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Rev Med Interne 2021 Apr 9. Epub 2021 Apr 9.

Service de médecine interne, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France; Université d'Aix-Marseille, Marseille, France.

Introduction: Idiopathic systemic capillary leak syndrome (ISCLS) also known as Clarkson syndrome is a rare and sudden life-threatening entity. Three consecutive phases are described. A first non-specific prodromal phase often manifests as "flu-like" symptoms and precedes capillary leak phase with major hypovolemic and distributive shock leading to serious and frequent multiorgan dysfunction syndrome (MODS). Read More

Indian J Crit Care Med 2021 Mar;25(3):337-339

Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India.

Hypotension can be explained by the cardiotoxic effects of an organophosphate poison, but a distributive shock is a rare event. This is a case report of a young north Indian man who presented to the emergency room in a comatose state and distributive shock. He was initially managed with intravenous crystalloids but required inotropic therapy to maintain the desired mean arterial pressure and organ perfusion and also required mechanical ventilation. Read More

Environ Sci Pollut Res Int 2021 Mar 31. Epub 2021 Mar 31.

Department of Economics, Hazara University Mansehra, Mansehra, Pakistan.

Global warming is one of the most serious environmental problems that the world faces today. Millions of human lives are at risk, hence the subject has gained enormous attention within academia and the research arena. Literature shows that the primary cause of global climate change or global warming is carbon (CO) emissions. Read More

J Am Coll Emerg Physicians Open 2021 Apr 2;2(2):e12395. Epub 2021 Mar 2.

Pediatric Intensive Care Unit DMU 3 Santé de l'enfant et de l'adolescent AP-HP Paris Saclay University - Bicetre hospital Le Kremlin-Bicêtre France.

Study Objective: In prehospital and emergency settings, vasoactive medications may need to be started through a peripheral intravenous catheter. Fear of extravasation and skin injury, with norepinephrine specifically, may prevent or delay peripheral vasopressor initiation, though studies from adults suggest the actual risk is low. We sought to study the risk of extravasation and skin injury with peripheral administration of norepinephrine in children in the prehospital setting. Read More

Front Vet Sci 2021 25;8:622127. Epub 2021 Feb 25.

Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States.

Sepsis is currently defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis may occur secondary to infection anywhere in the body, and its pathogenesis is complex and not yet fully understood. Variations in the host immune response result in diverse clinical manifestations, which complicates clinical recognition and fluid therapy both in humans and veterinary species. Read More

Healthcare (Basel) 2021 Feb 17;9(2). Epub 2021 Feb 17.

Faculty of Social Sciences & Humanities, Universiti Teknologi Malaysia (UTM), Johor 81310, Malaysia.

The service industry provides distributive services, producer services, personal services, and social services. These services largely breakdowns due to restrictions on border movements, confined travel and transportation services, a decline in international tourists' visitation, nationwide lockdowns, and maintaining social distancing in the population. Although these measures are highly needed to contain coronavirus, it decreases economic and financial activities in a country, which requires smart solutions to globally subsidize the services sector. Read More

Perfusion 2021 Feb 26:267659121998962. Epub 2021 Feb 26.

Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.

The hypodynamic septic shock appears to be a promising indication to veno-arterial membrane oxygenation (VA-ECMO) support of a patient with insufficient cardiac output. With cardiac recovery most of those patients progress into a hyperdynamic septic shock with cardiac output, which may not match critically low systemic vascular resistance to maintain perfusion pressures. Such refractory distributive shock represents a challenging indication to VA-ECMO. Read More

Curr Opin Anaesthesiol 2021 Apr;34(2):85-91

Department of Intensive Care, Fundación Valle del Lili - Universidad Icesi, Cali, Columbia.

Purpose Of Review: The aim of this study was to discuss the implication of microvascular dysfunction in septic shock.

Recent Findings: Resuscitation of sepsis has focused on systemic haemodynamics and, more recently, on peripheral perfusion indices. However, central microvascular perfusion is altered in sepsis and these alterations often persist despite normalization of various macro haemodynamic resuscitative goals. Read More

A A Pract 2021 Feb 11;15(2):e01402. Epub 2021 Feb 11.

From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.

Refractory hypotension is a known entity in liver transplantation. Catecholamine and vasopressin infusions are first-line therapies. There has been recent interest in angiotensin II (Ang-2) as an alternative vasopressor; however, liver failure patients were excluded from the original trials. Read More

BMJ Case Rep 2021 Feb 9;14(2). Epub 2021 Feb 9.

University Clinic of Pediatrics, Universidade de Coimbra Faculdade de Medicina, Coimbra, Coimbra, Portugal.

We report the case of an 11-year-old boy brought to our emergency department 2 hours after a viper bite to his right hand. He suffered severe pain and rapidly progressive swelling with signs of haemodynamic compromise in keeping with distributive shock. The oedema progressed from his right wrist upwards to his forearm and upper arm with compartment syndrome ultimately resulting. Read More

Rev Med Liege 2021 Feb;76(2):88-92

ULiège, Service de Cardiologie, GIGA Cardiovasculaire, CHU Liège, Belgique.

Cardiogenic shock is one of the four types of circulatory shock (cardiogenic, distributive, hypovolemic and obstructive). It is a serious complication associated with a hypoperfusion state of terminal organs and possible multivisceral failures, with a high mortality rate of nearly 50 %. It is secondary to an acute myocardial infarction in 8 out of 10 cases but only complicates it in 5 to 10 %. Read More

Cureus 2020 Dec 19;12(12):e12169. Epub 2020 Dec 19.

Emergency Medicine, Lehigh Valley Health Network, Allentown, USA.

Spontaneous tumor lysis syndrome (STLS) is a rare oncologic emergency caused by massive cancer cell lysis or necrosis without a precipitating factor. Although tumor lysis syndrome (TLS) is most commonly associated with hematologic malignancies, a small number of cases in solid tumor malignancies have been reported. We present a case of spontaneous tumor lysis syndrome in a 77-year-old female with a widely metastatic, poorly differentiated adenocarcinoma of unknown origin. Read More

WMJ 2020 Dec;119(4):240-247

The Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin.

Introduction: Prehospital medical teams encounter patients with varying states of shock that require the use of vasopressors for hemodynamic support during transport. Selection of a vasopressor is challenging due to the absent comparative literature in prehospital medicine, as well as practical limitation of use in an ambulance.

Areas Covered: This article discusses specific challenges in the delivery of vasopressor support for hemodynamically compromised patients in the prehospital environment. Read More

J Cardiothorac Vasc Anesth 2021 Apr 19;35(4):1018-1029. Epub 2020 Nov 19.

Department of Anesthesiology and Intensive Care, Heart- and Diabetes Center Mecklenburg - Western Pomerania, Karlsburg, Germany. Electronic address:

Hemodynamic conditions with reduced systemic vascular resistance commonly are observed in patients undergoing cardiac surgery and may range from moderate reductions in vascular tone, as a side effect of general anesthetics, to a profound vasodilatory syndrome, often referred to as vasoplegic shock. Therapy with vasopressors is an important pillar in the treatment of these conditions. There is limited guidance on the appropriate choice of vasopressors to restore and optimize systemic vascular tone in patients undergoing cardiac surgery. Read More

Rev Inst Med Trop Sao Paulo 2020 18;62:e99. Epub 2020 Dec 18.

Universidad Autónoma de Yucatán, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Laboratorio de Enfermedades Emergentes y Reemergentes, Mérida, Yucatán, México.

Hemophagocytic lymphohistiocytosis is a rare complication in Rickettsia typhi infections. We report the case of a 2-year-old boy with sudden night-onset fever, pallor, neck adenopathy and erythematous macular rash on the thorax, thighs and buttocks. During admission, he developed hyponatremia, hypoalbuminemia, anemia, thrombocytopenia, leukopenia, neutropenia, liver damage, hemorrhages and persistent fever. Read More

Cureus 2020 Nov 2;12(11):e11304. Epub 2020 Nov 2.

Internal Medicine, University of California Davis Health System, Sacramento, USA.

Introduction: Clinical assessment of cardiac output (CO) and systemic vascular resistance (SVR) in cardiac patients is often inaccurate. Since the genicular arteries form a watershed zone accessible to physical examination, we hypothesized that "cool knees" would reflect abnormalities in central hemodynamics.

Methods: Nineteen patients with cardiac diagnoses, but without distributive shock, had a measurement of skin temperature over the thigh, knee, and foot in parallel with central hemodynamics derived from invasive monitoring. Read More

Swiss Med Wkly 2020 Nov 5;150:w20378. Epub 2020 Dec 5.

Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.

Aims Of The Study: Invasive streptococcal infections affect more than half a million patients worldwide every year and have a high lethality. Little is known about the epidemiology and microbiological characteristics of streptococcal infections in Switzerland. This case series study aims to describe the demographics, known risk factors for streptococcal skin and soft tissue infections, clinical presentations, treatment and outcomes of patients admitted to the University Hospital Zurich between 2000 and 2014 with invasive streptococcal infections caused by Streptococcus pyogenes (group A Streptococcus), Streptococcus dysgalactiae ssp. Read More

Am J Emerg Med 2020 Nov 24. Epub 2020 Nov 24.

Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, 15 Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do 52727, Republic of Korea; Institute of Health Sciences, Gyeongsang National University, Jinju-si, 52727, Republic of Korea. Electronic address:

Isr Med Assoc J 2020 Jul;22(7):404-408

Department of Pediatric Critical Care, Rambam Healthcare Campus, Haifa, Israel.

Background: Methylene blue (MB), an inhibitor of nitric oxide synthesis and its effects is a potentially effective treatment against distributive shock states such as septic shock and vasoplegic syndrome. MB has been shown to alleviate vasoplegia and promote an increase in blood pressure. It may reduce mortality. Read More

J Intensive Care Med 2021 Apr 5;36(4):392-403. Epub 2020 Nov 5.

Pediatric Intensive Care Unit, 16499Hospital Infantil Universitario Niño Jesús, Madrid, Spain.

Background: Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease.

Objective: To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided. Read More

Adv Emerg Nurs J 2020 Oct/Dec;42(4):284-292

University of Miami School of Nursing and Health Studies, Coral Gables, Florida (Drs Gonzalez, Ortega, and Crenshaw) Keigwin School of Nursing, Jacksonville University, Jacksonville, FL (Dr de Tantillo).

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Read More

Adv Emerg Nurs J 2020 Oct/Dec;42(4):270-283

University of Miami School of Nursing and Health Studies, Coral Gables, Florida (Drs Gonzalez, Ortega, and Crenshaw); and Keigwin School of Nursing, Jacksonville University, Jacksonville, Florida (Dr de Tantillo).

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Read More

Crit Care Explor 2020 Oct 29;2(10):e0230. Epub 2020 Sep 29.

Sepsis Research Laboratory, Feinstein Institute for Medical Research, Manhasset, NY.

Objectives: To assess the early physiologic response to angiotensin-II treatment in patients with coronavirus disease 2019-induced respiratory failure and distributive shock.

Design: Retrospective consecutive-sample cohort study.

Setting: Three medical ICUs in New York during the coronavirus disease 2019 outbreak. Read More

J Am Coll Emerg Physicians Open 2020 Aug 25;1(4):379-382. Epub 2020 Jun 25.

Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan.

Anaphylactic shock to contrast media can progress to cardiac arrest despite appropriate treatment. During anaphylactic shock to contrast media, rapid vasodilation and a massive fluid shift can occur. Here we report a patient who developed cardiac arrest induced by anaphylactic shock to iodinated contrast medium and exhibited rapid collapse of the inferior vena cava (IVC) on enhanced abdominal computed tomography (CT) images. Read More

Prog Pediatr Cardiol 2020 Sep 2;58:101270. Epub 2020 Jul 2.

Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE 19803, USA.

We report one of the earliest known U.S. cases of multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C). Read More

Am J Emerg Med 2020 11 6;38(11):2491.e1-2491.e2. Epub 2020 Jun 6.

Sri Gokulam hospital, Salem, Tamilnadu, India.

Presenting a case of acute theophylline and salbutamol overdose with distributive shock. Twenty one years old lady presented with history of consumption of 3 gram of theophylline and 40 mg of salbutamol. On admission she had altered sensorium with the systolic blood pressure of 60 mmHg, unrecordable diastolic blood pressure and heart rate of 147/min. Read More

Indian J Crit Care Med 2020 May;24(5):313-320

Department of Emergency Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.

Introduction: Nontraumatic undifferentiated hypotension is one of the common and challenging critical presentations in the emergency department (ED) due to the difficulty in diagnosing the etiology of shock. In the present study, an attempt was made to test point-of-care ultrasound (PoCUS) as an early approach to improve the accuracy of diagnosis and to narrow the differentials in cases of nontraumatic undifferentiated hypotension.

Materials And Methods: This is a prospective explorative study conducted in the ED of a tertiary care hospital over a period of 18 months. Read More

Rev Cardiovasc Med 2020 06;21(2):289-295

Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Consideration of thrombolysis as first-line reperfusion therapy in patients with COVID-19 and STEMI is recommended by ACC/SCAI guidelines. We describe a patient with COVID-19, who presented with ST-elevation myocardial infarction and was treated with thrombolysis and anticoagulation. He was later found to have a significant persistent thrombus burden requiring thrombectomy and stent placement. Read More

Crit Care Explor 2020 Jun 5;2(6):e0120. Epub 2020 Jun 5.

Emory Center for Critical Care, Emory University, Atlanta, GA.

Objectives: Calcium channel blockers are highly protein-bound medications frequently used in the management of hypertension. Overdose results in severe hypotension and is the fourth most common cause of toxicity-related deaths in the United States. Management is mostly supportive, with currently no standard role for targeted drug removal. Read More