November 1, 2018
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Massive hemorrhage with hemodynamic instability or shock may arise from multiple causes and is a medical emergency requiring intensive care. Hemorrhagic shock typically develops with the loss of 30-40% of blood volume. Thankfully, its incidence is likely low. Treatment is focused on resuscitative efforts to restore blood volume and stop bleeding. Time is required to locate and secure the sources of blood loss. It is in this setting that resuscitation to maintain oxygen concentration, cardiac output, and circulating blood volume is necessary for survival. Massive transfusion protocols have been developed to provide rapid access to and administration of blood products in these situations.
Low-dose nocturnal dexmedetomidine infusion was shown to prevent delirium in critically ill patients.
In a retrospective cohort study, patients with limited English proficiency had lower rates of do not resuscitate orders, comfort measures orders, and advanced directives; higher rates of receiving certain types of life support; and longer hospital stays compared to their English-speaking counterparts.