Comparison of Vasopressor Duration in Septic Shock Patients With and Without Cirrhosis.

Background: Patients with cirrhosis have immune dysfunction, altered inflammatory response, and hemodynamic changes which increase risk of septic shock and potentially prolong management with fluids, vasopressors, and other therapies. Due to limited available guidance, this study aimed to characterize vasopressor use in patients with cirrhosis in relation to patients without cirrhosis in septic shock.

Methods: This was a retrospective matched cohort analysis of 122 patients admitted to the intensive care unit (ICU) at an academic medical center from January 2015 to November 2017.

Risk of occupationally acquired illnesses from biological threat agents in unvaccinated laboratory workers.

Many vaccines for bioterrorism agents are investigational and therefore not available (outside of research protocol use) to all at-risk laboratory workers who have begun working with these agents as a result of increased interest in biodefense research. Illness surveillance data archived from the U.S.

Future challenges in preparing for and responding to bioterrorism events.

The future success of our preparations for bioterrorism depends on many issues as presented in this article. If these issues are properly addressed, the resulting improvements in bioterrorism preparations will allow us to better deter and mitigate a bioterrorism incident and will also provide us with the added benefit of improvements in early detection, diagnosis, and treatment of natural disease outbreaks. Emergency physicians must take an active leading role in working with the various disciplines to produce a better-prepared community.

Hemorrhagic fever viruses as biological weapons: medical and public health management.

Objective: To develop consensus-based recommendations for measures to be taken by medical and public health professionals if hemorrhagic fever viruses (HFVs) are used as biological weapons against a civilian population.

Participants: The Working Group on Civilian Biodefense included 26 representatives from academic medical centers, public health, military services, governmental agencies, and other emergency management institutions.

Evidence: MEDLINE was searched from January 1966 to January 2002.

Anthrax as a biological weapon, 2002: updated recommendations for management.

Objective: To review and update consensus-based recommendations for medical and public health professionals following a Bacillus anthracis attack against a civilian population.

Participants: The working group included 23 experts from academic medical centers, research organizations, and governmental, military, public health, and emergency management institutions and agencies.

Evidence: MEDLINE databases were searched from January 1966 to January 2002, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare.

Clinical recognition and management of patients exposed to biological warfare agents.

Concern regarding the use of biological agents (bacteria, viruses, or toxins) as tools of warfare or terrorism has led to measures to deter their use or, failing that, to deal with the consequences. Unlike chemical agents, which typically lead to severe disease syndromes within minutes at the site of exposure, diseases resulting from biological agents have incubation periods of days. Rather than a paramedic, it will likely be a physician who is first faced with evidence of the results of a biological attack.

Biological weapons--a primer for microbiologists.

Biological weapons are not new. Biological agents have been used as instruments of warfare and terror for thousands of years to produce fear and harm in humans, animals, and plants. Because they are invisible, silent, odorless, and tasteless, biological agents may be used as an ultimate weapon-easy to disperse and inexpensive to produce.

Tularemia as a biological weapon: medical and public health management.

Objective: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if tularemia is used as a biological weapon against a civilian population.

Participants: The working group included 25 representatives from academic medical centers, civilian and military governmental agencies, and other public health and emergency management institutions and agencies.

Evidence: MEDLINE databases were searched from January 1966 to October 2000, using the Medical Subject Headings Francisella tularensis, Pasteurella tularensis, biological weapon, biological terrorism, bioterrorism, biological warfare, and biowarfare.

Bioterrorism.

Although biological agents have been used in warfare for centuries, several events in the past decade have raised concerns that they could be used for terrorism. Revelations about the sophisticated biological-weapons programs of the former Soviet Union and Iraq have heightened concern that countries with offensive-research programs, including those that sponsor international terrorism, might assist in the proliferation of agents, culturing capability, and dissemination techniques, and might benefit in these undertakings from the availability of skilled laboratory technicians. Release of sarin nerve agent in the Tokyo subway system in 1995 by the Aum Shinrikyo cult demonstrated that in the future terrorists might select unconventional weapons.

Botulinum toxin as a biological weapon: medical and public health management.

Objective: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if botulinum toxin is used as a biological weapon against a civilian population.

Participants: The working group included 23 representatives from academic, government, and private institutions with expertise in public health, emergency management, and clinical medicine.

Evidence: The primary authors (S.

A field-expedient algorithmic approach to the clinical management of chemical and biological casualties.

Warriors on the modern battlefield face considerable danger from possible attack with chemical and biological weapons. Aggravating this danger is the fact that medical resources at the lowest echelons of care, already likely to be strained to capacity during modern conventional combat, are at present inadequate to handle large numbers of chemical or biological casualties. Complicating this problem further is the austere nature of diagnostic modalities available at lower echelons.

Bioterrorism: agents of concern.

The intentional dispersal of biological agents by terrorists is a potential problem that increasingly concerns the intelligence, law enforcement, medical, and public health communities. Terrorists might choose biological agents over conventional and chemical weapons for multiple reasons, although it is difficult to predict, with certainty, which biological agents might prove attractive to terrorists. One can more confidently, however, derive a list of those few agents which, if used, would be of greatest public health consequence.

Immunization against potential biological warfare agents.

The intentional release of biological agents by belligerents or terrorists is a possibility that has recently attracted increased attention. Law enforcement agencies, military planners, public health officials, and clinicians are gaining an increasing awareness of this potential threat. From a military perspective, an important component of the protective pre-exposure armamentarium against this threat is immunization.

Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense.

Objective: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals following the use of plague as a biological weapon against a civilian population.

Participants: The working group included 25 representatives from major academic medical centers and research, government, military, public health, and emergency management institutions and agencies.

Evidence: MEDLINE databases were searched from January 1966 to June 1998 for the Medical Subject Headings plague, Yersinia pestis, biological weapon, biological terrorism, biological warfare, and biowarfare.

Weapons of mass destruction events with contaminated casualties: effective planning for health care facilities.

Biological and chemical terrorism is a growing concern for the emergency preparedness community. While health care facilities (HCFs) are an essential component of the emergency response system, at present they are poorly prepared for such incidents. The greatest challenge for HCFs may be the sudden presentation of large numbers of contaminated individuals.

Smallpox as a biological weapon: medical and public health management. Working Group on Civilian Biodefense.

Objective: To develop consensus-based recommendations for measures to be taken by medical and public health professionals following the use of smallpox as a biological weapon against a civilian population.

Participants: The working group included 21 representatives from staff of major medical centers and research, government, military, public health, and emergency management institutions and agencies. Evidence The first author (D.

Anthrax as a biological weapon: medical and public health management. Working Group on Civilian Biodefense.

Objective: To develop consensus-based recommendations for measures to be taken by medical and public health professionals following the use of anthrax as a biological weapon against a civilian population.

Participants: The working group included 21 representatives from staff of major academic medical centers and research, government, military, public health, and emergency management institutions and agencies.

Evidence: MEDLINE databases were searched from January 1966 to April 1998, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare.