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7 results

  • 19 - Aortic Dissection

  • from Section 4 - Cardiovascular Emergencies
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 169-176

  • Summary

    • Aortic dissection represents the most frequent aortic catastrophe with approximately 10,000 cases annually in the United States. Dissection occurs with a primary tear of the intimal layer of the aorta and then subsequent infiltration into the media layer, creating a false lumen that may extend the entire length of the aorta.

    • Propagation of the false lumen may result in obstruction of vascular branches of the aorta, leading to end organ hypoperfusion of the brain, heart, kidneys, spine or extremities.

    • The location of injury (i.e., ascending versus descending aorta) predicts mortality and guides management decisions.

  • A randomized, controlled trial of oral versus intravenous fluids for lowering blood glucose in emergency department patients with hyperglycemia

  • Sanjay Arora, Marc A. Probst, Laura Andrews, Marissa Camilion, Andrew Grock, Gregory Hayward, Michael Menchine
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 16 / Issue 3 / May 2014
    Published online by Cambridge University Press:
    04 March 2015, pp. 214-219
    Print publication:
    May 2014
    • Article
      • You have access
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  • Objectives:

    Blood glucose can be lowered via insulin and/or fluid administration. Insulin, although efficacious, can cause hypoglycemia and hypokalemia. Fluids do not cause hypoglycemia or hypokalemia, but the most effective route of fluid administration has not been well described. This study compared the efficacy and safety of oral versus intravenous fluids for reducing blood glucose in patients with hyperglycemia.

    Methods:

    We conducted a prospective, nonblinded, randomized, controlled trial. Inclusion criteria were blood glucose > 13.9 mmol/L, age > 18 years, and ability to tolerate oral fluids. Subjects were excluded for critical illness, contraindication to fluids, and/or hyperglycemia therapy prior to enrolment. Subjects were randomized to receive oral bottled water or intravenous normal saline (maximum 2 L) over 2 hours. The primary outcome of interest was a change in blood glucose at 2 hours across treatment arms.

    Results:

    The 48 subjects were randomized. Baseline blood glucose levels and total amount of fluid received were similar between the two groups. The mean decrease in blood glucose at 2 hours was similar for both treatment arms: a mean decrease of 3.4 mmol/L (20.2 mmol/L to 16.8 mmol/L) in the oral fluid group versus a mean decrease of 4.0 mmol/L (19.7 mmol/L to 15.7 mmol/L) in the intravenous fluid group. The mean difference between groups was −0.6 mmol/L (95% confidence interval −2.3–1.2; p = 0.51). No adverse events were observed in either group.

    Conclusion:

    In this unblinded randomized trial, oral and intravenous fluids were equally efficacious in lowering blood glucose levels in stable hyperglycemic patients and no adverse events were noted. Physicians should be mindful that, although similar, the reduction in blood glucose was modest in both groups.

  • 25 - Aortic dissection

  • from Section 4 - Cardiovascular emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 171-176

  • Summary

    This chapter discusses the diagnosis, evaluation and management of soft tissue injury: crush injury, arterial injury, and open fractures. The crush syndrome comprises the systemic manifestations that arise as a result of a crush injury once the external force is removed. Arterial injury can lead to hypotension if the hemorrhage is not addressed aggressively with source control and resuscitation with fluids. The mangled extremity severity score (MESS) is the most widely validated classification system of the lower extremity when evaluating the severity of open fractures. Limb viability is related to vascular status, patient age, duration of ischemia, and absorbed energy. Hypovolemic shock is the leading cause of death after soft tissue injury. Placement of two large-bore IVs and aggressive fluid resuscitation is necessary in the hypotensive individual. Cardiac arrhythmias and cardiac arrest contribute to a large percentage of early deaths in crush injury patients.

  • Optical SED models of galaxy mergers

  • Gregory F. Snyder, T. J. Cox, Christopher C. Hayward, Lars Hernquist, Patrik Jonsson
  • Journal:
    Proceedings of the International Astronomical Union / Volume 7 / Issue S284 / September 2011
    Published online by Cambridge University Press:
    17 August 2012, pp. 193-197
    Print publication:
    September 2011
    • Article
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  • I discuss recent work in which we construct models of poststarburst galaxies by combining fully three-dimensional hydrodynamic simulations of galaxy mergers with radiative transfer calculations of dust attenuation. The poststarburst signatures can occur shortly after a bright starburst phase in gas-rich mergers, and thus offer a unique opportunity to study the formation of bulges and the effects of feedback. Several additional applications of spatially-resolved spectroscopic models of interacting galaxies include multi-wavelength studies of AGN/starburst diagnostics, mock integral field unit data to interpret the evolution of ULIRGs, and the ‘Green Valley’.

    Optical spectra of simulated major gas-rich galaxy mergers can be found at http://www.cfa.harvard.edu/~gsnyder

  • 1 - The Nature of Endangered Species Protection

  • Edited by Jason F. Shogren, University of Wyoming, John Tschirhart, University of Wyoming
  • Book:
    Protecting Endangered Species in the United States
    Published online:
    06 July 2010
    Print publication:
    21 May 2001, pp 1-20

  • Summary

    INTRODUCTION

    During Earth's most recent 3.5 billion junkets around the Sun, its inhabitants have busied themselves adapting to myriad physical surroundings and finding niches within niches to carry out their life functions. In doing so, they established a bewildering number of species, each depending on thousands of fellow species for survival. Five times over the past 440 million years, the number of species crashed in mass extinctions initiated by exogenous shocks to their environments from meteorites, ice ages, and volcanic eruptions. After each shock, the number of species rebounded, and after the most recent shock 66 million years ago, the number rebounded to the 10 million or more species currently inhabiting Earth.

    Today, these inhabitants are again experiencing a mass extinction, although many argue this event is not due to an exogenous shock, but to the endogenous activities of a single species. There is evidence that species are disappearing worldwide at rates 10 to 1,000 times greater than natural rates of extinction (Jablonski 1991; May, Lawton, and Stork 1995; National Research Council 1995; Pimm, Russell, and Gittleman 1995). A casual look at data in the contiguous United States reveals a telling correlation between human populations and threatened and endangered species. Table 1.1 displays a state-by-state tally of species on the endangered species list (ESA) along with the percentage change in state population densities from 1970 to 1997, which encompasses the period the ESA has been in existence.