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Afr J Emerg Med 2022 Sep 17;12(3):165-171. Epub 2022 May 17.

Emergency Medicine department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

Introduction: Determination of intravascular volume status in patients admitted to the emergency centre is critical. Physical signs of hypovolaemic, distributive, cardiogenic, and obstructive shock frequently overlap, making an accurate diagnosis of shock state difficult. This is problematic because fluid loading is considered the first step in haemodynamically unstable patients' resuscitation. Read More

Shock 2022 05;57(5):740-748

Department of Vascular/Endovascular Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.

Background: Ischemia reperfusion injury causes a profound hyperdynamic distributive shock. Endovascular perfusion augmentation for critical care (EPACC) has emerged as a hemodynamic adjunct to vasopressors and crystalloid. The objective of this study was to examine varying levels of mechanical support for the treatment of ischemiareperfusion injury in swine. Read More

Mil Med 2022 May 16. Epub 2022 May 16.

Internal Medicine, Madigan Army Medical Center, Tacoma, WA 98430, USA.

The Seraph-100™ is a purification filter that blunts cytokine storm, providing a more favorable environment to establish immune homeostasis. We present a novel case of compassionate use of Seraph filter in a young, healthy active duty service member with heat injury-induced massive inflammatory response. The patient is a previously healthy 26-year-old male with altered mental status, tachycardia, fever to 40. Read More

Cureus 2022 Apr 29;14(4):e24606. Epub 2022 Apr 29.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, USA.

Acute pancreatitis is a risk factor for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Immediate detection and management of IAH and ACS are critical for patient survival. Obtaining accurate and consistent intra-abdominal pressure and urinary output with high frequency is challenging, but critical for effective patient management. Read More

Afr J Emerg Med 2022 Jun 21;12(2):154-159. Epub 2022 Apr 21.

Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI USA.

Introduction: In high-income settings, vasopressor administration to treat haemodynamic instability through a central venous catheter (CVC) is the preferred standard. However, due to lack of availability and potential for complications, CVCs are not widely used in low- and middle-income countries. This prospective cohort study evaluated the use of peripheral vasopressors and associated incidence of extravasation events in patients with haemodynamic instability at the Centre Hospitalier Universitaire Kigali, Rwanda. Read More

Eur J Radiol 2022 Jun 4;151:110290. Epub 2022 Apr 4.

Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Objective: To assess the role of thoraco-abdominal computed tomography (CT) in patients with undifferentiated shock in the emergency department (ED). Secondary aim was to assess common etiologies for undifferentiated shock.

Methods: This was a single-center, retrospective study evaluating patients with undifferentiated shock who underwent a dedicated "shock protocol" CT in the ED. Read More

Clin J Am Soc Nephrol 2022 May 4;17(5):706-716. Epub 2022 Apr 4.

Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio.

One of the primary reasons for intensive care admission is shock. Identifying the underlying cause of shock (hypovolemic, distributive, cardiogenic, and obstructive) may lead to entirely different clinical pathways for management. Among patients with hypovolemic and distributive shock, fluid therapy is one of the leading management strategies. Read More

Crit Care Clin 2022 Apr;38(2):429-441

The Medical College of Wisconsin, 9000 W. Wisconsin Avenue, MS B550B, Milwaukee, WI 53226, USA. Electronic address:

Shock is a state in which the cardiovascular system fails to adequately deliver required substrates to maintain end-organ perfusion, tissue homeostasis, and cellular metabolism. Rapid recognition of shock and intervention is of utmost importance to reverse the shock state. This article reviews uncommon etiologies of shock classified in the following categories: distributive, hypovolemic, cardiogenic, and dissociative shock. Read More

World J Hepatol 2022 Jan;14(1):287-294

Department of Surgery, University of Washington Medical Center, Seattle, WA 98195, United States.

Background: The liver has traditionally been regarded as resistant to antibody-mediated rejection (AMR). AMR in liver transplants is a field in its infancy compared to kidney and lung transplants. In our case we present a patient with alpha-1-antitrypsin disease who underwent ABO compatible liver transplant complicated by acute liver failure (ALF) with evidence of antibody mediated rejection on allograft biopsy and elevated serum donor-specific antibodies (DSA). Read More

Diabetes Care 2022 04;45(4):983-989

Division of Pediatric Cardiology, Department of Pediatrics.

Objective: To report and describe cases of children presenting with coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C) with new-onset type 1 diabetes mellitus (T1DM) in severe diabetic ketoacidosis (DKA).

Research Design And Methods: This prospective observational study was conducted to characterize children with COVID-19-related MIS-C and new-onset T1DM who were in DKA. MIS-C was diagnosed if Centers for Disease Control and Prevention and World Health Organization criteria were fulfilled. Read More

Crit Care Explor 2022 Jan 18;4(1):e0623. Epub 2022 Jan 18.

Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA.

Angiotensin II (ATII) was approved for septic or other distributive shock due to its property of increasing blood pressure within 3 hours. Limited data exist regarding its effectiveness when used in real-world clinical practice.

Objectives: This study examined ATII as a third-line vasopressor based on institutional approval. Read More

J Surg Case Rep 2021 Dec 11;2021(12):rjab543. Epub 2021 Dec 11.

Division of General Surgery, The Canberra Hospital, ACT, Australia.

The report presents a case of a 70-year-old male with a known mesenteric neuroendocrine tumour and metastases to the liver diagnosed with acute cholecystitis. During surgery, the patient developed a carcinoid crisis with mixed distributive and cardiogenic shock involving systemic vasodilation and arrhythmia. During surgical procedures, carcinoid crisis can be precipitated by tumours that secrete a pathological shower of vasoactive mediators. Read More

Methodist Debakey Cardiovasc J 2021 3;17(4):98-101. Epub 2021 Nov 3.

Baylor University Medical Center, Dallas, Texas, US.

Patients experiencing vasoplegia, a type of distributive shock, have limited options when conventional vasopressors are not appropriate or sufficient. This is especially true for patients with cardiac dysfunction, whether after heart transplant or ventricular assist device (VAD) implantation. Angiotensin II has been used in various clinical settings for distributive shock; however, its role in patients after orthotopic heart transplant or VAD implantation is not well studied. Read More

J Pharm Pract 2021 Oct 2:8971900211048623. Epub 2021 Oct 2.

Department of Pharmacy, 25815Loyola University Medical Center, IL, USA.

The effect of the use of antihypertensive agents in patients prior to the development of shock is unclear. The purpose of this study was to determine the impact of antihypertensive agents on vasopressor dose and duration in shock. This retrospective, single-center study included patients with shock who received at least one vasopressor for at least 24 hours after shock onset from January 1 to June 30, 2017. Read More

J Community Hosp Intern Med Perspect 2021 20;11(5):689-692. Epub 2021 Sep 20.

Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA.

: Central venous catheter (CVC) placement is one of the most commonly performed procedures in the intensive care unit for the institution of high-risk medications and nutrients. Despite the frequent use of ultrasound, inadvertent placement of CVC into the carotid artery is still possible. It carries significant morbidity due to the incidence of bleeding, arteriovenous fistula, and stroke. Read More

J Intensive Care Med 2021 Sep 13:8850666211044100. Epub 2021 Sep 13.

22494Cedars-Sinai Medical Center, Los Angeles, CA, USA.

We present a case of rapidly growing disseminated (MTB) that presented as an empyema necessitans (EN) in a 65-year-old woman with a single right lung transplant admitted for progressive dyspnea. While hospitalized, she had daily fevers and was found to have a right-sided chest wall abscess and pleural effusion. Acid-fast bacilli cultures from the abscess and pleural fluid grew MTB within 4 and 6 days, respectively. Read More

Cureus 2021 Jul 13;13(7):e16360. Epub 2021 Jul 13.

Emergency Medicine, Dalhousie University, Saint John, CAN.

Introduction Patients that present to the emergency department (ED) with undifferentiated hypotension have a high mortality rate. Hypotension can be divided into four categories: obstructive, hypovolemic, distributive, and cardiogenic. While it is possible to have overlapping or concomitant shock states, being able to differentiate between cardiogenic shock and the other categories is important as it entails a different treatment regime and extra cautions. Read More

Int J Mol Sci 2021 Jul 21;22(15). Epub 2021 Jul 21.

Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27106, USA.

Anaphylaxis is a severe, acute, life-threatening multisystem allergic reaction resulting from the release of a plethora of mediators from mast cells culminating in serious respiratory, cardiovascular and mucocutaneous manifestations that can be fatal. Medications, foods, latex, exercise, hormones (progesterone), and clonal mast cell disorders may be responsible. More recently, novel syndromes such as delayed reactions to red meat and hereditary alpha tryptasemia have been described. Read More

Environ Sci Pollut Res Int 2022 Jan 2;29(1):731-741. Epub 2021 Aug 2.

Department of Economics, Noakhali Science and Technology University, 3814, Noakhali, Bangladesh.

Even though remittance inflow in Bangladesh is a significant earning source for recipient individuals and one of the vital factors to the development model, its environmental impacts have been ignored in the empirical investigation. To fill this research gap, this article aims to elucidate the asymmetric effectiveness of remittance inflow on environmental degradation in Bangladesh by addressing foreign aid as an additional multiplier in a carbon dioxide (CO) emissions model, a first for this country. This paper, in doing so, utilizes the newly advanced nonlinear autoregressive distributive lag (NARDL) approach. Read More

Int J Mol Sci 2021 Jun 29;22(13). Epub 2021 Jun 29.

Trauma Team, Acute Care Surgery and Trauma Unit, Careggi University Hospital, Largo A. Brambilla 3, 50134 Florence, Italy.

Severe or major burns induce a pathophysiological, immune, and inflammatory response that can persist for a long time and affect morbidity and mortality. Severe burns are followed by a "hypermetabolic response", an inflammatory process that can be extensive and become uncontrolled, leading to a generalized catabolic state and delayed healing. Catabolism causes the upregulation of inflammatory cells and innate immune markers in various organs, which may lead to multiorgan failure and death. Read More

Am J Emerg Med 2021 Nov 19;49:265-267. Epub 2021 Jun 19.

Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France. Electronic address:

Symptomatic hiatal hernia (HH) is most often revealed by gastroesophageal reflux disease, but there are atypical presentations some of which are life-threatening. We report the case of a 57-year-old woman brought to the emergency department with isolated shortness of breath for 24 h. Initial explorations revealed unexplained hyperlactatemia (6. Read More

Clin Toxicol (Phila) 2022 01 3;60(1):76-82. Epub 2021 Jun 3.

Division of Medicinal Chemistry, Israel Institute for Biological Research, Ness Ziona, Israel.

Ricin, a plant-derived toxin originating from the seeds of (castor bean plant), is one of the most lethal toxins known. To date, no in-depth study of systemic exposure to ricin in a standardized large animal model has been reported. This study details for the first time the pathophysiological hemodynamic profile following systemic/intramuscular exposure to the ricin toxin in a porcine model by comprehensive cardiorespiratory monitoring of awake and anesthetized pigs. Read More

PLoS One 2021 1;16(6):e0251775. Epub 2021 Jun 1.

Division of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital-Polo Universitario-University of Milan, Milan, Italy.

Objective: The term Idiopathic Systemic Capillary Leak Syndrome (ISCLS) refers to an uncommon condition of severe distributive shock, resulting from an abrupt shift of fluids and proteins from the intravascular to the interstitial compartment. We hypothesise that the autonomic nervous system (ANS) fails in regulating the response to hypovolemia in acute ISCLS and that ANS variables characterise the progression to the recovery.

Design: Prospective cohort study of patients admitted to ICU for severe ISCLS flares. Read More

Drugs 2021 Jun 1;81(9):1079-1100. Epub 2021 Jun 1.

New Era Hospital, Nagpur, Maharashtra, India.

Introduction: Centhaquine (Lyfaquin) showed significant safety and efficacy in preclinical and clinical phase I and II studies.

Methods: A prospective, multicentric, randomized phase III study was conducted in patients with hypovolemic shock, systolic blood pressure (SBP) ≤ 90 mmHg, and blood lactate levels ≥ 2 mmol/L. Patients were randomized in a 2:1 ratio to the centhaquine group (n = 71) or the control (saline) group (n = 34). Read More

Crit Care Med 2021 11;49(11):e1151-e1156

Pediatric Intensive Care Unit, Necker Hospital, AP-HP Centre Université de Paris, Paris, France.

Trial Registration: NCT04420468.

Objectives: Severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children is frequently associated with shock; endothelial involvement may be one of the underlying mechanisms. We sought to describe endothelial dysfunction during multisystem inflammatory syndrome in children with shock and then assess the relationship between the degree of endothelial involvement and the severity of shock. Read More

Transpl Infect Dis 2021 Aug 1;23(4):e13636. Epub 2021 Jun 1.

Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Toxoplasma gondii can cause severe opportunistic infection in immunocompromised individuals, but diagnosis is often delayed. We conducted a retrospective review of solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients with toxoplasmosis between 2002 and 2018 at two large US academic transplant centers. Patients were identified by ICD-9 or ICD-10 toxoplasmosis codes, positive Toxoplasma polymerase chain reaction test result, or pathologic diagnosis. Read More

Physiol Rep 2021 05;9(9):e14871

Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, USA.

To date, existing animal models of the acute respiratory distress syndrome (ARDS) have failed to translate preclinical discoveries into effective pharmacotherapy or diagnostic biomarkers. To address this translational gap, we developed a high-fidelity swine model of ARDS utilizing clinically relevant lung injury exposures. Fourteen male swine were anesthetized, mechanically ventilated, and surgically instrumented for hemodynamic monitoring, blood, and tissue sampling. Read More

Curr Opin Pediatr 2021 06;33(3):275-280

Cohen Children's Medical Center, New Hyde Park, New York, USA.

Purpose Of Review: The current article summarizes updates on multisystem inflammatory syndrome in children (MIS-C) research and focuses on strategies to diagnose and manage these patients in the emergency department.

Recent Findings: MIS-C is an inflammatory syndrome that occurs approximately 4-5 weeks after severe acute respiratory syndrome coronavirus 2 infection. It is associated with symptoms such as fever, shock, abdominal pain, rash, and conjunctivitis along with laboratory abnormalities such as elevated inflammatory markers, coagulation factors, and cytokines. Read More

Rev Med Interne 2021 Sep 10;42(9):660-664. Epub 2021 Apr 10.

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