Non-Invasive Early Warning System of Systemic Hypoperfusion: Circulatory Shock and Sepsis - Part I: The Problem by Michael R. Pinsky, MD and Jacques Creteur, MD The Problem: Circulatory shock is defined as an inadequate oxygen (O2) delivery to tissue to sustain metabolic demand. If arterial oxygen content is adequate, then tissue ischemia develops only at the very extremes of low blood flow. Well before that time, normal physiologic adaptive mechanisms controlled by the autonomic nervous system and mediated primarily through increased sympathetic tone tend to sustain an adequate central arterial blood pressure despite falling total blood flow. Once this regulatory process is exhausted, however, systemic hypotension develops. Thus, systemic hypotension, defined as a mean arterial pressure <65 mmHg or a systolic arterial pressure <90 mmHg, occurs late in shock when tissue hypoperfusion is already compromising metabolic function. If circulatory shock associated with systemic hypotension persists, then generalized tissue ischemia manifests as end-organ failure, lactic acidosis and autonomic failure. If the bedside clinician waits for systemic hypotension to recognize circulatory insufficiency before treating their patient for circulatory shock, then he will have waited too long. #shock #hypoperfusion #sepsis #circulation
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In patients following renal denervation (RDN), it’s crucial to evaluate nocturnal blood pressure dipping as part of our assessment. Numerous studies highlight the significance of this dip in relation to cardiovascular event risk. However, we still need to understand how effective RDN is in influencing this parameter. While existing registries suggest positive outcomes, further research is necessary to explore this aspect in depth. #RDN #Cardiovascular
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Experimental Medicine , Faculty of Medicine, UBC, Vancouver | Medical Content Writing
"𝐓𝐡𝐞 𝐂𝐫𝐮𝐜𝐢𝐚𝐥 𝐑𝐨𝐥𝐞 𝐨𝐟 𝐁𝐥𝐨𝐨𝐝 𝐂𝐨𝐚𝐠𝐮𝐥𝐚𝐭𝐢𝐨𝐧 𝐢𝐧 𝐎𝐮𝐫 𝐒𝐮𝐫𝐯𝐢𝐯𝐚𝐥" Blood coagulation, or blood clotting, is a vital process that prevents excessive bleeding when our blood vessels are injured. This complex mechanism involves several key steps and components working harmoniously to form a stable blood clot. Here's a brief overview: Vascular Spasm: Blood vessels constrict to reduce blood flow at the injury site. 𝐏𝐥𝐚𝐭𝐞𝐥𝐞𝐭 𝐏𝐥𝐮𝐠 𝐅𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧: Platelets adhere to the injury site, forming a temporary plug. 𝐂𝐨𝐚𝐠𝐮𝐥𝐚𝐭𝐢𝐨𝐧 𝐂𝐚𝐬𝐜𝐚𝐝𝐞: This series of reactions, involving clotting factors, converts fibrinogen into fibrin, creating a mesh that stabilizes the platelet plug. 𝐂𝐥𝐨𝐭 𝐑𝐞𝐭𝐫𝐚𝐜𝐭𝐢𝐨𝐧 𝐚𝐧𝐝 𝐑𝐞𝐩𝐚𝐢𝐫: The clot contracts, reducing in size and facilitating wound healing. Eventually, the clot is dissolved as the vessel heals. Key players in this process include platelets, clotting factors (like fibrinogen and prothrombin), and fibrin, the protein that forms the mesh of the clot. Blood coagulation is crucial for survival, balancing the need to prevent excessive bleeding while maintaining fluidity within our vascular system. Understanding this process is key to addressing and managing various coagulation disorders. #Healthcare #MedicalScience #BloodCoagulation #Hemophilia #Thrombosis #VonWillebrandDisease #MedicalResearch #HealthAwareness
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An intensivist at Andalusia Hospitals in Alexandria, Egypt, holds a master's degree in Intensive Medicine and ACLS certified.
The MINUTES Bundle: Managing Shock Step by Step When managing shock, time is life. The MINUTES bundle outlines a structured approach to ensure rapid and effective care within the critical first 30 minutes: 🔸 M – Maintain ABCs • Secure airway, support breathing, and ensure circulation. • Decompress tension pneumothorax. • Control major bleeding. 🔸 IN – Infuse • Administer fluids and/or vasopressors as needed to stabilize hemodynamics. 🔸 IN – Investigate • Perform rapid blood tests (lactate, ABG, CBC). 🔸 U – Ultrasound • Utilize POCUS to identify the type of shock (hypovolemic, cardiogenic, obstructive, or distributive). 🔸 T – Treat the underlying • Address the root cause (e.g., sepsis, hemorrhage, pneumothorax). 🔸 E – Etiology • Confirm the diagnosis and refine treatment based on findings. 🔸 S – Stabilize • Maintain organ perfusion and monitor response to therapy. Timeline: 🕒 0 min: Recognize shock, initiate ABCs. 🕒 10 min: Begin fluids/vasopressors and run initial investigations. 🕒 20 min: Perform ultrasound and identify the type of shock. 🕒 30 min: Treat the etiology and stabilize organ function. #ShockManagement #CriticalCare #POCUS #Sepsis #TimelyIntervention #EveryMinuteCounts
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The MINUTES Bundle: Managing Shock Step by Step When managing shock, time is life. The MINUTES bundle outlines a structured approach to ensure rapid and effective care within the critical first 30 minutes: 🔸 M – Maintain ABCs • Secure airway, support breathing, and ensure circulation. • Decompress tension pneumothorax. • Control major bleeding. 🔸 IN – Infuse • Administer fluids and/or vasopressors as needed to stabilize hemodynamics. 🔸 IN – Investigate • Perform rapid blood tests (lactate, ABG, CBC). 🔸 U – Ultrasound • Utilize POCUS to identify the type of shock (hypovolemic, cardiogenic, obstructive, or distributive). 🔸 T – Treat the underlying • Address the root cause (e.g., sepsis, hemorrhage, pneumothorax). 🔸 E – Etiology • Confirm the diagnosis and refine treatment based on findings. 🔸 S – Stabilize • Maintain organ perfusion and monitor response to therapy. Timeline: 🕒 0 min: Recognize shock, initiate ABCs. 🕒 10 min: Begin fluids/vasopressors and run initial investigations. 🕒 20 min: Perform ultrasound and identify the type of shock. 🕒 30 min: Treat the etiology and stabilize organ function. #ShockManagement #CriticalCare #POCUS #Sepsis #TimelyIntervention #EveryMinuteCounts
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Medical Educator | Integrative Medicine @ Regenerative Renaissance
Understanding the role of Atrial Natriuretic Peptide (ANP) and B-type Natriuretic Peptide (BNP) is crucial for managing cardiovascular health. These heart-derived peptides respond to increased cardiac stress by promoting natriuresis, diuresis, and vasodilation, effectively reducing blood pressure and volume overload. ANP, produced by atrial cells, and BNP, by ventricular cells, help counteract heart failure symptoms by inhibiting the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system activity. This balance ensures a healthier cardiovascular system. #CardiovascularHealth #HeartHealth #ANP #BNP #MedicalScience #HypertensionManagement
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An ischemic stroke is when a clot cuts off blood flow to a part of the brain. Alteplase (IV r-tPA), the Gold Standard treatment for #ischemicstrokes, works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow1. When deciding whether or not to use alteplase, speed and accuracy are key, to reduce risks of bleeding, especially for patients who are on direct oral anticoagulants (DOACs). The Perosphere ClotChek, a novel, DOAC-sensitive, diagnostic device that is newly available in the EU, enables healthcare professionals to have a clear view of a patient’s coagulation status within 3-8 minutes. Learn more about the Perosphere ClotChek, our #pointofcare #coagulometer that is CE Marked in the EU: https://lnkd.in/eyM-idsD Source: Your Risk for Stroke and How to Be Prepared. American Heart Association. https://lnkd.in/d_bGrRZ4
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The results of this long-term prospective serial CCTA imaging study suggest that elevated Lp(a) levels are associated with coronary atherogenesis of high-risk, inflammatory, rupture-prone plaques over the long term
Higher Lp(a) levels were associated with increased progression of coronary plaque burden and increased presence of low-density noncalcified plaque and pericoronary adipose tissue inflammation. https://ja.ma/3W2lPB4
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Cardiologist, Nobel Heart Centre | Adj Asst Professor, Duke-NUS Medical School | Visiting Consultant, National Heart Centre Singapore & Changi Aviation Medical Centre | Flight Surgeon
Hence screening for Lp(a), at least once, is supremely important. 💥 Novel therapeutics are “akan datang” (“coming soon” in the local vernacular). But in the meantime, there’re strategies we employ to reduce overall cardiovascular risks in individuals with elevated Lp(a). For some of them, I also offer PCSK9 inhibitors. Go speak to your friendly neighborhood cardiologist if you’re keen for a check! We don’t bite. 😉 #preventivecardio #lp(a) #PCSK9i
Higher Lp(a) levels were associated with increased progression of coronary plaque burden and increased presence of low-density noncalcified plaque and pericoronary adipose tissue inflammation. https://ja.ma/3W2lPB4
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Semaglutides have gained considerable attention in recent years for helping to lower blood sugar for people with type 2 diabetes and more recently to help those with obesity or who are overweight with weight loss. Thanks to a 2023 clinical trial, the FDA has now expanded approval of semaglutides to treat heart conditions in people who are overweight, but don’t have diabetes. Dr. Nasser Lakkis, chair of internal medicine and a cardiologist with USA Health, discusses the use of semaglutides to improve cardiovascular health on WKRG's Medical Moment. https://ow.ly/CxNk50RPT8i
