1/105. Reversal by vasopressin of intractable hypotension in the late phase of hemorrhagic shock.BACKGROUND: Hypovolemic shock of marked severity and duration may progress to cardiovascular collapse unresponsive to volume replacement and drug intervention. On the basis of clinical observations, we investigated the action of vasopressin in an animal model of this condition. methods AND RESULTS: In 7 dogs, prolonged hemorrhagic shock (mean arterial pressure [MAP] of approximately 40 mm Hg) was induced by exsanguination into a reservoir. After approximately 30 minutes, progressive reinfusion was needed to maintain MAP at approximately 40 mm Hg, and by approximately 1 hour, despite complete restoration of blood volume, the administration of norepinephrine approximately 3 micrograms . kg(-1). min(-1) was required to maintain this pressure. At this moment, administration of vasopressin 1 to 4 mU. kg(-1). min(-1) increased MAP from 39 /-6 to 128 /-9 mm Hg (P<0.001), primarily because of peripheral vasoconstriction. In 3 dogs subjected to similar prolonged hemorrhagic shock, angiotensin ii 180 ng. kg(-1). min(-1) had only a marginal effect on MAP (45 /-12 to 49 /-15 mm Hg). plasma vasopressin was markedly elevated during acute hemorrhage but fell from 319 /-66 to 29 /-9 pg/mL before administration of vasopressin (P<0.01). CONCLUSIONS: Vasopressin is a uniquely effective pressor in the irreversible phase of hemorrhagic shock unresponsive to volume replacement and catecholamine vasopressors. Vasopressin deficiency may contribute to the pathogenesis of this condition.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/105. coma as an acute presentation of adrenoleukodystrophy.X-linked adrenoleukodystrophy is a metabolic disorder with broad clinical variations. A 4-year-old male admitted to the hospital with fever, hypotension, and coma as the presenting signs of adrenoleukodystrophy is reported. The initial presentation followed by rapidly developing disseminated intravascular coagulopathy and multiorgan failure suggested an initial diagnosis of septic shock. However, bronze skin pigmentation and a cranial computed tomography scan demonstrating posterior demyelination consistent with adrenoleukodystrophy led to the final diagnosis. The diagnosis was confirmed by the findings of elevated very-long-chain fatty acid levels and an elevated C24/C16 ratio in plasma and fibroblast cultures. Atypical presentations of the disease require a high index of suspicion to initiate treatment before the appearance of irreversible sequelae.- - - - - - - - - - ranking = 0.14743536682037keywords = shock, septic shock (Clic here for more details about this article) |
3/105. atrial fibrillation and continuous hypotension induced by sildenafil in an intermittent WPW syndrome patient.A 55-year-old Japanese man was hospitalized for palpitations and severe chest oppression one hour after he ingested about 1500 ml of beer and sildenafil (Viagra) 50 mg. At 43 years of age, he had been diagnosed with intermittent WPW syndrome following a paroxysmal supraventricular tachycardia (PSVT) attack. He took a 1 mg tablet of doxazosin daily for mild hypertension. On admission, his blood pressure was 90/54 mmHg and his heart beat was weak and irregular with a rate of about 220/min. Since atrial fibrillation (Af) was diagnosed on an electrocardiogram (minimum RR interval; 0.22 seconds), direct current shock was performed with 100 joules and 150 joules but conversion to sinus rhythm failed. Sinus rhythm returned spontaneously from Af four hours after taking sildenafil. Since blood pressure was 50/17 mmHg despite the return to sinus rhythm, blood pressure was maintained by dopamine for twelve hours after sinus rhythm returned. The patient underwent catheter ablation for curative therapy and thereafter has not had any further episodes of tachycardia.- - - - - - - - - - ranking = 0.125keywords = shock (Clic here for more details about this article) |
4/105. Postpartum clostridium sordellii infection associated with fatal toxic shock syndrome.Clostridium bacteria are anaerobic Gram positive spore-form-ing bacilli, known to cause distinct clinical syndromes such as botulism, tetanus, pseudomembranous colitis and myonecrosis. The natural habitats of Clostridium species are soil, water and the gastrointestinal tract of animals and humans. In 5-10% of all women, Clostridium species are also found to be normal inhabitants in the microbial flora of the female genital tract. In case of a non-sexually transmitted genital tract infection, Clostridium species are isolated in 4-20%, and clostridium welchii seems to be the most common isolate. clostridium sordellii is rarely encountered in clinical specimens (1% of Clostridium species), but it has been described as a human pathogen with fatal potential. Two toxins, a lethal and a hemorrhagic (that antigenically and pathophysiologically appear similar to clostridium difficile toxins B and A, respectively) are responsible for this potential. Reviewing the obstetric literature, only six cases of postpartum endometritis caused by C. sordellii, are described - all being fatal. In addition, one lethal case of spontaneous endometritis resulting from C. sordellii is reported. The clinical aspects of these cases include: - sudden onset with influenza-like symptoms in previously healthy women - progressive refractory hypotension - local and spreading tissue edema - absence of fever Laboratory findings include: - marked leukocytosis - elevated hematocrit. This paper reports the seventh fatal postpartum C. sorlellii associated toxic shock syndrome - the first recognized in scandinavia.- - - - - - - - - - ranking = 1.1915292209833keywords = shock, toxic shock syndrome, shock syndrome, toxic shock (Clic here for more details about this article) |
5/105. myocardial infarction in the newborn: a case report complicated by cardiogenic shock and associated with normal coronary arteries.Fatal myocardial infarction occurring in a neonate is reported. The patient presented with a clinical picture of cardiogenic shock simulating a hypoplastic left heart syndrome. Etiology of the myocardial infarction is uncertain for the coronary arteries were patent, anatomically and histologically normal, and there was no significant associated cardiac defect. The possible etiologies in relationship to myocardial infarction in the neonatal period are presented.- - - - - - - - - - ranking = 0.625keywords = shock (Clic here for more details about this article) |
6/105. Use of the intra-aortic balloon pump to stop gastrointestinal bleeding.Temporary aortic occlusion can be lifesaving in selected conditions. We describe the unorthodox use of an intra-aortic balloon pump without counterpulsation to achieve temporary vascular control in a patient with shock caused by rapid upper gastrointestinal bleeding. The technique of aortic balloon occlusion has been reported in several clinical circumstances, primarily trauma. However, its use to increase blood pressure and gain time for resuscitation before laparotomy for catastrophic gastrointestinal bleeding has not previously been described.- - - - - - - - - - ranking = 0.125keywords = shock (Clic here for more details about this article) |
7/105. minocycline hypersensitivity syndrome with hypotension mimicking septic shock.minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris. A serious but rare adverse effect caused by minocycline therapy is a hypersensitivity syndrome (HS), consisting of fever, skin eruption, and internal organ involvement that begins within 8 weeks of therapy initiation. We report a case of minocycline HS with unique features, namely, associated hypotension, and a rebound of the cutaneous eruption upon discontinuation of systemic steroids.- - - - - - - - - - ranking = 0.58974146728149keywords = shock, septic shock (Clic here for more details about this article) |
8/105. Cardiomediastinal tamponade and shock following three-stage transthoracic oesophagectomy.Massive gastric tube dilatation causing cardiomediastinal tamponade is an unusual cause of obstructive shock after transthoracic oesophagectomy. A 55-year-old female was operated for total transthoracic oesophagectomy. Twelve hours after the surgery, she developed hypotension and raised central venous pressure unresponsive to fluid infusion and ionotropes. X-ray chest showed a massively dilated stomach, which was causing intrathoracic tamponade. suction applied to the nasogastric tube led to aspiration of 150-200 ml of fluid and a large volume of air, which led to resolution of the haemodynamic instability. A simple manoeuvre like nasogastric suction in postoperative case of oesophagectomy can serve as a diagnostic as well as therapeutic tool. It must be performed before resorting to invasive and expensive examination or intervention.- - - - - - - - - - ranking = 0.625keywords = shock (Clic here for more details about this article) |
9/105. adrenal insufficiency in a patient with severe hypotension caused by bilateral adrenal hemorrhage.OBJECTIVE: To describe a patient with adrenal insufficiency and bilateral adrenal enlargement and to review causes of adrenal insufficiency, with special emphasis on adrenal hemorrhage. methods: We present the clinical course of a woman with apparent septic shock, who responded poorly to treatment with inotropic agents. The possible cause and management of such cases are discussed. RESULTS: A 44-year-old woman with no prior major illness required medical attention because of severe hypotension, volume depletion, acute renal failure, and shock. Numerous laboratory and radiologic studies were performed to determine the cause of her shock state. She did not respond to several inotropic agents. When she was found to have adrenal insufficiency, initiation of treatment with glucocorticoids promptly alleviated her hypotension. CONCLUSION: Critically ill patients who have sudden unexplained hypotension that does not respond to supportive management should be screened for adrenal insufficiency. The current patient emphasizes the importance of considering this disorder in the differential diagnosis of hypotension that is unresponsive to pressor agents.- - - - - - - - - - ranking = 0.39743536682037keywords = shock, septic shock (Clic here for more details about this article) |
10/105. Mucosal lesions in the human small intestine in shock.Characteristic mucosal lesions in resected small intestinal segments from seven patients are reported. Preoperatively, four patients were in shock and general hypotension while the three remaining cases showed signs of local intestinal hypotension. The microscopic appearance of the mucosal lesions was in all patients identical with that previously observed in the feline and canine small intestine after haemorrhage or local intestinal hypotension. It is proposed that an extravascular short-circuiting of oxygen in the mucosal countercurrent exchanger and an intravascular aggregation of blood cells might produce tissue hypoxia which makes the mucosa vulnerable to enzymatic degradation.- - - - - - - - - - ranking = 0.625keywords = shock (Clic here for more details about this article) |
| | Next -> |