Rhode Island medical journal (2013)
-
Acute pulmonary embolism (PE) causes significant morbidity and mortality, particularly for patients with subsequent right ventricular (RV) dysfunction. Once diagnosed, risk stratification is imperative for therapeutic decision making and centers on evaluation of RV function. Treatment includes supportive care, systemic anticoagulation, and consideration of reperfusion therapy. ⋯ Catheter directed thrombolysis (CDT) can be considered in certain intermediate risk patients although prospective, comparative data for its use are lacking. Surgical or catheter embolectomy are viable treatment options for high-risk patients in whom reperfusion therapy is warranted but who have absolute contraindications to thrombolysis. Further research is needed to better elucidate which patients with PE would most benefit from advanced reperfusion therapies.
-
Review
Lung Ultrasound for Diagnosing Patients with Severe Dyspnea and Acute Hypoxic Respiratory Failure.
Acute hypoxic respiratory failure can be caused by severe pneumonia, cardiogenic pulmonary edema (CPE), and acute respiratory distress syndrome (ARDS). Differentiating between these causes in critically ill patients can be challenging. Lung ultrasound (LUS) evaluation of acute respiratory failure has been developed and adopted only recently. LUS offers promise as a valuable clinical tool for the diagnosis and treatment of patients with severe dyspnea and acute hypoxic respiratory failure.
-
Acute kidney injury (AKI) is a common condition amongst critically ill patients in the medical intensive care unit (ICU) and is associated with increased morbidity and mortality. There are several areas of ongoing debate regarding management of AKI, specifically the initiation and timing of renal replacement therapy (RRT). In this review, we aim to concisely discuss epidemiology, current evidence with regards to optimal vascular access, timing of initiation and modality of renal replacement therapy in acute kidney injury in critically ill patients.
-
This article summarizes current data and recommendations regarding the care of patients in an intensive care unit (ICU) at the end of life. Through analysis of recent literature and society guidelines, we identified three areas of focus for practitioners in order to deliver compassionate care to patients and their families at this critical time - family communication, caregiver support, and palliative care involvement. Attention to these topics during critical illness may reduce stress-related disorders in both patients and family members, as well as increase satisfaction with the care delivered.