ICU research center

#Shock

Hypovolemic Shock

By Dr. Ahmed Hafez

Background Hypovolemic shock refers to a medical or surgical condition in which rapid fluid loss results in multiple organ failure due to inadequate circulating volume and subsequent inadequate perfusion. Endothelium plays a critical role in vascular physiological, pathophysiological, and reparative processes. The functions of the endothelium are highly altered following hypovolemic shock due to ischemia of the endothelial cells and by reperfusion due to resuscitation with fluids. Due to oxygen deprivation, endothelial cell apoptosis is induced following hypovolemic shock.  Most often, hypovolemic shock is secondary to rapid blood loss (hemorrhagic shock). Acute external blood loss secondary to penetrating trauma and

Continue Reading
#Coma

Hypoglycemic coma

By Dr. Ahmed Hafez

Practice Essentials Hypoglycemia is characterized by a reduction in plasma glucose concentration to a level that may induce symptoms or signs such as altered mental status and/or sympathetic nervous system stimulation. This condition typically arises from abnormalities in the mechanisms involved in glucose homeostasis. The most common cause of hypoglycemia in patients with diabetes is injecting a shot of insulin and skipping a meal or overdosing insulin.  The image below depicts a diagnostic algorithm for hypoglycemia. Signs and symptoms of hypoglycemia The glucose level at which an individual becomes symptomatic is highly variable (threshold generally at < 50 mg/dL). Carefully

Continue Reading
#Coma

Metabolic Acidosis Coma

By Dr. Ahmed Hafez

Practice Essentials Metabolic acidosis is a clinical disturbance characterized by an increase in plasma acidity. Metabolic acidosis should be considered a sign of an underlying disease process. Identification of this underlying condition is essential to initiate appropriate therapy.  The initial therapeutic goal for patients with severe acidemia is to raise the systemic pH above 7.1-7.2, a level at which dysrhythmias become less likely and cardiac contractility and responsiveness to catecholamines will be restored. This article discusses the differential diagnosis of metabolic acidosis and presents a scheme for identifying the underlying cause of acidosis by using laboratory tests that are available

Continue Reading
#Coma

Hyperosmolar Hyperglycemic State HHS Coma

By Dr. Ahmed Hafez

Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Although there are multiple precipitating causes, underlying infections are the most common. Other causes include certain medications, nonadherence to therapy, undiagnosed diabetes mellitus, substance abuse, and coexisting disease. In children and adolescents, hyperosmolar hyperglycemic state is often present when type 2 diabetes is diagnosed. Physical findings include profound dehydration and neurologic symptoms ranging from lethargy to coma. Treatment begins with intensive monitoring of the patient and laboratory values, especially glucose, sodium, and potassium levels. Vigorous correction of dehydration is

Continue Reading
#Coma

Diabetic Ketoacidosis (DKA) coma

By Dr. Ahmed Hafez

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. It occurs when absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel source. The overproduction of ketones ensues, causing them to accumulate in the blood and urine and turn the blood acidic. DKA occurs mainly in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. Laboratory studies

Continue Reading
#Coma

Cerebral coma

By Dr. Ahmed Hafez

What Is a Coma? A coma is a prolonged state of unconsciousness. During a coma, a person is unresponsive to their environment. The person is alive and looks like they are sleeping. However, unlike in a deep sleep, the person cannot be awakened by any stimulation, including pain. A coma is a prolonged state of unconsciousness. It is caused by an injury to the brain that can be due to increased pressure, bleeding, loss of oxygen, or buildup of toxins. The injury can be temporary and reversible but can also be permanent and lead to death. Coma Causes A coma

Continue Reading
#Shock

Cardiogenic shock

By Dr. Ahmed Hafez

Cardiogenic shock is a medical emergency resulting from inadequate blood flow to the body’s organs due to the dysfunction of the heart. Signs of inadequate blood flow include low urine production (<30 mL/hour), cool arms and legs, and decreased level of consciousness. People may also have a severely low blood pressure and heart rate. Causes of cardiogenic shock include cardiomyopathic, arrhythmic, and mechanical. Cardiogenic shock is most commonly precipitated by a heart attack. Treatment of cardiogenic shock depends on the cause with the initial goals to improve blood flow to the body. If cardiogenic shock is due to a heart

Continue Reading
#Coma

Uremic Encephalopathy

By Dr. Ahmed Hafez

Practice Essentials Uremic encephalopathy is an organic brain disorder. It develops in patients with acute kidney injury or chronic kidney disease, usually when the estimated glomerular filtration rate (eGFR) falls and remains below 15 mL/min.  Manifestations of this syndrome vary from mild symptoms (eg, lassitude, fatigue) to severe signs (eg, seizures, coma). Severity and progression depend on the rate of decline in kidney function; thus, symptoms are usually worse in patients with acute kidney injury. Prompt identification of uremia as the cause of encephalopathy is essential because symptoms are readily reversible following initiation of dialysis. Pathophysiology Uremic encephalopathy has a

Continue Reading
#Coma

Pneumothorax coma

By Dr. Ahmed Hafez

Practice Essentials Pneumothorax is defined as the presence of air or gas in the pleural cavity (ie, the potential space between the visceral and parietal pleura of the lung), which can impair oxygenation and/or ventilation. The clinical results are dependent on the degree of collapse of the lung on the affected side. If the pneumothorax is significant, it can cause a shift of the mediastinum and compromise hemodynamic stability. Air can enter the intrapleural space through a communication from the chest wall (ie, trauma) or through the lung parenchyma across the visceral pleura. See the image below. Signs and symptoms

Continue Reading
#Coma

Coma Due to Poisoning: Caution Urged in Intubation

By Dr. Ahmed Hafez

Tracheal intubation is recommended for comatose patients, but its use in individuals with altered consciousness due to acute poisoning remains uncertain. A French team conducted a large randomized trial to assess the risk–benefit ratio of a conservative approach in this context. Patients with altered consciousness are at high risk for respiratory distress and pneumonia. Acute poisoning, whether from alcohol, drugs, or medications, is a nontraumatic cause of altered consciousness that often leads to intubation. In the United States alone, 20,000 patients with acute poisoning are intubated annually. While this practice aims to prevent the inhalation of gastric content and, consequently,

Continue Reading
#Coma

Anaphylactic coma

By Dr. Ahmed Hafez

Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the following: an itchy rash, throat closing due to swelling that can obstruct or stop breathing; severe tongue swelling that can also interfere with or stop breathing; shortness of breath, vomiting, lightheadedness, loss of consciousness, low blood pressure, and medical shock. These symptoms typically start in minutes to hours and then increase very rapidly to life-threatening levels. Urgent medical treatment is required to prevent serious harm and death, even if the patient has used an epipen or

Continue Reading
#Coma

Hepatic encephalopathy & coma

By Dr. Ahmed Hafez

Key words: Hepatic failure, encephalopathy, neuro- logical alteration, astrocytes, ammonium. Abstract Hepatic encephalopathy (HE) is a complication that presents in as many as 28% of patients with cirrhosis, and reported up to ten years after the diagnosis of cir- rhosis. Commonly, it is observed in patients with se- vere hepatic failure and is characterized by neuropsy- chiatric manifestations that can range in severity from a mild alteration in mental state to a coma; additional- ly, some neuromuscular symptoms can be observed. This complication of either acute or chronic hepatic disease is the result of a diminished hepatic reservoir and inability

Continue Reading
#Coma

Alcoholic coma – Acute alcohol intoxication

By Dr. Ahmed Hafez

Key words: AUD, Fetal Alcoholic Spectrum Disorder, toxicity, binge, addiction, withdrawal Abstract Alcohol is a legal and yet detrimental psychoactive substance, capable of establishing addiction and impacting the physical, mental, social, and economic health of people. Alcohol intake causes a large variety of tissue damages severely impacting the nervous system, digestive and cardiovascular systems and causing oral cavity, oropha- ryngeal, hypopharyngeal, esophageal, colon-rectal, laryngeal, liver and intrahepatic bile duct, and breast cancers. Alcohol can also play a role in the pathogenesis of diabetes mellitus, cardiomyopathy and hemorrhagic strokes. When drunk during pregnancy it is proved to be responsible for serious

Continue Reading
Load More Posts