- sepsis
- septic syndrome / septicemia
- multiple organ dysfunction syndrome (MODS) / multiple organ failure (MOF)
Table of contents :
,
reproductive
immunology,
and pregnant's diseases)
(10-15%)
(2-10%),
other agents, rubella,
cytomegalovirus,
herpes
simplex
(TORCH) infection or syndrome : any of a group of infections seen in
neonates due to one of the causative agents having crossed the placental
barrier; they all have similar symptoms in babies and may be clinically
silent in the mothers
(1%)
with no neurological disorders (25.7 every 100,000 born alive)
(16.9 every 100,000 born alive)
(10.9 every 100,000 born alive)
with or without cleft
palate
(9.1 every 100,000 born alive)
without anencephaly
(5.5 every 100,000 born alive)
without anencephaly
(4.8 every 100,000 born alive)
(3.9 every 100,000 born alive)
and intestinal atresia (3.4 every 100,000 born alive)
or those with cerebral gigantism
addicted) during pregnancy; it includes maxillary hypoplasia, prominence
of the forehead and mandible, short palpebral fissures, microphthalmia,
epicanthal folds, severe growth retardation, mental retardation, and microcephaly.,
tracheo-esophageal
fistula
(VACTERL) with hydrocephalus (VACTERL-H)|
|
|
|
||
|
|
|
|
||
| total body mass (lean, fat, total body water (TBW)) | % ideal body weight (IBW) = (actual wt./ideal wt.) x 100 | 80-90% | 70-80% | < 70% |
| weight loss in 6 months | 5% | 5-10% | > 10% | |
| total body fat | triceps skin fold (TSF) thickness measured with a skin caliper
on the posterior aspect of the nondominant arm by pinching a fold of skin
from the underlying triceps muscle. Total body fat can be estimated from
TSF with the Siri equationref.
subscapular skinfold was measured below the lower vertex of the scapula with the skinfold caliper at 45° to vertical abdominal skinfold was measured halfway along an imaginary line joining the umbilicus and the anterosuperior iliac crest. fat-muscle index |
< 35% | ||
| skeletal muscle mass | midarm muscle circumference (MAMC) = midarm circumference
(MAC : in cm; sometimes arm circumference (AC) is conventionally measured
15 cm above the olecranon) - 0.1 . p(TSF
in mm)
midarm muscle area (MAMA) = (MAC - (p. TSF)2) / (4 . p). single point vs serial measurments. Assumptions : arm, muscle, bone are circular, TSF is 2x the thickness of fat, and bone area is constant
|
< 35%
(<110 mm) |
||
| creatinine height index (CHI) = (24 hr urinary creatinine / expected 24hr urine creatinine for height) x 100 | 80-90
or 60-80 |
60-80
or 40-60 |
< 60
or < 40 |
|
| visceral protein mass | serum albumin | 2.8-3.5 | 2.1-2.8 | < 2.1 |
| serum prealbumin | ||||
| serum transferrin = 0.8 (TIBC) - 43 | 150-200 | 100-150 | < 100 | |
| total lymphocyte count (TLC) | 1200-200 | 800-1200 | < 800 | |
| delayed hypersensitivity skin
tests |
reactive | reactive | anergic | |
| specific nutrients | serum vitamin A | < 20-40 mg/dL | ||
| serum vitamin D | < 15 ng/mL | |||
| prothrombin time (vitamin K) | > 2 sec prolonged | |||
| serum folate | < 3 ng/mL | |||
| RBC folate | < 140 ng/mL | |||
| serum calcium ionized | < 4 mg/dL | |||
| serum phosphorus | < 2 mg/dL | |||
| serum magnesium | < 1.5 mg/dL | |||
| iron-serum | < 50 mg/dL | |||
| serum hemoglobin | < 14 g/dL | |||
| serum ferritin | < 15 ng/mL | |||
: hydration, poor reproducibility
: immunosuppressive drugs, cancer, stress, surgery-associated
cachexia is caused by leptin
signaling through the hypothalamic melanocortin
receptor 4 (MC4-R)ref
or the AIDS,
resulting from a poorly understood relationship between anorexia and cachexia,
manifested by malnutrition, weight loss, muscular weakness, acidosis, and
toxemia. The anorexia may be caused by a severe metabolic disturbance that
contributes to development of cachectic wasting, which in turn reinforces
anorexia by release from the tumor of a humoral product that stimulates
the satiety center in the hypothalamus,
are best visualized on chest computed tomography (CT). Severe trauma to
the chest wall can be associated with large chest wall hematomas or collections
of air within the chest wall that can communicate with the intrathoracic
space. CT scanning can easily distinguish chest wall from parenchymal or
mediastinal injury, whereas this differentiation my not be possible with
chest radiography.
Symptoms & signs :
(22.7%)
(17.4%)
(11%)
(16.2%)
(12.8%)
tongue may slip downback into pharynx,
apnea, stridor, agitation
or nasopharyngeal airway
(better tolerated in awaken patients)
(Ch 14) connecting O2 erogator. First choice in babies as eventual
surgical cricoid injuries would cause developmental laryngeal anomalies
with 14 Ch needle-cannula (not allowing CO2 expulsion => do
not keep for > 15-20' to prevent respiratory acidosis) or open-surgery
requires 1-2 minutes (more superficial but smaller access), while tracheotomy
requires 15 minutes !
or hemothorax,
assess integrity of urethra with DRE => urinary catheterism to monitor
renal function, a good surrogate for heart and brain functions (whose function
cannot be assessed during organ-targeted therapies)
(95%) due to
due to tension
pneumothorax,
cardiac
tamponade
or myocardial
contusion
leading to severe arrhythmias
(jugular vein distension)
(vasodilatation, no tachycardia, flaccid tetra or paraplegia, complete
loss of anal sphincter tone at DRE before insertion of urinary catheter)|
|
|
|
|
| vital signs | return to normal | improvement, recurrent | remain abnormal |
| estimated blood loss | minimal (10-20% | moderate & ongoing (20-40%) | severe (> 40%) |
| need for more crystalloid (lactate Ringer's (LR) solution) | low | high | high |
| need for blood | low | moderate/high | immediate |
| need for surgery | possibly | likely | highly likely |
<= 8
<= 8 or decreases >= 2 points (=decreased level of consciousness)
can be postponed in mild traumas,
baby, consciouless, ...)
performed by an emergency physician sonographer (EPS)ref1,
ref2,
ref3,
ref4,
ref5,
ref6
when indicated
scanning allows a detailed view of intra-abdominal pathology. However,
most scanners are located a distance from the emergency department and
the patient must be stable before transfer. Use of a double contrast technique
also necessitates a delay before scanning can commence of typically 40
minutes to 1 hour]
:,
acute respiratory failure, and brain
injury),
20% in 2-3 weeks (e.g. sepsis from external wounds,
intestinal perforations, immunodeficiency (e.g. due to peripheral hypoperfusion
and ventilator-associated
pneumonia (VAP)),
atelectasis due to restrictive respiratory failure
)
,
confined to individuals of African descent, results in the production of
a full-length caspase-12 precursor protein (Csp12-L), instead of a truncated
caspase-12 protein (Csp12-S), leading to reduction in LPS-induced cytokine
production and subsequently an enhanced susceptibility to bacterial invasion
of the bloodstream (septicaemia) and increased mortality. Csp12-L might
function as a dominant negative regulator of the activity of other caspases,
potentially by antagonizing the inflammasome (the protein scaffold within
which active cytokines are produced) and the associated pro-inflammatory
pathways. Csp12-S was also found to inhibit NF-kB
activation, although to a lesser extent than Csp12-L. Caspase-12 antagonists
might have therapeutic potential for treating septic shockref
(hypoperfusion) + respiratory
alkalosis
(fever and tachypnea)
Varieties :
|
|
|
|
|
| Mycoplasma hominis |
|
|
ascending, during labor |
| Ureaplasma urealyticum |
|
|
ascending, during labor |
| Gardnerella vaginalis
and anaerobes |
|
|
ascending, during labor |
| group B Streptococcus
spp. |
|
|
ascending, during labor |
| Chlamydia trachomatis |
|
|
ascending, during labor |
| Listeria monocytogenes |
|
|
ascending, during labor, transplacental |
,
CVS,
cordocentesis,
or in utero fetal surgery)
(77.1%)
(8.9%)
(8.9%)
(4.4%)
(77.3%)
(9%)
(9%)
(4.5%),
maternal fever, chorioamnionitis,
asphyxia, cerebral hemorrhage,
IRDS,
and MAS,
but also in 8% of healthy newborns. Limited value in the first 12-24 hours;
variable response to non-bacterial infections; useful in follow-up of antibiotic
therapy,
preeclampsia,
PROM,
chorioamnionitis,
GBS colonization, and perinatal asphyxia; sensitivity = 61-85% (72-10