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4 results

  • The Flatness Index of Inferior Vena Cava can be an Accurate Predictor for Hypovolemia in Multi-Trauma Patients

  • Part of
  • Nazlı Ozcan Yazlamaz, Engin Ozakin, Betül T. Bastug, Evvah Karakilic, Filiz Baloglu Kaya, Nurdan Acar, Rusengul Koruk
  • Journal:
    Prehospital and Disaster Medicine / Volume 36 / Issue 4 / August 2021
    Published online by Cambridge University Press:
    06 May 2021, pp. 414-420
    Print publication:
    August 2021
  • Introduction:

    Shock is the leading cause of death in multi-trauma patients and must be detected at an early stage to improve prognosis. Many parameters are used to predict clinical condition and outcome in trauma. Computed tomography (CT) signs of hypovolemic shock in trauma patients are not clear yet, requiring further research. The flatness index of inferior vena cava (IVC) is a helpful method for this purpose.

    Methods:

    This is a prospective, cross-sectional study which included adult multi-trauma patients (>18 years) who were admitted to the emergency department (ED) and underwent a thoraco-abdominal CT from 2017 through 2018. The main objective of this study was to investigate whether the flatness index of IVC can be used to determine the hypovolemic shock at an early stage in multi-trauma patients, and to establish its relations with shock parameters. The patients’ demographic features, trauma mechanisms, vitals, laboratory values, shock parameters, and clinical outcome within 24 hours of admission were recorded.

    Results:

    Total of 327 (229 males with an average age of 40.9 [SD = 7.93]) patients were included in the study. There was no significant difference in the flatness index of IVC within genders (P = .134) and trauma mechanisms (P = .701); however, the flatness index of IVC was significantly higher in hypotensive (systolic blood pressure [SBP] ≤90 mmHg and/or diastolic blood pressure [DBP] ≤60 mmHg; P = .015 and P = .019), tachycardic (P = .049), and hypoxic (SpO2 ≤%94; P <.001) patients. The flatness index of IVC was also higher in patients with lactate ≥ 2mmol/l (P = .043) and patients with Class III hemorrhage (P = .003). A positive correlation was determined between lactate level and the flatness index of IVC; a negative correlation was found between Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) with the flatness index of IVC (for each of them, P <.05).

    Conclusion:

    The flatness index of IVC may be a useful method to determine the hypovolemic shock at an early stage in multi-trauma patients.

  • 25 - Aortic dissection

  • from Section 4 - Cardiovascular emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 171-176

  • Summary

    This chapter discusses the diagnosis, evaluation and management of soft tissue injury: crush injury, arterial injury, and open fractures. The crush syndrome comprises the systemic manifestations that arise as a result of a crush injury once the external force is removed. Arterial injury can lead to hypotension if the hemorrhage is not addressed aggressively with source control and resuscitation with fluids. The mangled extremity severity score (MESS) is the most widely validated classification system of the lower extremity when evaluating the severity of open fractures. Limb viability is related to vascular status, patient age, duration of ischemia, and absorbed energy. Hypovolemic shock is the leading cause of death after soft tissue injury. Placement of two large-bore IVs and aggressive fluid resuscitation is necessary in the hypotensive individual. Cardiac arrhythmias and cardiac arrest contribute to a large percentage of early deaths in crush injury patients.

  • Chapter 24 - Respiratory disease

  • from Section 4 - The pregnant patient with coexisting disease
  • Edited by Marc van de Velde, Helen Scholefield, Lauren A. Plante
  • Book:
    Maternal Critical Care
    Published online:
    05 July 2013
    Print publication:
    04 July 2013, pp 267-276

  • Summary

    Obstetricians most commonly encounter shock in the form of hemorrhage, but it is important to realize that shock can be classified in several types, and correction of the physiological derangement can correct the dysoxia at the tissue level before shock becomes irreversible. Etiologically shock is classified into the following types: hypovolemic shock (i.e. hemorrhage in coagulopathy), cardiogenic shock (myocardial dysfunction in the systemic inflammatory response syndrome and with toxins associated with septicemia), distributive shock (through activation of the systemic inflammatory response system), and obstructive shock (septic embolism). Therapy for cardiogenic shock requires restoration of adequate coronary perfusion in order to minimize further myocardial depression and necrosis. Anaphylactic and anaphylactoid reactions are clinically indistinguishable. The goals of management of anaphylaxis are interrupting contact with the responsible drug, modulating the effects of the released mediators, and preventing further mediator production and release.