Friday October 24, 2008
Unusual ventricular septal defect
Unusual ventricular septal defect
Friday, October 24, 2008
Thursday, October 23, 2008
Thursday October 23, 2008
Answer: Right pulmonary vein aneurysm (PVA)
Congenital PVA may progressively increase in size over the years and may rupture. Pulmonary venous aneurysm may occur as a component of congenital pulmonary arteriovenous malformation (PAVMN) or traumatic pulmonary arteriovenous pseuodoaneurysm (PAP). symptoms iclude hypoxia, congestive heart failure, hemoptysis and cerebral abscess. Pulmonary venous aneurysm may also be acquired and is known to be associated with rheumatic mitral insufficiency.
All these lesions may present as a mediastinal mass. Computed tomography, echocardiography and angiography usually help to differentiate from other vascular lesions.
Q: What is your Diagnosis?
Answer: Right pulmonary vein aneurysm (PVA)
Congenital PVA may progressively increase in size over the years and may rupture. Pulmonary venous aneurysm may occur as a component of congenital pulmonary arteriovenous malformation (PAVMN) or traumatic pulmonary arteriovenous pseuodoaneurysm (PAP). symptoms iclude hypoxia, congestive heart failure, hemoptysis and cerebral abscess. Pulmonary venous aneurysm may also be acquired and is known to be associated with rheumatic mitral insufficiency.
All these lesions may present as a mediastinal mass. Computed tomography, echocardiography and angiography usually help to differentiate from other vascular lesions.
Wednesday, October 22, 2008
Wednesday October 22, 2008
Q: What is half life of Xigris - Recombinant Protein C (Activated) ?
A; Xigris has a short half-life, indicating rapid inactivation of Xigris after stopping infusion and more than 70% get eliminate within 30 minutes.
General recommendations are
Q: What is half life of Xigris - Recombinant Protein C (Activated) ?
A; Xigris has a short half-life, indicating rapid inactivation of Xigris after stopping infusion and more than 70% get eliminate within 30 minutes.
General recommendations are
- Discontinue Xigris 2 hours prior to performing an invasive procedure and may restart immediately after uncomplicated, less invasive procedures
- Initiation of Xigris can be considered 12 hours after major invasive procedures or surgery
- Prophylactic heparin/LMWH may be continued while patient is on xigris
Note:
- Xigris may variably prolong the APTT. Therefore, the APTT cannot be reliably used to assess the status of the coagulopathy during Xigris infusion.
- Xigris has minimal effect on the PT
Tuesday, October 21, 2008
Tuesday October 21, 2008
Q: What percentage of patients may develop complications secondary to brachial artery cannulation?
Answer: upto 42%
It was established almost 40 years ago by Mortensen 1 that brachial artery cannulation is not an ideal location. The lack of collateral circulation about the elbow may predispose to forearm and hand ischemic complications.
Case report & review: Compartment Syndrome of the Forearm and Hand After Brachial Artery Cannulation (pdf) - Anesth Analg 1995; 81: 1092-4
Reference:
1. Mortensen JD. Clinical sequelae from arterial needle puncture, cannulation, and incision. Circulation 1967;35:1118-23.
Q: What percentage of patients may develop complications secondary to brachial artery cannulation?
Answer: upto 42%
It was established almost 40 years ago by Mortensen 1 that brachial artery cannulation is not an ideal location. The lack of collateral circulation about the elbow may predispose to forearm and hand ischemic complications.
Case report & review: Compartment Syndrome of the Forearm and Hand After Brachial Artery Cannulation (pdf) - Anesth Analg 1995; 81: 1092-4
Reference:
1. Mortensen JD. Clinical sequelae from arterial needle puncture, cannulation, and incision. Circulation 1967;35:1118-23.
Monday, October 20, 2008
Monday October 20, 2008
Dexmedetomidine (precedex) Infusion as Adjunctive Therapy for Acute Alcohol Withdrawal
Emerging literature is very promising for Dexmedetomidine (precedex) Infusion as an adjunctive therapy to benzodiazepines in acute alcohol withdrawal.
Review of literature shows that dexmedetomidine was shown to be beneficial in alcohol withdrawal delirium first in rats about 10 years ago ! 4 but later many case series in humans have shown a rapid response to alcohol withdrawal delirium after the standard treatment. 1, 2, 3, 5 Dexmedetomidine is a selective alpha-2 adrenergic agonist that possesses a high ratio of specificity for the alpha-2 versus the alpha-1 receptor.
The biggest advantage of Dexmedetomidine over benzodiazepines in acute alcohol withdrawal therapy, is that it doesn't suppress respiratory drive and carries simultaneuos properties of analgesia, sedation and anxiolysis.
Related article: The Role of Dexmedetomidine (Precedex) in the Sedation of Critically Ill Patients (ref: P&T, Vol. 30 No. 3 • March 2005 , 158-161)
References: click to get abstract / article
1. Dexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report - General Hospital Psychiatry , Volume 28 , Issue 4 , Pages 362 - 363
2. Dexmedetomidine in the Treatment of Withdrawal Syndromes in Cardiothoracic Surgery Patients - Journal of Intensive Care Medicine, Vol. 20, No. 2, 118-123 (2005)
3. Dexmedetomidine for peri-operative sedation and analgesia in alcohol addiction - Correspondence - Anaesthesia. 61(3):299-300, March 2006.
4. . Dexmedetomidine, diazepam, and propranolol in the treatment of ethanol withdrawal symptoms in the rat - Alcohol Clin Exp Res.1997 Aug;21(5):804-8
5. Dexmedetomidine Infusion as Adjunctive Therapy to Benzodiazepines for Acute Alcohol Withdrawal - Published Online, 9 September 2008, Tha annals of Pharmacotherapy.
Dexmedetomidine (precedex) Infusion as Adjunctive Therapy for Acute Alcohol Withdrawal
Emerging literature is very promising for Dexmedetomidine (precedex) Infusion as an adjunctive therapy to benzodiazepines in acute alcohol withdrawal.
Review of literature shows that dexmedetomidine was shown to be beneficial in alcohol withdrawal delirium first in rats about 10 years ago ! 4 but later many case series in humans have shown a rapid response to alcohol withdrawal delirium after the standard treatment. 1, 2, 3, 5 Dexmedetomidine is a selective alpha-2 adrenergic agonist that possesses a high ratio of specificity for the alpha-2 versus the alpha-1 receptor.
The biggest advantage of Dexmedetomidine over benzodiazepines in acute alcohol withdrawal therapy, is that it doesn't suppress respiratory drive and carries simultaneuos properties of analgesia, sedation and anxiolysis.
Related article: The Role of Dexmedetomidine (Precedex) in the Sedation of Critically Ill Patients (ref: P&T, Vol. 30 No. 3 • March 2005 , 158-161)
References: click to get abstract / article
1. Dexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report - General Hospital Psychiatry , Volume 28 , Issue 4 , Pages 362 - 363
2. Dexmedetomidine in the Treatment of Withdrawal Syndromes in Cardiothoracic Surgery Patients - Journal of Intensive Care Medicine, Vol. 20, No. 2, 118-123 (2005)
3. Dexmedetomidine for peri-operative sedation and analgesia in alcohol addiction - Correspondence - Anaesthesia. 61(3):299-300, March 2006.
4. . Dexmedetomidine, diazepam, and propranolol in the treatment of ethanol withdrawal symptoms in the rat - Alcohol Clin Exp Res.1997 Aug;21(5):804-8
5. Dexmedetomidine Infusion as Adjunctive Therapy to Benzodiazepines for Acute Alcohol Withdrawal - Published Online, 9 September 2008, Tha annals of Pharmacotherapy.
Sunday, October 19, 2008
Sunday October 19, 2008
Q: What difference does it make in giving 1 ampule of calcium gluconate and 1 ampule of calcium chloride to patient?
Answer: Calcium chloride contains 3 times more elemental calcium in camparison to same dose of calcium gluconate. 1 gram of Calcium gluconate contains 4.65 mEq of elemental Calcium but 1 gram of Calcium chloride contains 13.6 mEq of elemental Calcium.
Q: What difference does it make in giving 1 ampule of calcium gluconate and 1 ampule of calcium chloride to patient?
Answer: Calcium chloride contains 3 times more elemental calcium in camparison to same dose of calcium gluconate. 1 gram of Calcium gluconate contains 4.65 mEq of elemental Calcium but 1 gram of Calcium chloride contains 13.6 mEq of elemental Calcium.
Saturday, October 18, 2008
Saturday October 18, 2008
Scenario: 37 year old otherwise healthy male brought to ER with acute upper airway obstruction after developing severe angioedema secondary to seafood. In view of compromised airway, emergent intubation was performed. Despite securing airway, patient oxygen saturation remained low and required significant support of PEEP and FiO2 on mechanical ventilator. Patient's JVP is noticed to be elevated with bilateral crackles on lung auscultation. CXR showed pulmonary edema. Your probable diagnosis....
Answer: Postobstructive pulmonary edema (POPE)
POPE is the sudden onset of pulmonary edema following upper airway obstruction. There are two recognized types of POPE.
Type 1 POPE: follows a sudden, severe episode of upper airway obstruction such as postextubation laryngospasm, epiglottitis, croup, and choking.
Type II POPE: develops after surgical relief of chronic upper airway obstruction like tonsillectomy and removal of upper airway tumors.
References:
Guffin TN, Har-el G, Sanders A, Lucente FE, Nash M. Acute postobstructive pulmonary edema. Otolaryngol Head Neck Surg 1995;112:235-7.
Lang SA, Duncan PG, Shephard DA, Ha HC. Pulmonary oedema associated with airway obstruction. Can J Anaesth 1990;37:210-8.
Oswalt CE, Gates GA, Holmstrom FM. Pulmonary edema as a complication of acute airway obstruction. Rev Surg 1977;34:364-7.
Galvis AG. Pulmonary edema complicating relief of upper airway obstruction. Am J Emerg Med 1987; 5:294-7.
Scarbrough FE, Wittenberg JM, Smith BR, Adcock DK. Pulmonary edema following postoperative laryngospasm: case reports and review of the literature. Anesth Prog 1997;44:110-6.
Dicpinigaitis PV, Mehta DC. Postobstructive pulmonary edema induced by endotracheal tube occlusion. Intensive Care Med 1995;21:1048-50.
Scenario: 37 year old otherwise healthy male brought to ER with acute upper airway obstruction after developing severe angioedema secondary to seafood. In view of compromised airway, emergent intubation was performed. Despite securing airway, patient oxygen saturation remained low and required significant support of PEEP and FiO2 on mechanical ventilator. Patient's JVP is noticed to be elevated with bilateral crackles on lung auscultation. CXR showed pulmonary edema. Your probable diagnosis....
Answer: Postobstructive pulmonary edema (POPE)
POPE is the sudden onset of pulmonary edema following upper airway obstruction. There are two recognized types of POPE.
Type 1 POPE: follows a sudden, severe episode of upper airway obstruction such as postextubation laryngospasm, epiglottitis, croup, and choking.
Type II POPE: develops after surgical relief of chronic upper airway obstruction like tonsillectomy and removal of upper airway tumors.
References:
Guffin TN, Har-el G, Sanders A, Lucente FE, Nash M. Acute postobstructive pulmonary edema. Otolaryngol Head Neck Surg 1995;112:235-7.
Lang SA, Duncan PG, Shephard DA, Ha HC. Pulmonary oedema associated with airway obstruction. Can J Anaesth 1990;37:210-8.
Oswalt CE, Gates GA, Holmstrom FM. Pulmonary edema as a complication of acute airway obstruction. Rev Surg 1977;34:364-7.
Galvis AG. Pulmonary edema complicating relief of upper airway obstruction. Am J Emerg Med 1987; 5:294-7.
Scarbrough FE, Wittenberg JM, Smith BR, Adcock DK. Pulmonary edema following postoperative laryngospasm: case reports and review of the literature. Anesth Prog 1997;44:110-6.
Dicpinigaitis PV, Mehta DC. Postobstructive pulmonary edema induced by endotracheal tube occlusion. Intensive Care Med 1995;21:1048-50.
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