Pilar Acosta

Therapeutic Hypothermia: Past, Present, and Future

Cardiac arrest causes devastating neurologic morbidity and mortality. The preservation of the brain function is the final goal of resuscitation. Therapeutic hypothermia (TH) has been considered as an effective method for reducing ischemic injury of the brain. The therapeutic use of hypothermia has been utilized for millennia, and over the last 50 years has been routinely employed in the operating room. TH gained recognition in the past 6 years as a neuroprotective agent in victims of cardiac arrest after two large, randomized, prospective clinical trials demonstrated its benefits in the postresuscitation setting. Extensive research has been done at the cellular and molecular levels and in animal models. There are a number of proposed applications of TH, including traumatic brain injury, acute encephalitis, stroke, neonatal hypoxemia, and near-drowning, among others. Several devices are being designed with the purpose of decreasing temperature at a fast and steady rate, and trying to avoid potential complications. This article reviews the historical development of TH, and its current indications, methods of induction, and potential future.

Is the Mortality in the Emergency Department Sepsis score a reliable predictive tool for the ED physician

In the United States, approximately 700000 patients a year will present to the emergency department (ED) with sepsis, severe sepsis, or septic shock [1]. This spectrum of illnesses ranks among the leading reasons for admission to intensive care units throughout the world. Indeed, sepsis and the multiorgan dysfunction syndrome, which commonly follows sepsis, use enormous intensive care unit resources and have a mortality rate that ranges from 30% to 50% [2]. The ability to promptly and accurately evaluate a patients source of sepsis, as well as the severity of illness (including mortality risk), upon presentation to the ED is important to health care providers to implement prompt and appropriate therapy [3]. Those patients in the ED who suffer from severe sepsis are critically ill and require immediate attention to avoid deterioration. Some treatment algorithms have evolved over the past few decades in an attempt to rapidly resuscitate these patients and improve outcome [4]. It is clear that a prompt diagnosis, risk stratification, and management of patients with sepsis are major determinants to a successful treatment [2]. A variety of scoring systems have been developed in an attempt to determine severity of illness in critically ill patients, such as Acute Physiology and Chronic Health Evaluation (APACHE), APACHE II, APACHE III, the Therapeutic Intervention Scoring System, the Mortality Predictor Model, and the Simplified Acute

Long Term Recovery of Diaphragmatic Function in a Patient with Unilateral Diaphragmatic Pacemaker

Diaphragmatic pacing, also known as electrophrenic respiration or phrenic pacing has been used for quite some time in patients with respiratory failure due to diaphragmatic paralysis. We present a case of patient with respiratory insufficiency due to unilateral phrenic nerve injury as a result of radiation therapy for breast cancer. The patient had a diaphragmatic pacer inserted, with significant recovery on her symptoms. Three years after this procedure, the patient recovered her phrenic nerve function, and this was confirmed by nerve conduction study.