Hypovolemic shock and septic shock present similar symptoms, such as increased heart rate and decreased blood pressure. However, the two conditions have different causes, mechanisms, and treatment approaches. Early differentiation between the two conditions can have a positive impact on patient prognosis. In this case, the patient underwent a right ovarian cystectomy due to a teratoma torsion during a previous pregnancy, followed by treatment for a postoperative infection. While recovering, the patient underwent an emergency cesarean section due to sudden severe abdominal pain. After the surgery, unstable vital signs were suggestive of hypovolemia due to massive bleeding from the cesarean section. Therefore, fluid infusion and blood transfusion were initiated. The vital signs did not improve. So, the patient was reassessed. Body temperature and the previously elevated C-reactive protein levels were remeasured. The results of the reassessment indicated a septic condition due to previous infection. The patient was prescribed additional vasopressors and antibiotics for the following week. Subsequently, the patient’s vital signs stabilized, and the treatment was discontinued.

Hypovolemic shock and septic shock present similar symptoms, such as increased heart rate and decreased blood pressure. However, the two conditions have different causes, mechanisms, and treatment approaches. Early differentiation between the two conditions can have a positive impact on patient prognosis. In this case, the patient underwent a right ovarian cystectomy due to a teratoma torsion during a previous pregnancy, followed by treatment for a postoperative infection. While recovering, the patient underwent an emergency cesarean section due to sudden severe abdominal pain. After the surgery, unstable vital signs were suggestive of hypovolemia due to massive bleeding from the cesarean section. Therefore, fluid infusion and blood transfusion were initiated. The vital signs did not improve. So, the patient was reassessed. Body temperature and the previously elevated C-reactive protein levels were remeasured. The results of the reassessment indicated a septic condition due to previous infection. The patient was prescribed additional vasopressors and antibiotics for the following week. Subsequently, the patient’s vital signs stabilized, and the treatment was discontinued.

Hypovolemic shock and septic shock present similar symptoms, such as increased heart rate and decreased blood pressure. However, the two conditions have different causes, mechanisms, and treatment approaches. Early differentiation between the two conditions can have a positive impact on patient prognosis. In this case, the patient underwent a right ovarian cystectomy due to a teratoma torsion during a previous pregnancy, followed by treatment for a postoperative infection. While recovering, the patient underwent an emergency cesarean section due to sudden severe abdominal pain. After the surgery, unstable vital signs were suggestive of hypovolemia due to massive bleeding from the cesarean section. Therefore, fluid infusion and blood transfusion were initiated. The vital signs did not improve. So, the patient was reassessed. Body temperature and the previously elevated C-reactive protein levels were remeasured. The results of the reassessment indicated a septic condition due to previous infection. The patient was prescribed additional vasopressors and antibiotics for the following week. Subsequently, the patient’s vital signs stabilized, and the treatment was discontinued.

Hypovolemic shock and septic shock present similar symptoms, such as increased heart rate and decreased blood pressure. However, the two conditions have different causes, mechanisms, and treatment approaches. Early differentiation between the two conditions can have a positive impact on patient prognosis. In this case, the patient underwent a right ovarian cystectomy due to a teratoma torsion during a previous pregnancy, followed by treatment for a postoperative infection. While recovering, the patient underwent an emergency cesarean section due to sudden severe abdominal pain. After the surgery, unstable vital signs were suggestive of hypovolemia due to massive bleeding from the cesarean section. Therefore, fluid infusion and blood transfusion were initiated. The vital signs did not improve. So, the patient was reassessed. Body temperature and the previously elevated C-reactive protein levels were remeasured. The results of the reassessment indicated a septic condition due to previous infection. The patient was prescribed additional vasopressors and antibiotics for the following week. Subsequently, the patient’s vital signs stabilized, and the treatment was discontinued.

Hypovolemic shock and septic shock present similar symptoms, such as increased heart rate and decreased blood pressure. However, the two conditions have different causes, mechanisms, and treatment approaches. Early differentiation between the two conditions can have a positive impact on patient prognosis. In this case, the patient underwent a right ovarian cystectomy due to a teratoma torsion during a previous pregnancy, followed by treatment for a postoperative infection. While recovering, the patient underwent an emergency cesarean section due to sudden severe abdominal pain. After the surgery, unstable vital signs were suggestive of hypovolemia due to massive bleeding from the cesarean section. Therefore, fluid infusion and blood transfusion were initiated. The vital signs did not improve. So, the patient was reassessed. Body temperature and the previously elevated C-reactive protein levels were remeasured. The results of the reassessment indicated a septic condition due to previous infection. The patient was prescribed additional vasopressors and antibiotics for the following week. Subsequently, the patient’s vital signs stabilized, and the treatment was discontinued.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Background: Lightwand is a convenient tool that can be used instead of a laryngoscope for intubation. Tracheal intubation causes direct stimulation of the larynx, drastically increasing hemodynamic values including blood pressure and heart rate. This study aims to identify the effect of different doses of esmolol on hemodynamic changes during lightwand intubation. Methods: The study subjects included 140 patients who underwent general anesthesia for elective surgery. The patients were randomly divided into four groups (35 patients in each group). The ‘C’ group only received 20 ml of normal saline, while the ‘E0.5’, ‘E1’, and ‘E2’ groups received 20 ml of normal saline containing esmolol—0.5 mg/kg, 1 mg/kg, and 2 mg/kg, respectively, injected 2 min prior to intubation. The patients’ blood pressure, heart rate, and rate-pressure product were measured six times, before and after the intubation. Results: The degree of heart rate elevation was suppressed in the E1 and E2 groups compared to the C group, and RPP after intubation significantly decreased in the E2 group compared to the C group. Conclusions 1–2 mg/kg of a single esmolol injection prior to lightwand intubation effectively blunts heart rate elevation, and 2 mg/kg of esmolol injection blunts rate-pressure product elevation.

Purpose: This study was conducted to demonstrate objective stability of postoperative pain management status managed by nurse-based, anesthesiologist-supervised Acute Pain Service (APS). Methods: A retrospective descriptive review was conducted with 5,748 patients who had used intravenous Patient Controlled Analgesia (PCA) from January to December 2017. Data were analyzed using descriptive statics, Frequency analysis, ANOVA, Cross tabulation with X2 test, and Correlation coefficient. Results: As the APS nurse's education date increased, the period of using PCA was statistically significantly longer, and the period of stopping PCA while using it became shorter (p<.001). Statistically significant, the most painful operations were extremities, spine, upper abdomen, and thorax, while the least painful surgery was lower abdomen (p<.001). Lower abdominal surgery used the highest amount of PCA (p<.001), and extremities and spinal surgery, the lowest amount of PCA and frequently stop using it (p<.001). The most common side effects were nausea and vomiting after surgery, with an incidence of 16.0% within 24 hours and 9.8% within 48 hours. The overall error caused by PCA was 1.5%, with 84.3% being caused by human errors. Conclusion With the pain management effect of APS nurses, patients used PCA more effectively. There were also fewer side effects and error rates compared to prior studies.Therefore, it is suggested that this system is safe and effective for pain management.

BACKGROUND: Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children. METHODS: Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1.5 mg/kg, and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg. Agitation was measured using the objective pain score, Cole 5-point score, and Richmond Agitation Sedation Scale score at the end of surgery, on arrival in the recovery room, and 10 and 30 min after arrival. RESULTS: The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia (OPS = 0 (0-4), RASS = -4 [(-5)-1]) and were transferred to the recovery room (OPS = 0 (0-8), RASS = -1 [(-5)-3]) (P < 0.05). There was no significant difference in the severity of agitation among the three groups at other time points (P > 0.05). CONCLUSIONS: When pediatric strabismus surgery is accompanied by sevoflurane anesthesia, an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room. TRIAL REGISTRATION Clinical Research Information Service, No. KCT0002925; https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11532.
Anesthesia ; methods ; Child ; Child, Preschool ; Double-Blind Method ; Humans ; Injections, Intravenous ; Lidocaine ; administration & dosage ; pharmacology ; Propanolamines ; administration & dosage ; pharmacology ; Sevoflurane ; therapeutic use ; Strabismus ; surgery ; Wakefulness ; drug effects

BACKGROUND: This study was conducted to develop a pre-discharge group education program for liver transplant patients, and to contribute to improving the knowledge and performance of self-management after discharge. METHODS: This investigation was a methodological study consisting of analysis, design, development, operation, and evaluation stages. RESULTS: The constituent items of the pre-discharge group education program for liver transplant patients include medication management, infection management, emergency management, outpatient management, complication management, nutrition management, exercise management, wound and drainage management, disability registration, and sex life. The pre-discharge group education program for liver transplant patients was conducted once a week, 30 minutes for the coordinator, 40 minutes for the clinical nurse specialist (including 10 minutes for wound and drainage management), 30 minutes for pharmacists, 20 minutes for the nutritionist, and 20 minutes for social workers. Additionally, the contents of the lecture announced by PowerPoint were made the same as the booklet. The overall knowledge level before and 3 months after the pre-discharge group education program for liver transplantation patients increased significantly from 17.32±1.53 to 19.74±0.89. At the 3-month time point, the overall compliance was 77.39±3.04 out of 80. Overall satisfaction was 9.32±0.93 on a scale of 10. Finally, the need for medication was the highest at 3 months. CONCLUSIONS: It is expected that this program can be utilized in the clinical field as an effective nursing education intervention.
Compliance ; Drainage ; Education* ; Education, Nursing ; Emergencies ; Humans ; Liver Transplantation ; Liver* ; Methods ; Nurse Clinicians ; Nutritionists ; Outpatients ; Pamphlets ; Pharmacists ; Self Care ; Social Work ; Social Workers ; Wounds and Injuries