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Category: Critical Care Articles

Toxicity, Aluminum ?>

Toxicity, Aluminum

Toxicity, Aluminum Introduction Background Aluminum is a trivalent cation found in its ionic form in most kinds of animal and plant tissues and in natural waters everywhere. It is the third most prevalent element and the most abundant metal in the earth’s crust. Dietary aluminum is ubiquitous, but in such small quantities that it is not a significant source of concern in persons with normal elimination capacity. Urban water supplies may contain a greater concentration because water is usually treated…

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Toxic Shock Syndrome ?>

Toxic Shock Syndrome

Toxic Shock Syndrome Introduction Background Toxic shock syndrome (TSS) is a toxin-mediated multisystem disease precipitated by infection with either Staphylococcus aureus or group A Streptococcus (GAS), also called Streptococcus pyogenes. The clinical syndrome is characterized by a rapid onset of high fever, hypotension, diffuse rash (petechial or maculopapular), severe myalgia, vomiting, diarrhea, headache, and nonfocal neurologic abnormalities. Mortality is high.

Systemic Inflammatory Response Syndrome ?>

Systemic Inflammatory Response Syndrome

Systemic Inflammatory Response Syndrome Introduction Background In 1992, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) introduced definitions for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS). The idea behind defining SIRS was to define a clinical response to a nonspecific insult of either infectious or noninfectious origin. SIRS is defined as 2 or more of the following variables:

Respiratory Failure ?>

Respiratory Failure

Respiratory Failure Introduction Background Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. In practice, respiratory failure is defined as a PaO2 value of less than 60 mm Hg while breathing air or a PaCO2 of more than 50 mm Hg. Furthermore, respiratory failure may be acute or chronic. While acute respiratory failure is characterized by life-threatening derangements in arterial blood gases and acid-base…

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Halothane Hepatotoxicity ?>

Halothane Hepatotoxicity

Halothane Hepatotoxicity Introduction Background Halothane and other halogenated inhalational anesthetic agents, such as enflurane, isoflurane, sevoflurane, and desflurane, are known to cause severe liver dysfunction. The National Halothane Study, a retrospective analysis, reviewed the incidence and mortality rates of postoperative hepatic necrosis from 1959-1962.1 This study found that, of 82 cases of fatal hepatic necrosis, 9 cases were deemed likely to be drug induced. Seven of the 9 patients had received halothane. Based on this study, the risk of fatal…

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Encephalopathy, Hypertensive ?>

Encephalopathy, Hypertensive

Encephalopathy, Hypertensive Introduction Background Hypertension affects more than 60 million Americans. With adequate control, fewer than 1% of patients experience a hypertensive crisis. Hypertensive crisis is classified as hypertensive emergency or hypertensive urgency. Acute or ongoing vital target organ damage, such as damage to the brain, kidney, or heart, in the setting of severe hypertension is considered a hypertensive emergency. It requires a prompt reduction in blood pressure within minutes or hours. The absence of target organ damage in the…

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Drug-Induced Hepatotoxicity ?>

Drug-Induced Hepatotoxicity

Drug-Induced Hepatotoxicity Introduction Background Drugs are an important cause of liver injury. More than 900 drugs, toxins, and herbs have been reported to cause liver injury, and drugs account for 20-40% of all instances of fulminant hepatic failure. Approximately 75% of the idiosyncratic drug reactions result in liver transplantation or death. Drug-induced hepatic injury is the most common reason cited for withdrawal of an approved drug. Physicians must be vigilant in identifying drug-related liver injury because early detection can decrease…

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Delirium Tremens ?>

Delirium Tremens

Delirium Tremens Introduction Background Delirium tremens (DTs) is a severe manifestation of alcohol withdrawal. Pearson first described it in 1813 as an acute psychosis following abstinence from alcohol. Although it only occurs in a relatively small number of patients who undergo alcohol withdrawal, it can be fatal. DTs is a medical emergency that requires prompt recognition and treatment. Pathophysiology

Systemic Inflammatory Response Syndrome ?>

Systemic Inflammatory Response Syndrome

Systemic Inflammatory Response Syndrome Introduction Background In 1992, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) introduced definitions for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS). The idea behind defining SIRS was to define a clinical response to a nonspecific insult of either infectious or noninfectious origin. SIRS is defined as 2 or more of the following variables: Fever of more than 38°C or…

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Snakebite ?>

Snakebite

Snakebite Introduction Background Most snakebites are innocuous and are delivered by nonpoisonous species. Twenty-five species of poisonous snakes make North America their home. Worldwide, only about 15% of the more than 3000 species of snakes are considered dangerous to humans. The family Viperidae is the largest family of venomous snakes, and members of this family can be found in Africa, Europe, Asia, and the Americas. The family Elapidae is the next largest family of venomous snakes. In North America the…

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