Sudden deterioration in RV function can rapidly lead to shock, cardiovascular collapse, and death. In the ED, it is important to rapidly recognize and treat common precipitants of acute decompensation. These include sepsis, tachyarrhythmias, hypoxia, pulmonary embolism (PE), and the abrupt withdrawal of vasodilator medications.
Assess severity of dyspnea, including need for intubation/airway management based on physical examination. Emergent intubation indicated regardless of cause if severe respiratory distress/arrest. Consider Critical diagnoses → may be able to cure patient and avert intubation if the underlying cause is corrected (i.e. chest tube insertion, foreign body removal…)
When glucocorticoid medication is suddenly withheld, the atrophic cortex is unable to produce sufficient cortisol and a potentially life-threatening cortisol deficiency may develop. Therefore, glucocorticoid therapy should always be tapered off by gradual reduction of the dosage.
The Anxious State limbic system, in particular the amygdala, facilitates autonomic arousal under conditions of uncertainty or distress. The increase in sympathetic tone contributes to a state of readiness with…
I. Replacement therapy The adrenal cortex (AC) produces the glucocorticoid cortisol (hydrocortisone) and the mineralocorticoid aldosterone. Both steroid hormones are vitally important in adaptation responses to stress situations, such as…
Hyperphosphatemia Hyperphosphatemia is defined as a serum level above 2.5 mg/dL, but it is usually clinically significant only when levels are greater than 5 mg/dL. Although it is rare in…
The goal for the patient in shock is rapidly identifying that the patient is in shock, finding the cause of shock and treating the cause while simultaneously resuscitating the patient.…
Infectious meningitis can be caused by a variety of bacterial, viral, fungal, and parasitic organisms. Bacterial and viral organisms account for the most common types of infectious meningitis...
A classic scenario of life-threatening hemorrhage requiring emergent anticoagulant reversal is that of intracranial hemorrhage (ICH). We extrapolate recommendations for other hemorrhages from this often-studied patient group...
Thyroid storm is an extreme version of hyperthyroidism with a mortality rate that approaches 30%, even with treatment. The recognition and management of thyroid storm can be difficult in the…