By Jocelyn C. P Proby
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Renal failure is common. Diagnosis The initial evaluation of the patient in shock should include a determination of the cause. In most cases of hypovolemic shock, it is readily apparent that trauma or blood loss is the primary cause, but care must be taken not to overlook septic, cardiogenic, or anaphylactic shock. Initial resuscitation should begin during the evaluation. In the case of external blood loss, blood should be cross-matched while fluids are infused for resuscitation. Gastrointestinal bleeding can be evaluated and potentially treated with upper or lower endoscopy, or evaluated with angiography once the patient is stabilized.
Exhalation can be prolonged by decreasing the RR or the tidal volume. Both of these changes can result in worsening respiratory acidosis, and acid–base status should be followed with ABG analysis. If the inspiratory flow rate is <100 L/min, increasing the rate may reduce total inspiratory time and allow for longer exhalation, although increasing the flow rate above this level may hyperinflate areas of the lung that have less airway resistance, and could lead to barotrauma. References 1. Mehta S, Jay GD, Woolard RH et al.
Either placebo or 40,000 units of rHuEPO was given subcutaneously per week, starting on ICU day 3, for a total of three doses (patients in the ICU on study day 21 received a fourth dose). 4% for placebo vs. 5% for rHuEPO), and a 19% reduction in the total units transfused to the rHuEPO group. While reducing the number of transfusions required, rHuEPO did not change clinical outcomes (including mortality rate, rate of organ failure, and length of stay in the ICU), and has yet to gain widespread recommendation for routine use.