding who were admitted to intensive care unit beds during a 6-month period. The primary outcome measures were new bleeding episodes and platelet transfusion complications. ⋯ Predictors of platelet transfusion were platelet count and postoperative status, but not invasive procedure. The practice of platelet transfusion in critically ill patients with thrombocytopenia varies. Prospective studies evaluating restrictive versus liberal platelet transfusion strategies are warranted.
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J Intensive Care Med · Mar 2007
ReviewCritical care issues in the patient after major joint replacement.
Admission rates of orthopedic patients to intensive care units are increasing. Thus, an intensivist's familiarity with specific problems associated with major joint replacement surgery is of utmost importance in order to meet the needs of this particular patient population. ⋯ Perioperative risk factors for morbidity and mortality and the epidemiology, diagnosis, and treatment of cardiopulmonary complications in this patient population are discussed. Procedure-specific complications such as fat embolism and acrylic bone cement-related issues are reviewed.
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J Intensive Care Med · Mar 2007
Case ReportsCerebral oximetry monitoring provides early warning of hypercyanotic spells in an infant with tetralogy of Fallot.
A 3.6-kg, 3-month-old infant with a history of tetralogy of Fallot and increasing hypercyanotic spells was brought to the operating room for operative repair. Before the initiation of cardiopulmonary bypass, it was noted that an abrupt decrease in the cerebral oximetry value occurred before pulse oximetry measured the decrease in oxygen saturation. ⋯ For the first time, this case illustrates that cerebral oximetry monitoring may be able to identify the onset of hypercyanotic spells and desaturation before standard pulse oximetry. Cerebral oximetry may provide a quicker identification of acute changes in the clinical status of infants and children by identifying hypoxemia before pulse oximetry.