tag:blogger.com,1999:blog-43790698306617565992024-02-19T15:27:31.141-08:00June 2011 - ArchiveUnknownnoreply@blogger.comBlogger29125tag:blogger.com,1999:blog-4379069830661756599.post-28394805702907932422011-06-29T10:39:00.000-07:002011-06-29T10:39:00.501-07:00<strong><strong><span style="color: #003300;"></span></strong></strong><span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><span style="color: #003300;"><div align="left" style="color: black;"><strong><span style="font-family: Arial, Helvetica, sans-serif;">Rocuronium versus succinylcholine for rapid sequence induction intubation - <span style="color: #000099;"><span style="color: black;">Cochrane Review</span></span></span></strong><br />
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<em><span style="color: #003300; font-family: Arial, Helvetica, sans-serif;"><strong>In emergency situations some patients need a general anaesthetic with an endotracheal tube (tube to help them breathe). It is important to have fast acting medications to allow physicians to complete this procedure quickly and safely. Currently, the muscle relaxant medication most often used to accomplish this is succinylcholine. Succinylcholine is fast acting and lasts for only a few minutes which is very desirable in this setting. However, some patients cannot use this medication as it can cause serious salt imbalances or reactions, so an equally effective medication without these side effects is desired. This meta-analysis compared one possible alternative, rocuronium, for the quality of intubation conditions (the ease with which physicians can quickly and safely pass the endotracheal tube). In this review, we have combined the results of 37 studies, with a total of 2690 patients, which compared the effects of succinylcholine versus rocuronium on intubation conditions. We have found that rocuronium is less effective than succinylcholine for creating excellent intubation conditions. Rocuronium should therefore only be used as an alternative to succinylcholine when it is known that succinylcholine should not be used.</strong></span></em><br />
<br />
<strong><span style="font-family: Arial, Helvetica, sans-serif;">Click </span><a href="http://www2.cochrane.org/reviews/en/ab002788.html" target="_blank"><span style="color: #660000; font-family: Arial, Helvetica, sans-serif;">here</span></a><span style="font-family: Arial, Helvetica, sans-serif;"> to read review</span></strong></div></span></span></span></span></span></span></span></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-65370174323726776662011-06-28T03:45:00.000-07:002011-06-28T03:45:00.929-07:00<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><span style="color: #003300;"><strong><em><span style="color: #003300;"><span style="font-size: small;"><span style="color: #660000;">Q:</span> What advantage vasopressin has over other pressors particularly over epinephrine in code (ACLS) situation?</span></span></em></strong></span></span></span></span></span></span></span></span></span></span></span><br />
<br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><span style="color: #003300;"><span style="font-size: small;"><span style="color: #000066;"><em><span style="color: #660000;"><strong>Answer:</strong></span></em> </span><span style="color: #000066;"><strong>Most pressors including epinephrine loses much of its effectiveness in an acidotic plasma, but</strong><strong> vasopressin demonstrates vasoconstricting efficacy even with severe acidosis.</strong></span></span><span style="color: #0c343d;"> </span></span></span></span></span></span></span></span></span></span></span></span><br />
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<br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><span style="color: #003300;"><span style="color: #0c343d; font-size: xx-small;">Wenzel V, Krismer AC, Arntz HR, Sitter H, Stadlbauer KH, Lindner KH. </span><a href="http://reference.medscape.com/medline/abstract/14711909" target="_blank"><span style="color: #0c343d; font-size: xx-small;">A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation</span></a><span style="color: #0c343d; font-size: xx-small;">. <em>N Engl J Med</em>. Jan 8 2004;350(2):105-13</span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><span style="color: #003300;"></span></span></span></span></span></span></span></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-52291289423615939422011-06-27T06:12:00.000-07:002011-06-27T15:47:15.109-07:00<div align="left" style="color: black;"><strong><span style="color: #660000; font-family: Arial, Helvetica, sans-serif;">On time lag between Precedex start and its effect</span></strong><br />
<br />
<span style="color: #000066; font-family: Arial, Helvetica, sans-serif;"><strong>Loading dose of dexmedetomidine (precedex) is 1 mcg/kg loading dose, administered over 10 minutes, followed by a maintenance infusion of 0.2–0.7 mcg/kg/hour.</strong></span><br />
<br />
<strong><span style="color: #000066; font-family: Arial, Helvetica, sans-serif;">Important pearl to remember that despite with loading dose onset of sedation occurs after 10 to 15 minutes unlike instant sedation from propofol. If a loading dose is not used, time to onset of the sedative effect may be even more extended.</span></strong></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-15384790886660293982011-06-26T11:15:00.000-07:002011-06-26T18:12:16.833-07:00<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><span style="color: #003300;"></span></span></span></span></span></span></span></span></span></span></span><br />
<div align="left" style="color: black; font-size: small;"><strong><em><span style="color: #660000;">Q:</span> In properly inserted IABP, on estimate how much improvement in renal perfusion is expected?</em></strong></div><div align="left" style="color: black; font-size: small;"> </div><div align="left" style="color: black; font-size: small;"><strong><em><span style="color: #660000;"></span></em></strong> </div><div align="left" style="color: black; font-size: small;"><strong><em><span style="color: #660000;">Answer:</span> About 25%</em></strong></div><div align="left" style="color: black; font-size: small;"> </div><div align="left" style="color: black; font-size: small;"><strong><span style="color: #000066;">Kidney blood flow can increase up to 25% due to increase in cardiac output. Decrease in urine output after insertion of IABP should raise the suspicion of juxta-renal balloon positioning.</span></strong></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-91938907059443858012011-06-25T03:40:00.000-07:002011-06-25T03:40:00.617-07:00<strong><strong><span style="color: #003300; font-size: large;"></span></strong></strong><br />
<div align="center" style="color: black; font-size: small;"><span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><span style="color: #660000;"><span style="font-size: x-small;"><strong>Mediastinoscopy</strong></span></span></span></span></span></span></span></span></span></span></span></span><br />
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<div align="center"><iframe frameborder="0" height="300" src="http://player.vimeo.com/video/10062414?title=0&byline=0&portrait=0" width="400"></iframe></div><div align="center"></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-7450349164489804612011-06-24T11:20:00.000-07:002011-06-24T15:08:21.671-07:00<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><strong><span style="color: #660000;"></span></strong></span></span></span></span></span></span></span></span></span></span><br />
<div style="color: black;"><span style="font-size: x-small;"><strong>Regarding Tigecycline in <span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span class="goog_qs-tidbit goog_qs-tidbit-0">MDR </span><i><span class="goog_qs-tidbit goog_qs-tidbit-0">Klebsiella </span></i><span class="goog_qs-tidbit goog_qs-tidbit-0">and MDR </span><i><span class="goog_qs-tidbit goog_qs-tidbit-0">Acinetobacter baumannii</span></i><span class="goog_qs-tidbit goog_qs-tidbit-0"> </span></span></span></span></strong></span><br />
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<span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span class="goog_qs-tidbit goog_qs-tidbit-0"><strong><span style="color: #660000;">Q:</span> <em><span style="color: #003300;">72 year old NHR female is admitted to ICU with Urosepsis. Record shows previous cultures growing MDR <span class="goog_qs-tidbit goog_qs-tidbit-0">Klebsiella resistant to most antibiotics. Pharmacy suggested <span style="color: #660000;"><span style="color: #660000;"><span class="goog_qs-tidbit goog_qs-tidbit-0"><span style="color: #003300;">Tigecycline?</span></span></span></span></span></span></em></strong></span></span></span></span><br />
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<span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><strong><span class="goog_qs-tidbit goog_qs-tidbit-0"><span style="color: #660000;">Answer:</span> <span style="color: #000066;">Tigecycline is one of the very few antibiotics which are</span></span><span style="color: #000066;"><sup> </sup><span class="goog_qs-tidbit goog_qs-tidbit-0">highly active against multidrug-resistant (MDR) </span><i><span class="goog_qs-tidbit goog_qs-tidbit-0">Klebsiella pneumoniae</span></i><sup> </sup><span class="goog_qs-tidbit goog_qs-tidbit-0">and MDR </span><i><span class="goog_qs-tidbit goog_qs-tidbit-0">Acinetobacter baumannii</span></i><span class="goog_qs-tidbit goog_qs-tidbit-0"> (MDR</span> KP/AB) but may require high dosing for maximal therapeutic effectiveness. </span></strong></span></span></span><strong><span style="color: #000066;">In such cases use an initial dose of 200<sup> </sup>mg IV followed by 100 mg IV daily. If patient does not<sup> </sup>respond to this dose further higher dose can be use with initial dose of 400 mg IV followed<sup> </sup>by 200 mg IV daily.</span> </strong></div><div style="color: black;"><strong><br />
</strong></div><div style="color: black; font-size: small;"><span style="color: #000066;"><strong><em><span style="color: #003300;">Caution:</span></em> Tigecycline should be<sup> </sup>given slowly in 250 - 500 ml bag to avoid GI symptoms.</strong></span><br />
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<br />
<span style="color: #000066;"><span style="font-size: xx-small;">Reference: </span><a href="http://jcm.asm.org/cgi/content/full/47/5/1613" target="_blank"><span style="color: black; font-size: xx-small;">Pharmacokinetic Considerations regarding Tigecycline for Multidrug-Resistant (MDR) <i>Klebsiella pneumoniae</i> or MDR <i>Acinetobacter baumannii</i> Urosepsis</span></a><span style="font-size: xx-small;"><span style="color: black;"> - Journal of Clinical Microbiology, May 2009, p. 1613, Vol. 47, No. 5</span></span></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-64800279031791249822011-06-23T05:18:00.000-07:002011-06-23T05:18:00.329-07:00<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><strong><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;">Tiger Tube</span></span></span></span></strong></span></span></span></span></span></span></span></span></span></span><br />
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<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><strong><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><em>"......The recent development of ‘self-migrating’ Tiger tube is a promising alternative to endoscopically-placed nasojejunal tube. This eliminates the need of endoscopy with its costs and logistic difficulties. The aggressive approach to commence EN would improve outcome in critically ill patients and avoid complications associated with PN. Bedside clinicians can pass the tube into the stomach (which takes around 5-10 minutes) and then wait for the tube to migrate into the jejunum over the next 6-12 hours. This simple procedure potentially reduces the financial and manpower resources implicated in managing critically ill patients. Since it may lower the rate of regurgitation and aspiration, the incidence of ventilator-associated pneumonia can be potentially reduced".</em></span></span></span></span></strong></span></span></span></span></span></span></span></span></span></span><br />
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<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><strong><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #000066;">Read case report and discussion <a href="http://www.eimjm.com/Vol6-No1/Vol6-No1-C15.htm" target="_blank"><span style="color: #660000;">here</span></a></span></span></span><span style="color: #660000;"><span style="color: #660000;"><span style="font-size: x-small;"><span style="color: #000066; font-family: Arial,Helvetica,sans-serif;"><em></em></span></span></span></span></span></strong></span></span></span></span></span></span></span></span></span></span><br />
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<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><strong><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="font-size: x-small;"><span style="color: #000066; font-family: Arial,Helvetica,sans-serif;"><em>(<b>Enteral Nutrition In Intensive Care: ‘Tiger Tube’ – For Small Bowel Feeding In Acute Pancreatitis. Case Report - </b><b><span lang="DE">Mohd Basri bin Mat Nor. </span></b>Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia.)</em></span></span></span></span></span></strong></span></span></span></span></span></span></span></span></span></span><br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><strong><span style="color: #660000;"></span></strong></span></span></span></span></span></span></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-13624135001185656572011-06-22T02:44:00.000-07:002011-06-22T12:56:24.017-07:00<div style="color: black; font-size: small; text-align: left;"><span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial,Helvetica,sans-serif;"><strong><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black; font-size: x-small;">Ultrasound for subclavian central lines (CVC)</span></span></span></span></strong></span></span></span></span></span></span></span></span></span></span><span style="font-size: x-small;"></span></div><div style="color: black; font-size: small;"><br />
</div><div style="color: black;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #000066;">Ultrasound guided Internal Jugular CVC is now pretty much standard but see this study published this month in CCM Journal</span> 1.</span></span></div><div style="color: black;"></div><div style="color: black;"><span style="color: #660000;"><span style="color: #660000;"></span></span><span style="color: #660000;"><span style="color: #660000;"><span style="color: #000066;">463 mechanically ventilated patients were compared - the ultrasound-guided subclavian vein cannulation (200 patients) vs. the landmark method (201 patients) using an infraclavicular approach. Patients were stratified with regard to age, gender, and body mass index</span>.</span></span><br />
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<span style="color: #660000;">Results</span>: </div><div style="color: black; font-size: small;"><div id="pAbstractText_1606901160"><ul><li><span style="color: #000066;">No significant differences in the presence of risk factors for difficult cannulation between the two groups of patients were recorded. </span></li>
<li><span style="color: #000066;">Subclavian vein cannulation was achieved in 100% of patients in the ultrasound group as compared with 87.5% in the landmark one (p < .05). </span></li>
<li><span style="color: #000066;">Average access time and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < .05). </span></li>
<li><span style="color: #000066;">In the landmark group, artery puncture and hematoma occurred in 5.4% of patients, respectively, hemothorax in 4.4%, pneumothorax in 4.9%, brachial plexus injury in 2.9%, phrenic nerve injury in 1.5%, and cardiac tamponade in 0.5%, which were all increased compared with the ultrasound group (p < .05). </span></li>
<li><span style="color: #000066;">Catheter misplacements did not differ between groups</span>. </li>
</ul><span style="color: #660000;">Conclusions:</span> <span style="color: #000066;">The present data suggested that ultrasound-guided cannulation of the subclavian vein in critical care patients is superior to the landmark method and should be the method of choice in these patients</span>.<br />
<br />
<h4><a href="http://journals.lww.com/ccmjournal/Abstract/2011/07000/Real_time_ultrasound_guided_subclavian_vein.1.aspx" target="_blank"><span style="color: #003300; font-size: xx-small;">Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study</span></a><span style="color: #003300; font-size: xx-small;"> - <span class="ej-j-source" id="ctl00_SPWebPartManager1_g_d33d2dad_c8bd_422e_a0d1_ddd975adba1b__1b7cd8da3e97_sectionListControl_sectionListView_ctrl0_sectionDisplayControl_subSectionListView_ctrl0_subSectionDisplayControl_itemListControl_itemListView_ctrl0_itemDisplayControl_ctl00_lblLegacyJournalTitle">Critical Care Medicine</span>. 39(7):1607-1612, July 2011.</span></h4></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-80179287706518634912011-06-21T06:18:00.000-07:002011-06-21T14:44:49.252-07:00<strong><span style="color: #660000;">Case</span>: </strong><strong><em><span style="color: #003333;">Define chylothorax and describe different treatment modalities?</span></em></strong><br />
<br />
<strong><span style="color: #660000;">Answer</span>: <span style="color: black;">Chylothorax is defined as triglycerides more than 113 mg/dl (1.24 mmol/L) in pleural cavity.</span><br />
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<span style="color: black;">A number of therapeutic interventions have been used to reduce chyle production and promote resolution of a chylothorax. Initial management typically includes restriction or temporary cessation of enteral feedings. Enteral feedings high in medium-chain triglycerides (MCT), or parenteral nutrition may be used. Total parenteral nutrition typically results in resolution in 75 to 80% of cases by that time. In resistant cases, pleurodesis, ligation of the thoracic duct, or placement of drains and pleuroperitoneal shunts may be considered. </span></strong><br />
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<strong><span style="color: black;">Octreotide has become another option for management of patients with chylothorax. Although the exact mechanism by which the drug exerts its effects has not been defined, it is believed that the multiple effects of octreotide on the gastrointestinal tract and the reduction in splanchnic blood flow reduce thoracic duct flow and decrease the triglyceride content of chyle.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-19940505131616320102011-06-20T07:39:00.000-07:002011-06-22T12:57:07.328-07:00<strong><span style="color: #660000;">Q:</span> </strong><strong><em><span style="color: #003333;">54 year old male with end stage liver disease may require large volume paracentesis. Patient is labeled as allergic to Albumin. What is your alternative to prevent circulatory dysfunction after large-volume paracentesis? </span></em></strong><br />
<br />
<strong><span style="color: black;"><span style="color: #660000;">Answer:</span> </span><span style="color: black;">Use of terlipressin</span></strong><br />
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<strong><span style="color: black;">The removal of 5 litres of fluid or more is considered large-volume paracentesis. The AASLD (American Association for the Study of Liver Diseases) suggests that postparacentesis albumin infusion may not be necessary for a single paracentesis of less than 5 litres; however, for large-volume paracenteses consider an albumin infusion of 8-10 g per liter of fluid removed.</span></strong><br />
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<strong><span style="color: black;">Another alternative is to use terlipressin (1 mg every 4 hours for 48 hours) rather than albumin for prevention of circulatory dysfunction after large-volume paracentesis. Studies suggest that terlipressin is as effective as albumin.</span></strong> <br />
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<span style="color: #003300;"><span style="font-size: xx-small;">References: Click to get abstract</span></span><br />
<span style="font-size: xx-small;"></span><br />
<span style="color: #003300;"><span style="font-size: xx-small;">1. </span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/18251131" target="_blank"><span style="color: #003300;"><span style="font-size: xx-small;">The efficacy of terlipressin in comparison with albumin in the prevention of circulatory changes after the paracentesis of tense ascites</span></span></a><span style="color: #003300;"><span style="font-size: xx-small;"> --a randomized multicentric study. Hepatogastroenterology. Oct-Nov 2007;54(79):1930-3. </span></span><br />
<span style="font-size: xx-small;"></span><br />
<span style="color: #003300;"><span style="font-size: xx-small;">2. </span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/16460491" target="_blank"><span style="color: #003300;"><span style="font-size: xx-small;">Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study.</span></span></a><span style="font-size: xx-small;"><span style="color: #003300;"> J Gastroenterol Hepatol. Jan 2006;21(1 pt 2):303-7.</span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-65302533143207468192011-06-19T08:30:00.000-07:002011-06-19T08:30:02.062-07:00<div style="color: black;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><em><span style="color: #003300;"><strong><span style="color: #660000;">Q:</span> CMV Retinitis can be treated by ganciclovir or foscarnet, </strong></span></em></span></span></span></span></span></span></span></span></span> </span><br />
<br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial, Helvetica, sans-serif;"><em><strong>A) orally,</strong></em></span></span></span></span></span></span></span></span></span></span><br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial, Helvetica, sans-serif;"><em><strong>B) intravenously, </strong></em></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300;"><em><strong>C) </strong></em></span></span></span></span></span></span></span></span></span></span><span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300;"><em><strong>intravitreal injection</strong></em></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial, Helvetica, sans-serif;"><em><strong>D) intravitreal implant</strong></em></span></span></span></span></span></span></span></span></span></span><br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #003300; font-family: Arial, Helvetica, sans-serif;"><em><strong>E) All of the above.</strong></em></span></span></span></span></span></span></span></span></span></span></div><br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #003300;"><span style="color: #660000;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><strong><span style="color: black;"><span style="color: #660000;"><span style="color: black;"><span style="color: #000066;"><span style="color: #660000;"></span></span></span></span></span></strong></span></span></span></span></span></span></span></span></span><br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #003300;"><span style="color: #660000;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><strong><span style="color: black;"><span style="color: #660000;"><span style="color: black;"><span style="color: #000066;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #660000;">Answer:</span> E (all of the above)</span></span></span></span></span></strong></span></span></span></span></span></span></span></span></span><br />
<br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #003300;"><span style="color: #660000;"><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: #660000;"><span style="color: black;"><span style="color: #660000;"><span style="color: black;"><strong><span style="color: #000066; font-family: Arial, Helvetica, sans-serif;">Beside regular route of administration it is interesting to note that the Vitrasert ganciclovir implant is a sustained-release intravitreal implant that is used for the treatment of cytomegalovirus (CMV) retinitis. Each implant is designed to release drug over a 5 to 8 month period.</span></strong></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="color: #003300;"><span style="color: #660000;"><span style="color: black;"></span></span></span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-4379069830661756599.post-49090887881061887002011-06-18T09:28:00.000-07:002011-06-18T09:28:00.288-07:00<strong><span style="color: #990000;">7 "Ps" of intubation.</span></strong><br />
<ol><li><strong><span style="color: black;">Pre-oxygenate the patient </span></strong></li>
<li><strong><span style="color: black;">Prepare the equipments</span></strong></li>
<li><strong><span style="color: black;">Put down (sedate) the patient</span></strong></li>
<li><strong><span style="color: black;">Paralyse the patient </span></strong></li>
<li><strong><span style="color: black;">Place the tube </span></strong></li>
<li><strong><span style="color: black;">Placement confirmation (via auscultation, EZcap or CXR) </span></strong></li>
<li><strong><span style="color: black;">Pen down (document) the procedure</span></strong></li>
</ol>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-92113898458148842792011-06-17T06:35:00.000-07:002011-06-17T06:35:01.468-07:00<strong><span style="color: #990000;">Fentanyl Cough</span></strong><br />
<strong><span style="color: black;">Fentanyl is probably the most commonly used opioid in ICUs. Fentanyl is associated with coughing in upto 30% of patients. Usually its benign but may become explosive causing discomfort and increased intracranial and intra-ocular pressures. The various mechanisms proposed to explain fentanyl induced cough are inhibition of central sympathetic outflow leading to vagal predominance, histamine release or deformation of the tracheobronchial wall stimulating the irritant receptors.</span></strong><br />
<br />
<strong><span style="color: black;">Treatment is aerosol inhalation of Salbutamol, beclomethasone or sodium chromoglycate if needed</span></strong>.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-27384929278538183562011-06-16T05:20:00.000-07:002011-06-16T05:20:00.457-07:00<b><span style="color: #990000;">Q:</span> <em><span style="color: #0c343d;">52 year old male developed intracranial hemorrhage after receiving thrombolytic therapy for CVA. What is the treatment?</span></em> <br />
<br />
<span style="color: #990000;">Answer:</span> <span style="color: black;">Transfusion of cryoprecipitate.<br />
<br />
Prepare for administration of 6 to 8 units of cryoprecipitate containing factor VIII. It is not a bad idea to also adminster 6 to 8 units of platelets.</span> </b>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-78612173048661718102011-06-15T07:37:00.000-07:002011-06-15T07:37:00.728-07:00<div class="post hentry"><a href="" name="8094160969280535336"></a><div class="post-header"><div class="post-header-line-1"></div></div><div class="post-body entry-content"><strong><span style="color: #660000;">Q:</span> <em><span style="color: #003300;">Progesterone is also an “anticonvulsant.” True or false?</span></em></strong></div><div class="post-body entry-content"><strong><em><span style="color: #003300;"></span></em></strong> </div><div class="post-body entry-content"><strong><em><span style="color: #003300;"></span></em><span style="color: #660000;">Answer:</span><span style="color: #444444;"> </span><span style="color: black;">True</span></strong></div><div class="post-body entry-content"><strong><span style="color: black;"></span></strong> </div><div class="post-body entry-content"><strong><span style="color: black;">Catamenial epilepsy is defined as seizure exacerbation in women aligned with their menstrual cycle. It usually subsides in menopause and thought to be related to estrrogen.</span></strong></div><div class="post-body entry-content"><strong><span style="color: black;"> </span></strong><span style="color: black;"> </span></div><div class="post-body entry-content">Progesterone is the mainstay of the treatment.</div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-26983970465653268372011-06-14T06:50:00.000-07:002011-06-14T06:50:00.878-07:00<strong><span style="font-family: Times, "Times New Roman", serif;"><span style="color: #660000;">Q;</span> <em><span style="color: #003333;">52 year old female went into supraventricular tachycardia. While you call for Adenosine at bedside, clinical pharmacist inform you that patient is on chronic Aggrenox for her stroke?</span></em></span></strong><br />
<br />
<strong><span style="font-family: Times, "Times New Roman", serif;"><span style="color: #660000;">Answer:</span> <span style="color: black;">Aggrenox is the combination of Aspirin and extended release Dipyridamole. Dipyridamole potentiates the action of adenosine so the lower doses (usually half) should be given. </span><span style="color: black;">Give only half of recommended dose of Adenosine.</span></span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-64152501576432125192011-06-13T05:55:00.000-07:002011-06-13T18:52:27.165-07:00<div style="color: black; font-size: small; text-align: left;"><span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #003300;"><span style="color: #660000;"><strong><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;">Q</span>: <em><span style="color: #003333;">An extremely vasculopath patient (almost impossible to obtain central line) presented to ER with organophosphate poisoning. Till Vascular team access vessel what could be an alternate route of Atropine in its symptomatic treatment?</span></em></span></span></strong></span></span></span></span><br />
<div style="color: black; font-size: small; text-align: left;"><br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #003300;"><span style="color: #660000;"><strong><span style="color: #990000;"><span style="color: #660000;"><span style="color: #660000;">Answer</span>:<span style="color: black;"> Sublingual</span></span></span></strong></span></span></span></span></div><strong><span style="color: #003300;"><span style="color: #660000;"><span style="color: black;"><span style="color: #990000;"><span style="color: black; font-family: Arial, Helvetica, sans-serif; font-size: 85%;"></span></span></span></span></span></strong><br />
<div style="text-align: left;"><br />
</div><div style="color: black; font-size: small; text-align: left;"><span style="color: #333300; font-size: 78%;"></span></div><div style="color: black; font-size: small; text-align: left;"><span style="color: #333300; font-size: 78%;"></span></div><div style="color: black; font-size: small; text-align: left;"><span style="color: #333300; font-size: 78%;"><span style="font-size: xx-small;">Rajpal S, Ali R, Bhatnagar A, Bhandari SK, Mittal G. </span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/20159382" target="_blank"><span style="color: #333300; font-size: 78%;"><span style="font-size: xx-small;">Clinical and bioavailability studies of sublingually administered atropine sulfate</span></span></a><span style="color: #333300; font-size: 78%;"><span style="font-size: xx-small;">. <i>Am J Emerg Med</i>. Feb 2010;28(2):143-50.</span></span></div></div><span style="color: #660000;"></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-2572619366068288942011-06-12T07:42:00.000-07:002011-06-12T17:57:20.902-07:00<strong><span style="color: black;">Q; </span><span style="color: #134f5c;"><em>Succinylcholine is contraindicated (relatively) for intubation in which poisoining?</em></span></strong><br />
<br />
<strong><span style="color: black;">Answer: Organophosphate poisoining.</span></strong><br />
<strong><br />
<span style="color: black;"></span></strong><br />
<strong><span style="color: black;">Organophosphate may potentiate effects of succinylcholine. Succinylcholine is relatively contraindicated in Organophosphate poisoining.</span></strong> <b></b>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-66391585006922373312011-06-11T06:20:00.000-07:002011-06-11T19:37:39.812-07:00<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #003300;"><span style="color: #660000;"><strong><span style="color: #990000;"><span style="color: #660000;">Q:</span> <em><span style="color: #003333;">Why blood in pleural fluid does not clot?</span></em></span></strong></span></span></span></span><br />
<br />
<span style="color: #ffffcc;"><span style="color: #003333;"><span style="color: #003300;"><span style="color: #660000;"><span style="color: #990000;"><span style="color: #660000;"><strong>Answer:</strong></span> <span style="color: black;"><strong>Hemorrhage within the pleural space generally does not clot due to 3 reasons</strong></span></span></span></span></span></span><ol><li><span style="color: black;"><strong>mechanical defibrination (movement of lungs) </strong></span></li>
<li><span style="color: black;"><strong>activation of fibrinolytic mechanisms </strong></span></li>
<li><span style="color: black;"><strong>Also, platelets disappears within hours following hemorrhage</strong></span></li>
</ol>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-12088720096700228312011-06-10T07:58:00.000-07:002011-06-10T18:20:41.570-07:00<strong><span style="color: #990000;">5 Grades of SAH (Subarachnoid Hemorrhage)</span></strong><span style="color: black;"><strong>Subarachnoid hemorrhage (SAH) implies the presence of blood within the subarachnoid space from some pathologic process (traumatic and nontraumatic hemorrhages).</strong></span><br />
<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidfkJHyYAxF9vI3-Fu5TDb2KLfGIHTQVeGauRYkayIun5Wyt4fYrmvgKrC1gJ_8pXm7ekFlSOQAHHlsV_mOLVdQKg89Xf1NEuvmL220VtXZaF-0zqYJwxnBusIaQz2u4jTeQhX2ZcDmXJt/s1600/sah3.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5477033470814379970" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidfkJHyYAxF9vI3-Fu5TDb2KLfGIHTQVeGauRYkayIun5Wyt4fYrmvgKrC1gJ_8pXm7ekFlSOQAHHlsV_mOLVdQKg89Xf1NEuvmL220VtXZaF-0zqYJwxnBusIaQz2u4jTeQhX2ZcDmXJt/s400/sah3.jpg" style="cursor: hand; display: block; height: 400px; margin: 0px auto 10px; text-align: center; width: 355px;" /></a><br />
<br />
<strong><span style="color: black;"><span style="color: #660000;">Grade I</span> - Mild headache with or without meningeal irritation<br />
<br />
<span style="color: #660000;">Grade II</span> - Severe headache but nonfocal examination, with or without mydriasis<br />
<br />
<span style="color: #660000;">Grade III</span> - Mild alteration in neurologic examination, including mental status<br />
<br />
<span style="color: #660000;">Grade IV</span> - Obviously depressed level of consciousness or focal deficit<br />
<br />
<span style="color: #660000;">Grade V</span> - Patient either posturing or comatose</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-26477096203458719402011-06-09T08:58:00.000-07:002011-06-09T08:58:00.412-07:00<span style="color: #ffffcc;"><span style="color: #003333;"><em><span style="color: #003300;"><strong><span style="color: #660000;">Q</span>: Which commonly use ICU vasopressor is also used as a treatment to abort low flow priapism?</strong></span></em></span></span><br />
<br />
<span style="color: #ffffcc;"><span style="color: #003333;"></span></span><span style="color: #660000; font-family: Arial,Helvetica,sans-serif;"><span style="color: #ffffcc;"><span style="color: #003333;"><strong><em>Answer:</em></strong> <strong><span style="color: #000066;">Phenyepherine</span></strong></span></span></span><br />
<br />
<div style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #ffffcc;"><span style="color: #003333;"><strong><span style="color: #000066;">Phenylephrine is also used to abort </span><span style="color: #000066;">priapism</span></strong><span style="color: #000066;"><strong>. It is diluted and injected directly into the corpora cavernosa. The mechanism of action is to cause constriction of the blood vessels entering into the penile region thus breaking the cycle that continues the priapism. <span style="color: #003300;"><em>Dose:</em></span></strong> </span><span style="color: #000066;"><strong>M</strong><strong>ixture of 1 ampule of phenylephrine (1 mL:1000 mcg) and dilute it with an 9 mL of normal saline. Use a <u>29-gauge needle</u>, inject 0.3-0.5 mL into the corpora cavernosa, wait 10-15 minutes before repeating the dose</strong></span><span style="color: black;">.</span></span></span></span></div><br />
<div style="color: black;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #ffffcc;"><span style="color: #003333;"><strong><span style="color: #000066;">Other pressor which can also be used is </span><span style="color: #000066;">epinephrine. Methylene blue is also been suggested for the same pupose</span><span style="color: black;">.</span></strong></span></span></span></div><br />
<div style="color: black; font-size: small;"><span style="color: black; font-family: Arial,Helvetica,sans-serif;"><span style="color: #ffffcc;"><span style="color: #003333;"><strong><em>Related post</em>: <a href="http://05-2011-icuroom.blogspot.com/2011_05_11_archive.html" target="_blank"><em><span style="color: #660000;">Priapism in sickle cell disease</span></em></a></strong></span></span></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-24699778265933911252011-06-08T06:34:00.000-07:002011-06-08T20:58:34.682-07:00<strong><span style="color: #660000;">B. anthracis and iron</span><br />
<br />
</strong><strong><span style="color: black;">B. anthracis must acquire iron in order to grow and proliferate in its host environment. The most readily available iron sources for pathogenic bacteria are the heme. In order to scavenge heme from hemoglobin and myoglobin, B. anthracis uses its secretory siderophore. These proteins separate heme from hemoglobin, allowing surface proteins of B. anthracis to transport it into the cell.<br />
<br />
</span><br />
</strong> <br />
<span style="font-size: 85%;">1. Hotta K, Kim CY, Fox DT, Koppisch AT. - Siderophore-mediated iron acquisition in Bacillus anthracis and related strains.- Microbiology. 2010 Jul;156(Pt 7):1918-25. Epub 2010 May 13.<br />
<br />
2. Purohit M, Sassi-Gaha S, Rest RF., Rapid sporulation of Bacillus anthracis in a high iron, glucose-free medium. J Microbiol Methods. 2010 Sep;82(3):282-7. Epub 2010 Jul 16.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-65414857368113035482011-06-07T10:38:00.000-07:002011-06-07T10:38:00.333-07:00<div><div><strong><font color="#660000">Mnemonic for Massive Hemoptysis<br /></font><br /><em><font color="#003300">BATTLE CAMP</font></em> </strong></div><div><strong><br />Bronchitis and bronchiectasis,<br />Aspergilloma,<br />Tumor,<br />Tuberculosis,<br />Lung abscess,<br />Emboli<br /><br />Coagulopathy,<br />Autoimmune disorders, AVM and alveolar hemorrhage,<br />Mitral stenosis,<br />Pneumonia</strong></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-92152343565360993312011-06-06T05:18:00.000-07:002011-06-06T05:18:00.967-07:00<strong><span style="color:#000000;"><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">What is Rasmussen's aneurysm?<br /></span></em><br /><br /><span style="color:#660000;">Answer:</span> Rasmussen's aneurysm is a pulmonary artery aneurysm adjacent or within a tuberculous cavity. It may lead to rupture and fatal hemoptysis. Rasmussen's aneurysm is caused by weakening of the pulmonary artery wall from adjacent cavitary tuberculosis.<br /></span></strong><span style="color:#ffffcc;"><span style="color:#003333;"><span style="font-family:Times New Roman;"><span style="font-family:Times New Roman;"><span style="color:#000066;"></span></span></span></span></span><br /><span style="color:#ffffcc;"><span style="color:#003333;"><span style="font-family:Times New Roman;"><span style="font-family:Times New Roman;"><span style="color:#000066;"><span style="font-family:Arial,Helvetica,sans-serif;"><strong><span style="color:#003300;"></span></strong></span></span></span></span></span></span><br /><span style="color:#ffffcc;"><span style="color:#003333;"><span style="font-family:Times New Roman;"><span style="font-family:Times New Roman;"><span style="color:#000066;"><span style="font-family:Arial,Helvetica,sans-serif;"><strong><span style="color:#003300;">Please see:</span> </strong></span><a href="http://medind.nic.in/ibq/t05/i3/ibqt05i3p234.pdf" target="_blank"><span style="font-family:Arial,Helvetica,sans-serif;color:#660000;"><strong>Rasmussen's aneurysm</strong></span></a><span style="font-family:Arial,Helvetica,sans-serif;"><strong> <span style="color:#003300;"><em>(Dr. </em></span></strong></span></span></span><span style="font-family:Arial,Helvetica,sans-serif;"><em><span style="color:#003300;"><strong>Arni Raghavendrarao Raghuram, Department of Cardiothoracic Surgery, Meenakshi Mission Hospital and Research Center, Madurai, Tamilnadu) - pdf</strong></span></em><br /></span></span></span></span><span style="color:#ffffcc;"><span style="color:#003333;"><span style="font-family:Times New Roman;"><span style="font-family:Arial,Helvetica,sans-serif;"></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4379069830661756599.post-77866915638687842962011-06-05T10:10:00.000-07:002011-06-05T10:10:00.806-07:00<div><strong><font color="#660000">Q:</font> <em><font color="#003300">How Desmopressin (DDAVP) helps in uremic bleeding (Mechanism of action)?<br /></font></em><br /><br /><font color="#660000">Answer</font>: <font color="#000000">The mechanism of action of DDAVP is believed to be - by releasing factor VIII from storage sites, potentially increasing the concentration of factor VIII and minimizing the effects of dysfunctional vWF. Larger vWF–factor-VIII multimers are reported in the plasma after infusion of DDAVP, which probably reduce bleeding time.</font></strong></div>Unknownnoreply@blogger.com0