cardiovascular-agents and Coma

Danhong Injection (DHI), a Chinese Materia Medica standardized product extracted from Radix Salviae Miltiorrhizae and Flos Carthami tinctorii, has the actions of promoting blood circulation and resolving stasis to promote regeneration. The clinical therapeutic effects of DHI on traumatic intracranial hematoma (TICH) were observed. Eighty patients with TICH were randomly assigned to trial group and a control group (40 patients per group), and all were administered with routine medication. Additionally, DIH was administered intravenously to patients in the trial group. Pre and post-treatment GCS was observed in the two groups, along with GOS after therapy. The intracranial hematoma absorption, hemorheological changes, and changes in coagulation indexes pre- and post-treatment were evaluated. The results indicated that GCS and GOS after therapy for the trial group were superior to those for the control group (p<0.05). There was a significant post-treatment difference in the intracranial hematoma absorption between the two groups (p<0.01). Each hemorheological index in the trial group improved significantly as compared with that of the control group (p<0.05 or p<0.01). The plasma levels of fibrinogen and D-dimer in the trial group were significantly decreased after therapy (p<0.01). These results suggest that DHI is conducive to the recovery of patients with TICH.

Topics: Absorption; Adolescent; Adult; Blood Viscosity; Cardiovascular Agents; Carthamus; Coma; Drugs, Chinese Herbal; Erythrocyte Aggregation; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Flowers; Humans; Intracranial Hemorrhage, Traumatic; Male; Medicine, Chinese Traditional; Middle Aged; Phytotherapy; Plant Extracts; Plant Roots; Plants, Medicinal; Salvia miltiorrhiza; Young Adult

Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used.

Topics: Acidosis, Lactic; Acute Kidney Injury; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Antidepressive Agents; Cardiovascular Agents; Cardiovascular Diseases; Coma; Diabetes Mellitus, Type 2; Drug Synergism; Drug Therapy, Combination; Emergencies; Fatal Outcome; Female; Humans; Hypoglycemic Agents; Ibuprofen; Male; Metformin; Middle Aged; Nephrology; Physician's Role; Polypharmacy

Comatose survivors of out-of-hospital cardiac arrest (OHCA) have high in-hospital mortality due to a complex pathophysiology that includes cardiovascular dysfunction, inflammation, coagulopathy, brain injury and persistence of the precipitating pathology. Therapeutic hypothermia (TH) is the only intervention that has been shown to improve outcomes in this patient population. Due to the similarities between the post-cardiac arrest state and severe sepsis, it has been postulated that early goal-directed hemodyamic optimization (EGDHO) combined with TH would improve outcome of comatose cardiac arrest survivors.. We examined the feasibility of establishing an integrated post-cardiac arrest resuscitation (PCAR) algorithm combining TH and EGDHO within 6h of emergency department (ED) presentation.. In May, 2005 we began prospectively identifying comatose (Glasgow Motor Score<6) survivors of OHCA treated with our PCAR protocol. The PCAR patients were compared to matched historic controls from a cardiac arrest database maintained at our institution.. Between May, 2005 and January, 2008, 18/20 (90%) eligible patients were enrolled in the PCAR protocol. They were compared to historic controls from 2001 to 2005, during which time 18 patients met inclusion criteria for the PCAR protocol. Mean time from initiation of TH to target temperature (33 degrees C) was 2.8h (range 0.8-23.2; SD=h); 78% (14/18) had interventions based upon EGDHO parameters; 72% (13/18) of patients achieved their EGDHO goals within 6h of return of spontaneous circulation (ROSC). Mortality for historic controls who qualified for the PCAR protocol was 78% (14/18); mortality for those treated with the PCAR protocol was 50% (9/18) (p=0.15).. In patients with ROSC after OHCA, EGDHO and TH can be implemented simultaneously.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Blood Gas Analysis; Blood Pressure; Cardiovascular Agents; Clinical Protocols; Cohort Studies; Coma; Emergency Service, Hospital; Feasibility Studies; Female; Heart Arrest; Humans; Hypothermia, Induced; Male; Middle Aged; Oxygen; Retrospective Studies; Young Adult

Topics: Adult; Anuria; Bradycardia; Cardiovascular Agents; Cold Temperature; Coma; Combined Modality Therapy; Drug Overdose; Electric Countershock; Emergencies; Extracorporeal Membrane Oxygenation; Female; Frostbite; Humans; Hypotension; Hypothermia; Intermittent Positive-Pressure Ventilation; Psychotropic Drugs; Resuscitation; Suicide, Attempted; Ventricular Fibrillation

Topics: Barbiturates; Cardiovascular Agents; Coma; Dihydroergotamine; Ergot Alkaloids; Oxytocics; Scopolamine