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Shock Index

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81. Are Balanced Crystalloids the Preferred Resuscitation Fluid for Severe Sepsis and Septic Shock?

Are Balanced Crystalloids the Preferred Resuscitation Fluid for Severe Sepsis and Septic Shock? Systematic Review Snapshot TAKE-HOME MESSAGE Balanced crystalloids in sepsis have been linked indirectly with lower mortality and should be considered as an alternative to unbalanced crystalloids as the initial resuscitation ?uid. Are Balanced Crystalloids the Preferred Resuscitation Fluid for Severe Sepsis and Septic Shock? EBEM Commentators Clark G. Owyang, MD Kaushal H. Shah, MD Department (...) ); very low 0.95 (0.65–1.38); very low —, no direct comparisons available between two ?uids. DATA SOURCES The authors searched MEDLINE (1948 to December 2012), EMBASE (1980 to December 2012), ACP Journal Club (1991 to December 2012), the Cochrane Central Register of Controlled Trials, HealthSTAR, the Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). MEDLINE and CINAHL searches were updated in August 2013 and March 2014. Previously

2015 Annals of Emergency Medicine Systematic Review Snapshots

82. Syncope and Chest Pressure, then an Unusual Bradycardia with Shock

Syncope and Chest Pressure, then an Unusual Bradycardia with Shock Dr. Smith's ECG Blog: Syncope and Chest Pressure, then an Unusual Bradycardia with Shock Saturday, May 16, 2020 This comment on this case is from Jerry Jones, and is so good that I am pasting it at the top of this post so everyone can read it: "When the problem is just sinus bradycardia, the cause is typically increased parasympathetic input that moves the sinus pacemaker from the upper SA node to the lower SA node ("lower (...) to atropine, whereas complete AV block is unlikely to respond. (Complete AV block might respond to atropine when there is a narrow QRS, as this indicates that the block is above the bundle of His; when the QRS is wide, atropine will not work). Wenckebach is usually a benign rhythm. However, this is an extreme case of Wenckebach, and associated with syncope and shock. So one must be ready to treat like complete AV block with chronotropic meds such as dobutamine, or pacing, if necessary. So making

2020 Dr Smith's ECG Blog

83. Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?

Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on? Dr. Smith's ECG Blog: Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on? Sunday, June 28, 2020 A middle-aged patient presented in continued ventricular fibrillation after 5 minutes of down time and 45 minutes of prehospital resuscitation by medics, using King Airway, LUCAS, ), defibrillation 4 times, and epinephrine x 3 through an intraosseous line. The patient had continued (...) was to devise some new, definitive interpretation for the rhythms in this case — it didn’t happen for me. Instead — I’ll simply add this 9th Learning Point: Accept that your peri-resuscitation patient may not show you an easy-to-interpret tracing. When this happens — Be content with the basics . VFib and malignant VT rhythms need to be shocked. In contrast — rhythms such as seen in the 2nd tracing above do not need to be shocked — because even though there is much I can’t explain on this 2nd ECG

2020 Dr Smith's ECG Blog

84. Clinical metrics in emergency medicine: the shock index and the probability of hospital admission and inpatient mortality. (Abstract)

Clinical metrics in emergency medicine: the shock index and the probability of hospital admission and inpatient mortality. The shock index (SI), defined as the ratio of HR to systolic BP, has been studied as an alternative prognostic tool to traditional vital signs in specific disease states and subgroups of patients. However, literature regarding its utility in the general ED population is lacking. Our main objective was to determine the probability of admission and inpatient mortality based

2016 Emergency Medicine Journal

85. Global end-diastolic volume index vs central venous pressure goal-directed fluid resuscitation for chronic obstructive pulmonary disease patients with septic shock: a randomized controlled trial. (Abstract)

Global end-diastolic volume index vs central venous pressure goal-directed fluid resuscitation for chronic obstructive pulmonary disease patients with septic shock: a randomized controlled trial. This study aimed to investigate the clinical effects of early goal-directed therapy according to the global end-diastolic volume index (GEDI) on chronic obstructive pulmonary disease (COPD) patients with septic shock.A total of 71 COPD patients with septic shock were randomly assigned to 2 groups (...) for COPD patients with septic shock; however, it cannot reduce the mortality rate.Copyright © 2016 Elsevier Inc. All rights reserved.

2016 American Journal of Emergency Medicine Controlled trial quality: uncertain

86. Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study. (Abstract)

Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study. Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity.A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (...) (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1.22, >1.0, and >0.9 in the emergency department were used for 4-6, 7-12 and 13-16year-olds, respectively. Patients with ISS ≤15 were excluded to conform to the original paper. Discrimination outcomes were compared between SIPA and shock index (SI).Of 1008 patients, 386 met inclusion. SI was elevated in 321, and SIPA elevated in 282. The percentage of patients with elevated index (SI or SIPA) and blood transfusion

2016 Journal of Pediatric Surgery

87. The use of the reverse shock index to identify high-risk trauma patients in addition to the criteria for trauma team activation: a cross-sectional study based on a trauma registry system. Full Text available with Trip Pro

The use of the reverse shock index to identify high-risk trauma patients in addition to the criteria for trauma team activation: a cross-sectional study based on a trauma registry system. The presentation of decrease blood pressure with tachycardia is usually an indicator of significant blood loss. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the haemodynamic status of trauma patients. As an SBP lower than the HR (...) (RSI<1) may indicate haemodynamic instability, the objective of this study was to assess whether RSI<1 can help to identify high-risk patients with potential shock and poor outcome, even though these patients do not yet meet the criteria for multidisciplinary trauma team activation (TTA).Cross-sectional study.Taiwan.We retrospectively reviewed the data of 20 106 patients obtained from the trauma registry system of a level I trauma centre for trauma admissions from January 2009 through December 2014

2016 BMJ open

88. Use of the reverse shock index for identifying high-risk patients in a five-level triage system. Full Text available with Trip Pro

Use of the reverse shock index for identifying high-risk patients in a five-level triage system. The ratio of systolic blood pressure (SBP) to heart rate (HR), called the reverse shock index (RSI), is used to evaluate the hemodynamic stability of trauma patients. To minimize undertriage in emergency departments (EDs), we evaluated whether RSI < 1 (i.e., SBP lower than HR) could be used as an additional variable to identify patients at high risk for more severe injury within a level category

2016 Scandinavian journal of trauma, resuscitation and emergency medicine

89. Validation of a novel index of hemorrhage using a lower body negative pressure shock model. (Abstract)

Validation of a novel index of hemorrhage using a lower body negative pressure shock model. Vital signs are late indicators of blood loss in trauma patients. Indexed Heart to Arm Time (iHAT) is a non-invasive index based on a modified pulse transit time (mPTT) indexed to the time between R waves on the electrocardiogram (RR interval). We aimed to investigate how early iHAT is able to detect central hypovolemia during the progression from mild to severe simulated hemorrhage induced by applying

2016 Minerva anestesiologica

90. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi Full Text available with Trip Pro

Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive

2016 Scientific reports

91. Using the Reverse Shock Index at the Injury Scene and in the Emergency Department to Identify High-Risk Patients: A Cross-Sectional Retrospective Study Full Text available with Trip Pro

Using the Reverse Shock Index at the Injury Scene and in the Emergency Department to Identify High-Risk Patients: A Cross-Sectional Retrospective Study The ratio of systolic blood pressure (SBP) to heart rate (HR), called the reverse shock index (RSI), is used to evaluate the hemodynamic stability of trauma patients. A SBP lower than the HR (RSI < 1) indicates the probability of hemodynamic shock. The objective of this study was to evaluate whether the RSI as evaluated by emergency medical

2016 International journal of environmental research and public health

92. Ultrasonographic assessment of inferior vena cava/abdominal aorta diameter index: a new approach of assessing hypovolemic shock class 1 Full Text available with Trip Pro

Ultrasonographic assessment of inferior vena cava/abdominal aorta diameter index: a new approach of assessing hypovolemic shock class 1 We designed this study to expand the usage of ultrasound to detect early occurrence of hypovolemia. We explore the potential use of inferior vena cava (IVC) and abdominal aorta (AA) diameter index (IVC:AA) measured ultrasonographically to detect class 1 hypovolemic shock with blood loss less than 15%.ᅟThe aim of this study was to determine the changes (...) of IVC:Aorta index as 1.14±2SD with SD 0.18 as a cut off value for class 1 hypovolemic shock.The IVC:Aorta diameter index can be used as a parameter for detecting early phase (Class 1) of hypovolemic shock.

2016 International journal of emergency medicine

93. Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction. Full Text available with Trip Pro

Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction. Data on the prognostic value of the shock index in patients with ST-elevation myocardial infarction (STEMI) are scarce. Furthermore, the relationship of the shock index with myocardial damage is unknown. The aim of this study was to evaluate the association of the shock index with markers of myocardial damage and clinical outcome in patients with STEMI.This multicenter study analyzed 791 (...) patients. Patients were categorized in 2 groups according to the admission shock index (optimized cut-off=0.62). Infarct severity was determined by cardiac magnetic resonance (CMR) imaging. Patients with cardiogenic shock that were unable to undergo CMR acquisition were excluded. Major adverse cardiac events (MACE) were defined as a composite of death, reinfarction and congestive heart failure within 12 months. Patients with elevated admission shock index (n=321 [40.6%]) had a significantly larger area

2016 Circulation journal : official journal of the Japanese Circulation Society Controlled trial quality: uncertain

94. Standing shock index: An alternative to orthostatic vital signs. (Abstract)

Standing shock index: An alternative to orthostatic vital signs. Objective The lack of a sensitive, practical bedside test for hypovolemia has rekindled interest in the shock index (heart rate divided by systolic blood pressure). Here, we compare the effect of blood donation on standing shock index values with its effect on values for the supine shock index and orthostatic change in shock indicies (OCSI).This is a re-analysis of data collected for an earlier report. Data were available from 292 (...) adults below age 65 and 44 adults ages 65 and over, donating 450mL of blood. We obtained supine and standing vital signs before and after donation and then calculated 95% confidence intervals for differences based on the t-distribution.Blood donation resulted in a mean increase in the standing shock index of 0.09 [95% CI, 0.08-0.11] in younger adults and 0.08 [95% CI, 0.05-0.11] in older adults. These changes were similar to those noted for OCSI (young, 95% CI, 0.08-0.10; old, 95% CI, 0.04-0.10

2016 American Journal of Emergency Medicine

95. Hyaluronic Acid (HA), Platelet-Rich Plasm and Extracorporeal Shock Wave Therapy (ESWT) promote human chondrocyte regeneration in vitro and ESWT-mediated increase of CD44 expression enhances their susceptibility to HA treatment. Full Text available with Trip Pro

Hyaluronic Acid (HA), Platelet-Rich Plasm and Extracorporeal Shock Wave Therapy (ESWT) promote human chondrocyte regeneration in vitro and ESWT-mediated increase of CD44 expression enhances their susceptibility to HA treatment. Novel strategies have been proposed for articular cartilage damage occurring during osteoarthritis (OA) and -among these- Extracorporeal Shock Wave Therapy (ESWT), intra-articular injections of Platelet-Rich Plasma (PRP) or Hyaluronic Acid (HA) revealed encouraging (...) during prolonged chondrocyte culture. We then attested the efficiency of all such treatments to stimulate the expression of markers of chondrogenic potential such as SOX9 and COL2A, to increase the Ki67 proliferation index as well as to antagonize the traditional marker of chondrosenescence p16INK4a (known as Cdkn2a). Furthermore, all our samples showed an ESW- and HA-mediated enhancement of migratory and anti-inflammatory activity onto the cytokine-rich environment characterizing OA. Taken together

2019 PLoS ONE

96. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction Full Text available with Trip Pro

efficacy endpoint, cardiac index evolution was similar between the 2 groups (p = 0.43) from baseline (H0) to H72. For the main safety endpoint, the observed higher incidence of refractory shock in the epinephrine group (10 of 27 [37%] vs. norepinephrine 2 of 30 [7%]; p = 0.008) led to early termination of the study. Heart rate increased significantly with epinephrine from H2 to H24 while remaining unchanged with norepinephrine (p < 0.0001). Several metabolic changes were unfavorable to epinephrine (...) compared with norepinephrine, including an increase in cardiac double product (p = 0.0002) and lactic acidosis from H2 to H24 (p < 0.0001).In patients with CS secondary to acute myocardial infarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743

2018 EvidenceUpdates

97. Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States. Full Text available with Trip Pro

total net worth at study entry.Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53% women), 2430 (...) Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States. A sudden loss of wealth-a negative wealth shock-may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.To determine whether a negative wealth shock was associated with all-cause

2018 JAMA

98. Resuscitation with Hydroxyethyl Starch Maintains Hemodynamic Coherence in Ovine Hemorrhagic Shock. (Abstract)

Resuscitation with Hydroxyethyl Starch Maintains Hemodynamic Coherence in Ovine Hemorrhagic Shock. Fluid resuscitation in hemorrhagic shock aims to restore hemodynamics and repair altered microcirculation. Hemodynamic coherence is the concordant performance of macro- and microcirculation. The present study on fluid therapy in hemorrhagic shock hypothesized that the choice of fluid (0.9% sodium chloride [saline group] or balanced 6% hydroxyethyl starch 130/0.4 [hydroxyethyl starch group (...) ]) impacts on hemodynamic coherence.After instrumentation, 10 sheep were bled up to 30 ml/kg body weight of blood stopping at a mean arterial pressure of 30 mmHg to establish hemorrhagic shock. To reestablish baseline mean arterial pressure, they received either saline or hydroxyethyl starch (each n = 5). Hemodynamic coherence was assessed by comparison of changes in mean arterial pressure and both perfused vessel density and microvascular flow index.Bleeding of 23 ml/kg blood [21; 30] (median [25th

2020 Anesthesiology

99. Effect of sub-hypothermia blood purification technique in cardiac shock after valvular disease surgery. Full Text available with Trip Pro

Effect of sub-hypothermia blood purification technique in cardiac shock after valvular disease surgery. To observe the effect of sub-hypothermia (HT) blood purification technique in the treatment of cardiac shock after heart valve disease.The patients were randomly divided into normothermic (NT) continuous blood purification (CBP) group (NT group) and HT CBP group (HT group). Observe the cardiac index (CI), the oxygen delivery (DO2) and oxygen consumption (VO2) ratio, Acute Physiology (...)  ± 3.4 days vs 12.5 ± 3.5 days, P = .017,), mechanical ventilation time (4.2 ± 1.3 days vs 7.5 ± 2.7 days, P = .034,), CBP time (4.6 ± 1.4 days vs 10.5 ± 4.0 days, P = .019), mortality (12.50% vs 23.40%, P = .024). But the incidence of bradycardia in HT group was much higher than the NT group (29.16% vs 14.89%, P = .029).HT blood purification is a safer and more effective treatment than NT blood purification for patients who suffered from cardiac shock after valve surgery.

2020 Medicine

100. The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma. Full Text available with Trip Pro

The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma. When resuscitating patients with hemorrhagic shock following trauma, fluid volume restriction and permissive hypotension prior to bleeding control are emphasized along with the good outcome especially for penetrating trauma patients. However, evidence that these concepts apply well to the management of blunt trauma is lacking, and their use in blunt trauma remains (...) controversial. This study aimed to assess the impact of vasopressor use in patients with blunt trauma in severe hemorrhagic shock.In this single-center retrospective study, we reviewed records of blunt trauma patients with hemorrhagic shock and included patients with a probability of survival < 0.6. Vital signs on arrival, characteristics, examinations, concomitant injuries and severity, vasopressor use and dose, and volumes of crystalloids and blood infused were compared between survivors and non-survivors

2020 BMC Emergency Medicine

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