Zia Awan

By Abdulgafoor M. Tharayil, Adel Ganaw, Syed Abdulrahman, Zia M. Awan and Sujith M. Prabhakaran

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are continuation of the same pathological and physiological processes that are largely unrecognized in critical patients. From an era of indistinct definitions and recommendations, this condition has been studied extensively and experts have come forward with clear definitions and recommendations for management. IAH is graded in four grades and ACS is IAH above 20 cm H2O with new organ dysfunction. IAH/ACS can present as acute, hyperacute, or chronic and aetiologically can be classified into primary, secondary and tertiary. It affects various body systems including respiratory, cardiovascular, central nervous, gastrointestinal, renal and hepatic systems adversely and results in deleterious consequences. Management of IAH/ACS is based on the evacuation of intra-luminal and extra-luminal contents, improving the abdominal wall compliance. There are various surgical techniques recommended for preventing the development of IAH/ACS and mitigating the negative consequences. New medical therapies such as octreotide, tissue plasminogen activator, melatonin and vitamin C are being investigated and non-pharmacological methods such as continuous negative abdominal pressure (CNAP) have been introduced recently but are still experimental and not recommended for routine use.

Part of the book: Intensive Care

By Moad Ali M. Ehfeda, Adel Ganaw, Sohel Mohamed Gamal Ahmed, Arshad Chanda, Zia Mahood, Salem Jabira, Hossam Algallie, Ahmad H.M. Almaqadma, Mahmud M.A. Ben Masoud, Ali O. Mohamed Bel Khair and Qazi Zeeshan

Gastrointestinal endoscopy has become fundamental procedure for diagnosis and treatment of gastrointestinal tract diseases. Generally, the gastrointestinal endoscopy is minimally invasive procedure. However, it can cause considerable amount of discomfort and pain which make the procedure unsafe, complicated and refusal of follow up procedures if done without safe sedation. The sedation is required to alleviate anxiety, provide analgesia, amnesia and to improve endoscopic performance specifically in therapeutic procedures. The safe administration of sedative and analgesic medications, irrespective of the regimen used, requires knowledge of the individual needs of patients. The combination of benzodiazepines and opioids is now the most widely used sedation regimen for sedation in gastrointestinal endoscopic procedures. Generally, sedation for gastrointestinal endoscopy is considered safe, however, it has the potential for serious complications. Therefore, endoscopist should assess the patients properly before the endoscopy as well as should be aware of all possible complications and the risk factors. Furthermore, skilled staff and emergency equipment should be available in endoscopy suit. This chapter discuss in details all the aspects of safe procedural sedation during GI endoscopies.

Part of the book: Esophagitis and Gastritis

By Mohammad Zubair, Wael Khalaf, Zia Awan, Hossam Algallie, Nissar Shaikh and Gamal Al-Ameri

Thyroid storm is rare, acute medical endocrine emergency. It is aggressive manifestation of the hyperthyroid state. If delayed or not treated can be fatal or cause severe disabilities. Historically thyroid storm was a common complication of toxic goiter and goiter surgery but recently more common in hyperthyroidism patients with acute illness or surgical intervention and inadequately treated hyperthyroid patients. There is usually precipitating factor that lead to thyroid storm, such as emergency surgery, extreme stress, or acute severe illness. Clinical manifestations involve major body organ dysfunctions and range from fever, dysrhythmias, heart failure, vomiting, diarrhea, jaundice, and convulsions to coma. The pathophysiology of thyroid storm is organ dysfunction due to excessive thyroid hormones. Thyroid storm is diagnosed by clinical presentation, Electrocardiogram (ECG), chest X-ray findings and thyroid point of care ultrasound (POCUS), and the scoring systems. Management should be started without delay. Apart from supportive care airway, breathing, circulation, and disability (ABCD) approach and antithyroid medications should be administered. Delay in management will increase morbidity and mortality. Initially, propylthiouracil (PTU), beta-blocker, iodine, steroids, and bile chelating agent are the treatment. The thyroid mortality ranges from 20 to 30%.

Part of the book: Heat Illness and Critical Care