Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
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Indian J Crit Care Med · Jan 2013
Risk factors for hospital-acquired hypernatremia among critically ill medical patients in a setting utilizing a preventive free water protocol: Do we need to do more?
Hospital-acquired hypernatremia (HAH) is a frequent concern in critical care, which carries high mortality. ⋯ The study suggests that administration of free water to prevent HAH should be more meticulously complied with in patients who are elderly, present with AKI, suffer multi-organ dysfunction, require mechanical ventilation, receive enteral feeds and drugs like mannitol or ionotropes.
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Mechanical ventilation is one of the most commonly applied interventions in intensive care units. Despite its life-saving role, it can be a risky procedure for the patient if not applied appropriately. To decrease risks, new ventilator modes continue to be developed in an attempt to improve patient outcomes. ⋯ Adaptive support ventilation (ASV) is a positive pressure mode of mechanical ventilation that is closed-loop controlled, and automatically adjust based on the patient's requirements. In order to deliver safe and appropriate patient care, clinicians need to achieve a thorough understanding of this mode, including its effects on underlying respiratory mechanics. This article will discuss ASV while emphasizing appropriate ventilator settings, their advantages and disadvantages, their particular effects on oxygenation and ventilation, and the monitoring priorities for clinicians.
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Indian J Crit Care Med · Jan 2013
Early, reliable, utilitarian predictive factors for fat embolism syndrome in polytrauma patients.
Fat embolism is one of the apocalyptic pulmonary complications following high energy trauma situations. Since delay in diagnosis may have devastating consequences, early, easily accessible and relatively inexpensive investigations for risk stratification may prove useful, especially in developing nations. ⋯ The combination of three factors including polytrauma (with NISS >17), serum lactate >22 mmol/l at admission (within 12 hours of injury) fall in oxygen saturation (SaO2 below 90% in the initial 24 hours) predict the development of post-traumatic pulmonary complications, especially the fat embolism syndrome.
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Indian J Crit Care Med · Oct 2012
Clinical profile, species-specific severity grading, and outcome determinants of snake envenomation: An Indian tertiary care hospital-based prospective study.
We undertook this study to assess the clinical profile and outcome determinants of different snake envenomation as well as to assign species-specific severity grade to different cases based on clinico - laboratory evidence scale. ⋯ There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.
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Indian J Crit Care Med · Oct 2012
Case ReportsThe use of extracorporeal life support in adolescent amlodipine overdose.
Calcium channel blocker (CCB) toxicity is associated with refractory hypotension and can be fatal. A 13 year old young woman presented to the emergency department(ED) six hours after an intentional overdose of amlodipine, barbiturates, and alcohol. She remained extremely hypotensive despite the administration of normal saline and calcium chloride and despite infusions of norepinephrine, epinephrine, insulin, and dextrose. ⋯ The patient's blood pressure and end organ function immediately improved after cannulation. She was successfully decannulated after 57 hours of ECLS and was neurologically intact. Patients with calcium channel blocker overdose who are resistant to medical interventions may respond favorably to early ECLS.