ABSTRACT
Early goal-directed treatment is an evidence-based approach to guide hemostatic therapy during major periprocedural bleeding. If viscoelastic coagulation tests are not available, an algorithm, termed the pyramid of hemostatic interventions, can help manage severe bleeding. Pregnant women accumulate huge reserves of prothrombotic and antifibrinolytic hemostatic elements to avoid peripartum blood loss. We provide comparison of therapeutic hemostatic approaches and natural gestational process and identified remarkable analogy between early goal-directed management of bleeding and hemostatic adaptation of pregnant woman. Therefore, gestational hemostasis serves as a natural model for goal-directed hemostasis resuscitation and can foster understanding of hemostatic management of periprocedural bleeding.
ABSTRACT
In December 2019, a cluster of pneumonia cases of unknown origin occured in Wuhan, China. The identified infective agent is a novel corona virus called "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) and the respiratory disease caused by this agent aquired the name "coronavirus disease 2019" (COVID-19). In March 2020, the World Health Organization (WHO) declared the novel coronavirus outbreak a pandemic. We reviewed the international literature regarding the novel coronavirus outbreak. Here below, we focus mainly on the diagnostic issues of COVID-19 and on the estimation of the prognosis. We detail the relevant anamnestic factors and initial examination results which serve as basics for the clinical suspicion of COVID-19. We also focus on the proper method of microbiological sampling and the relevant informations regarding diagnostic tests like the gold standard real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2. We also cite the current national epidemiologic regulations of testing for novel coronavirus. In the last section, we emphasize the importance and the potential way of early identification of high-risk patients. The COVID-19 pandemic may cause substantial epidemiological and healthcare burden even in Hungary. In addition to the epidemiologic interventions aiming the deceleration of the outbreak, the early identification and the correct hospital treatment remain key issues since these may influence mortality. The chances of the critically ill patients could be improved solely by a high-quality and careful critical care. It is prudent to meet the experiences of colleagues working hard with these patients in the already heavily infected countries. Orv Hetil. 2020; 161(17): 667671.
Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Risk Assessment , Betacoronavirus/genetics , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , COVID-19 Vaccines , China , Clinical Laboratory Techniques , Critical Illness , Humans , Hungary , Pandemics , Prognosis , Real-Time Polymerase Chain Reaction , SARS-CoV-2ABSTRACT
Critical-care physicians are facing a challenging process in healthcare due to the overwhelming case number of hypoxic respiratory failure patients. Pneumonia has an utmost importance in the primary pathomechanism of the development of critical illness in the COVID-19 patients. Thus, imaging techniques are situated in the frontline to aim the diagnostic decision-making, to follow up the progress and to evaluate the possible complications. Reviewing the available literature, so far the common chest CT, chest X-ray and chest wall ultrasound features are presented, and recommendations are pronounced for the indications of the different modalities. At the initial phase, the atypical presentations of the virus infection are multiplex, peripheral ground glass opacities situated in the right lower lobe of the lung evolving rapidly into a bilateral involvement of the middle and basal zones. Along with the progression, the ratio of the consolidation is increasing subsequently deteriorating into fibrosis with reticular pattern. Chest ultrasound performed at the bedside has a paramount importance to reduce the possible number of health-care worker contacts in consequence of the strict and special infection control orders established on account of the SARS-CoV-2 pandemia. Orv Hetil. 2020; 161(17): 672677.
