污染性休克:诊断和治疗方面的进展
Christopher W Seymour1, Matthew R Rosengart2
1Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Pittsburgh, Pennsylvania.
JAMA
|August 19, 2015
概括
及时诊断和治疗是感染性休克的关键, 最近的证据表明,与个性化管理策略相比,规范化护理几乎没有优势.
科学领域:
- 危急护理医学
- 紧急医疗
- 传染性疾病
背景情况:
- 每年有超过23万名美国患者患有感染性休克,
- 通过感染患者的低血压和低输血症状来定义,需要紧急识别.
研究的目的:
- 审查目前对败血症冲击的理解和管理策略.
- 根据最近的证据强调诊断方法和治疗考虑.
主要方法:
- 对感染性休克的临床定义和诊断工具的审查.
- 对随机临床试验治疗方案的证据分析.
- 讨论液体复苏和血管活性药物策略.
主要成果:
- 在三项试验中,与非方案化治疗相比,方案化治疗的益处很小.
- 聚焦超声波有助于识别复杂的生理.
- 基乙粉不推使用;结晶物和白的作用仍在争论中.
结论:
- 早期诊断依赖于病史,体检和潜在的聚焦超声波.
- 及时注射液体和血管活性药物对于循环恢复至关重要.
- 临床医生必须认识到基于协议的治疗在感染性休克管理中的局限性.
相关概念视频
Blood Pressure Imbalances and Circulatory Shock
1.9K
Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
1.9K
Acute Pyelonephritis II: Diagnostic Studies and Management
668
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
668
Pneumonia IV: Management
1.1K
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
1.1K
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
672
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
672
Endocarditis III: Medical Management
334
Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
334
Endocarditis IV: Nursing Management
582
Infective endocarditis (IE) is a chronic infection of the heart's endocardium, primarily affecting the heart valves. A detailed nursing assessment for a patient with IE involves collecting subjective and objective data to ensure an accurate diagnosis and timely intervention.Subjective DataThe nurse gathers information about the patient's symptoms and complaints during the subjective assessment. Patients with infective endocarditis often report non-specific symptoms that can mimic other...
582


