Case report: methylene blue for cardiogenic shock

Cardiogenic shock is the primary cause of death in hospitalized patients with acute myocardial infarction, particularly when left ventricle failure occurs. The best management of shock secondary to right or left ventricle failure is reestablishing blood flow in the infarct-related artery. (1) Despite quick treatment, cardiogenic shock causes 50% of deaths within the first 24 hour of the event. (2) A new paradigm for cardiogenic shock assumes that the pathophysiology of the disease includes the participation of guanylate cyclase, leading to the production of nitric oxide that contributes to the vasodilation and the poor response to vasopressors of some patients with this complication. (2)


Early goal-directed therapy in the management of severe sepsis/septic shock in an academic emergency department in Malaysia

Sepsis continues to be a major cause of mortality and morbidity throughout the world. The annual incidence of severe sepsis was approximately 3.0 cases per 1,000 of the population. (1) In the United States alone, the incidence of severe sepsis will see an annual increase of 1.5% which may be attributable to an increasing ageing population. (1) Early goal-directed therapy (EGDT) was proposed by Rivers et al in 2001. This protocol advocates aggressive treatment commencing in the emergency department to achieve certain haemodynamic goals. This achieved a 16% absolute risk reduction for in-hospital mortality. (2)


The Medical Emergency Team and prevention of sudden cardiac death: where is the data?

Traditionally, cardiopulmonary resuscitation (CPR) has been the main tool for treating victims of cardiac arrest. This therapeutic modality has been known for millennia, and despite its widespread use for the last five decades, it has had only few modifications. The popular belief that CPR is an effective approach for patients with cardiopulmonary arrest has been supported by television medical drama series that always show CPR as a medical icon. (1) However, even when CPR is performed by trained providers, the outcomes remain quite poor, with most patients who require in-hospital CPR dying before hospital discharge, with survival to discharge rates that range from 1 to 20%.