ABSTRACT
Gastrointestinal (GI) emergencies and disorders are among the most common reasons to be admitted to an intensive care unit (ICU). In addition, critically ill patients admitted to the ICU for non-GI-related diseases are frequently at risk of developing GI complications during their hospitalization. This article details the epidemiology/etiology, clinical presentation, diagnostic assessment, and management of the following GI emergencies: upper and lower GI bleed, acute pancreatitis, and ascending cholangitis.
Subject(s)
Emergencies , Pancreatitis , Humans , Acute Disease , Pancreatitis/diagnosis , Pancreatitis/therapy , Intensive Care Units , Critical IllnessABSTRACT
Human gestation and birthing result in many deviations from usual physiology that are nonetheless normal to be seen. However, on occasion, certain complications in the obstetric patient can be life-threatening to both mother and fetus. Timely recognition of these disorders and allocation of the appropriate resources are especially important. These conditions often require an intensive care unit admission for closer monitoring and supportive care. They can affect an array of physiological systems and can lead to significant morbidity. Such complications are discussed in greater detail in this article.
Subject(s)
Emergencies , Intensive Care Units , Pregnancy , Female , Humans , HospitalizationABSTRACT
CASE PRESENTATION: A 57-year-old man with history of stage IIIB right-sided malignant pleural mesothelioma was admitted from his oncologist's office for progressive dyspnea of two weeks duration. He had associated dyspnea at rest and a new dry cough. He denied sputum production, hemoptysis, or fevers, but he did endorse chills, fatigue, and weight loss. The patient was a veteran of the Navy and had extensive international travel in his 20s. He had never been incarcerated and denied any sick contacts or recent travels. He had received a diagnosis of mesothelioma 11 months earlier after presenting to his physician's office with complaints of shortness of breath on exertion. Initial imaging revealed a large right-sided pleural effusion with irregular pleural thickening. He underwent right-sided thoracoscopy, and the pleural biopsy result was consistent with epithelioid mesothelioma. Because of invasion of his seventh rib, he was not a candidate for surgery and underwent palliative radiation and chemotherapy with cisplatin, pemetrexed, and bevacizumab. He was undergoing his eighth cycle of chemotherapy at the time of presentation.
Subject(s)
Chemoradiotherapy/methods , Lung , Mesothelioma, Malignant , Multiple Pulmonary Nodules/diagnostic imaging , Neoplasm Metastasis/diagnostic imaging , Pleural Neoplasms , Biopsy/methods , Bronchoscopy/methods , Diagnosis, Differential , Disease Progression , Dyspnea/diagnosis , Dyspnea/etiology , Fatal Outcome , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Mesothelioma, Malignant/pathology , Mesothelioma, Malignant/physiopathology , Mesothelioma, Malignant/therapy , Middle Aged , Neoplasm Staging , Pleural Neoplasms/pathology , Pleural Neoplasms/physiopathology , Pleural Neoplasms/therapy , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methodsABSTRACT
This article describes the various steps required to confirm the diagnosis of chronic obstructive pulmonary disease (COPD). The GOLD Criteria developed by the Global Initiative for COPD will be outlined as they relate to the diagnosis and management of COPD. Pulmonary function testing, imaging, and symptom assessment will be explored.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Humans , Severity of Illness Index , Symptom AssessmentABSTRACT
Chronic obstructive pulmonary disease is a highly symptomatic disease that may lead to significant morbidity. Even with optimal therapy, the patient's quality of life can be severely affected. These symptoms include dyspnea, anxiety, depression, and malnourishment. Palliative care is a branch of medicine that specializes in the care of patients with a terminal illness no matter what stage of the disease they are in. It implements a family-centered approach to help patients deal with their symptoms. It also helps with shared decision-making and advanced care planning.
Subject(s)
Palliative Care , Pulmonary Disease, Chronic Obstructive , Terminal Care , Anxiety , Dyspnea , Humans , Quality of LifeABSTRACT
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can vary from asymptomatic to severe symptoms. It can lead to respiratory failure and acute respiratory distress syndrome requiring intubation and mechanical ventilation. Triaging patients is key to prevent spread, conserving medical resources, and providing appropriate care. The treatment of these patients remains supportive. Respiratory failure due to the virus should be managed by providing supplemental oxygen and early intubation. Some patients develop acute respiratory distress syndrome and refractory hypoxemia. In this article, we review the 2 phenotypes of respiratory failure, mechanical ventilation and the management of refractory hypoxemia.
Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology , COVID-19 , Coronavirus Infections/prevention & control , Humans , Intubation , Pandemics/prevention & control , Phenotype , Pneumonia, Viral/prevention & control , Randomized Controlled Trials as Topic , Respiration, Artificial , TriageABSTRACT
Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as "Mimics of ARDS." It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy.
