Vasopressors Acidosis

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Illustration of the different types of pressors used in ICU, effects and advantages.

Occult Causes Of Non-response To Vasopressors

Occult Causes of Non-Response to Vasopressors Intro: Vasoactive substances are powerful therapeutic medications that can boost a patients blood pressure and perfusion to target organs. They are often used in resuscitation to support tissue perfusion though their benefits are mostly unproven and may be harmful in certain circumstances (i.e. hypovolemia, hemorrhage). The cognitive response to hypotension should not be reaching for a pressor. The primary therapy for any sick hypotensive patient is treatment of the underlying pathology. While many patients will respond to these medications, we occasionally encounter non-responder-patients who despite substantial doses do not show hemodynamic parameter improvements. Absence of response can result from a number of causes including misidentification of the underlying pathology (i.e. I missed the massive PE or pericardial tamponade thinking the patient was in septic shock). Premature diagnostic closure can lead us to simply push on with higher doses of pressors and adding additional pressors. However, there should be a cognitive pause at this point where the clinician reassesses the situation, considers alternate causes and therapeutics. Continue reading >>

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  1. Todd Neal

    Thought I'd document my efforts here, if anyone is interested. Using what I know (or think I know) about nutritional ketosis, I'm going to try it very strictly for 28 days (4 weeks) and see where I end up. If I'm at all successful, I'll likely continue for another couple weeks.
    Weight: 170
    Height: 5' 7"
    Abs Showing: Upper
    BF: Unknown
    [I don't know my body fat, I'm going to use calipers tonight for it. I'll update tomorrow with that. I'm really only interested in getting my abs more visible--currently my upper abs are showing a little, the lower ones are hidden--so the mirror test takes priority over calipers for me.]
    So the plan is to eat <50g of carbs, <120g protein, and the rest fat each day. I'm not worried about calorie count, never have been, and at this point I'm not measuring my foods either. Hahaha, we'll see how this goes.
    I do plan on daily WoDs as much as 6 days per week, but already I find I'm tired while starting this diet. I workout in the mornings and it's difficult waking up before 6am. I blame the lack of carbs, but I'm also fairly sure I just need to adapt, so I'll monitor morning energy as I go.
    As for nutrition on workout days, I'll have a banana immediately after the workout to replenish glycogen, but not so much as to fall out of ketosis. I know that one high-carb meal can take me out of ketosis for the next 3 days, so I'm going to be very careful about cheating.
    Ok, I'll let everyone know how it goes.

  2. Paulo Santos

    The fact that you are not tracking your calories will be a total failure. If you don't get the results you want, how do you know it isn't because you were eating too many calories?

  3. Adam Shreim

    I think the usual prescription for a keto diet is 15-30g of Carbs, per day.

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Epinephrine is a medication that acts on adrenergic receptors. Commonly used in anaphylaxis and cardiac arrest. Learn more about this powerful vasopressor here! VASOPRESSOR & INOTROPE COURSE OUT NOW! Only At https://www.udemy.com/vasopressors-in... Follow Us on Social Media: Facebook: https://www.facebook.com/medzcoolmedia Instagram: https://www.instagram.com/medzcool/ Twitter: https://twitter.com/medzcool CodeHealth: https://codehealth.io/medzcool Support Medzcool in Making More Educational Content: https://www.patreon.com/medzcool

Chapter 23: Use Of Vasopressors

1) Which of the following conditions can result in a lowering of blood pressure in critically ill patients? B.Decreased pulmonary capillary wedge pressure 2) The central venous pressure (CVP) catheter is a device that is used to effectively perform what function in critically ill patients? B.Administer drugs directly into the central circulation 3) Which of the following statements about central venous oxygen saturation is correct? A.It indirectly measures oxygen extraction by tissues. B.It may be low in inadequately volume-resuscitated patients with septic shock. C.It measures adequacy of volume resuscitation more accurately than does blood pressure measurement. D.It should be targeted to a value in excess of 70%. 4) Which of the following parameters is a measurement of regional perfusion? A.Arterial blood lactate concentration 5) Stimulation of the beta adrenergic receptor by agonists results in a physiologic response mediated by which of the following? 7) Which of the following outcomes is a goal that should be achieved within THREE hours of presentation in a patient with septic shock? 8) Which of the following explains the development of lactic acidosis by a catecholamine? A.E Continue reading >>

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  1. pca1987

    Hello guys. (first of all I'm sorry if my english is too bad)
    I've just read the FAQ and saw that not necessarily keto tests will be positive when you are in ketosis, but I've always tested myself and it's been always positive. (I use accu-check keto-diabur test, the only I could find here in Brazil).
    Last week for the first time it was negative. I did not eat more carbs than usual. I'm always below 20-30 grams.
    I've been counting calories since Aug-2012 and reading nutrition facts since forever, so I'm kind of already "experienced" in dieting and knowing what I should eat or not.
    I'm 1.72m tall (5ft 6in - 5ft 7'in) and currently 86kg (189 lbs). I've lost 31 kg (~ 69 lbs) so far.
    Any ideas why I'm not positive in ketosis test anymore?

  2. ashsimmonds

    Those accu-check things are only to see if you're PISSING ketones, not whether you're ketogenic. The correlation is good for newbies, but poor for "veterans". After a few weeks/months you should be keto-adapted, which effectively means your body uses basically all the ketone bodies it produces.
    Early on your body produces excess ketones, this is what newbies call ketosis whereas it's actually ketonuria - ie your body discarding ketones because it hasn't established the required mechanisms to use them appropriately yet. If you want to know for sure, get a blood monitor - but FWIW after a while you just know whether you're ketogenic by the general feeling you have.
    TL;DR - not being "in ketosis" is actually a good thing for a long term low-carber

  3. pca1987

    Thanks for replying. I didnt know that and it totally makes sense, since I'm eating low carbs for months.
    Well this was more motivational than the actual test being positive :) Thanks again

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In this video we discuss the progression of a systemic infection including systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock and multi organ dysfunction syndrome.

Lactate Clearance And Vasopressor Seem To Be Predictors For Mortality In Severe Sepsis Patients With Lactic Acidosis Supplementing Sodium Bicarbonate: A Retrospective Analysis

Lactate Clearance and Vasopressor Seem to Be Predictors for Mortality in Severe Sepsis Patients with Lactic Acidosis Supplementing Sodium Bicarbonate: A Retrospective Analysis Contributed equally to this work with: Su Mi Lee, Seong Eun Kim Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Contributed equally to this work with: Su Mi Lee, Seong Eun Kim Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea Affiliations: Department of Internal Medicine, Dong-A University, Busan, Korea, Institute of Medical Science, Dong-A University College of Medicine, Busan, Korea Initial lactate level, lactate clearance, C-reactive protein, and procalcitonin in critically ill patients with sepsis are associated with hospital mortality. However, no study has yet discovered which factor is most important for mortality in severe sepsis patients with lactic acidosis. We sought to clarify this issue in patients with lacti Continue reading >>

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  1. GailaMonster

    My ketosis strips arrived in the mail today. I was SO excited. After reading the instructions, however, i am somewhat confused. The packaging says the sample must be room temperature prior to testing. Do i really need to capture my pee in a glass and wait for it to cool down?
    Also, when it a good time/frequency to test? part of me wants to pee on them every time i go, but they wouldn't last very long with that plan. they were kind of expensive.
    Lastly, what is a "good" reading? i have heard people try to get as "into" ketosis as possible. other people say that a darker color may just indicate dehydration, and that any ketones in the urine means you're in keto and losing.
    I was so excited to pee on all the things...

  2. GailaMonster

    Ha! I like the face you made in the "how to pee" pic. I don't like the strips i bought; they have like 2 pages of instructions that made me completely second guess myself on how to pee on the damn things. "Use room temperature, fresh, well-stirred urine." um...... if the urine is fresh, it ain't room temperature! instead of stirring, i jumped up and down a bunch, and did this.

  3. ICOrthogonal

    Too funny.
    Now show us your six string!

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