tag:blogger.com,1999:blog-55572659699776417612024-03-20T00:47:51.099-07:00icuroom.net July 2007 archiveUnknownnoreply@blogger.comBlogger30125tag:blogger.com,1999:blog-5557265969977641761.post-70462990759862112452007-07-31T06:17:00.001-07:002007-07-31T06:17:48.988-07:00<strong><span style="color:#000066;">Tuesday July 31, 2007</span><br /><br /><br /><span style="color:#660000;">Q;</span> <em><span style="color:#003333;">In which heart valvular condition, Intra Aortic Balloon Pump (IABP) counterpulsation is contra-indicated for anginal symproms?</span></em><br /><br /><br /><span style="color:#660000;">A;</span> <span style="color:#000000;">Severe Aortic valvular insufficiency (Aortic Regrurgitation). </span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;">It worsen the the diastolic augmentation of IABP and so the magnitude of regurgitation.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-68214687705946936652007-07-30T14:15:00.000-07:002007-07-30T14:17:23.653-07:00<strong><span style="color:#000000;"><span style="color:#000066;">Monday July 30, 2007<br /></span><span style="color:#990000;">Intractable ventriculat tachycardia in ventricular aneurysm<br /></span><br /></span><span style="color:#000000;">If any one of the clinical symptoms are present in Left Ventricular Aneurysm, surgery is indicated.<br /><br />1. Angina<br />2. CHF<br />3. Systemic thrombolism<br />4. Malignant Arrhythmias<br /><br />Intractable ventriculat tachycardia in the postmyocardial infarction patient should alert the physician for the presence of ventricular aneurysm. Establishment of circus movement between the aneurysmal and viable myocardium play a role. Ischemic dead and fibrosed tissue may help in establishing reentry phenomenon by creating an area of relative refractoriness and decrimental conduction. It can also act as an independently firing ectopic pacemaker site.</span></strong><br /><br /><span style="color:#003333;"><br /></span><span style="font-size:78%;color:#003333;">Reference:<br /><br />1. Left ventricular reconstruction: The aim and the reality after twenty years, J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 17 - 20. </span><br /><span style="font-size:78%;"><br /><span style="color:#003333;">2. Recurrent Ventricular Tachycardia, Successfully Treated by Excision of Ventricular Aneurysm - CHEST, VOL. 62, NO. 4, OCTOBER, 1972</span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-35981367814822105602007-07-29T08:16:00.000-07:002007-07-29T08:19:00.070-07:00<strong><span style="color:#000066;">Sunday July 29, 2007</span><br /><span style="color:#990000;">Treating Digoxin toxicity</span></strong><br /><strong></strong><br /><strong><span style="color:#660000;">Case:</span> </strong><strong><em><span style="color:#003333;">74 year old male has been found to have arrhythmia with runs of wide complex ventricular tachycardia. Patient so far remained hemodynamically stable. You request crash cart near bed, applied pads to chest and send STAT labs and start reviewing patient's chart. You noticed 4 days ago digoxin level was 1.9 and since then his serum creatinine is steadily rising from 1.6 to 2.8. You suspected "Dig. toxicity" and called lab to run STAT dig. level. Indeed Dig. level is back with 3.4 and accompanying labs showed K+ level of 6.9. You ordered "Digi-bind" (Digoxin Immune Fab). Pharmacy informed you, "it will take time before Digi-bind gets to ICU". Interim you started treating hyperkalemia with IV insulin, D-50, IV bicarb., IV calcium and albuterol neb. treatments.Where did you go wrong ?<br /></span></em><br /><span style="color:#660000;">Answer:</span> Calcium has shown to make digoxin toxicity worse. It may be more wise to avoid calcium in management of hyperkalemia from digoxin toxicity. Some literature has shown the similar membrane stabalizing effect from magnesium and may be used instead of calcium .Caution should be taken not to go very aggressive in treating hyperkalemia, or atleast potassium should be followed very closely if DigiFab is planned. With administration of DigiFab (Digibind), potassium shifts back into the cell and life threatening hypokalemia may develop rapidly. Digoxin causes a shift of potassium from inside to outside of the cell and may cause severe hyperkalemia but overall there is a whole body deficit of potassium. With administration of Digi-bind, actual hypokalemia may manifest which could be equally life threatening.</strong><br /><br /><br /><span style="font-size:78%;color:#003333;">References: click to get abstract/article</span><br /><span style="font-size:78%;color:#003333;"></span><br /><span style="font-size:78%;color:#003333;">1. </span><a href="http://emj.bmjjournals.com/cgi/content/full/19/2/183" target="_blank"><span style="font-size:78%;color:#003333;">Calcium for hyperkalaemia in digoxin toxicity</span></a><span style="font-size:78%;color:#003333;"> - Emerg Med J 2002; 19:183</span><br /><span style="font-size:78%;color:#003333;"></span><br /><span style="font-size:78%;color:#003333;">2. </span><a href="http://ndt.oxfordjournals.org/cgi/content/full/19/5/1333-a" target="_blank"><span style="font-size:78%;color:#003333;">Using calcium salts for hyperkalaemia</span></a><span style="font-size:78%;color:#003333;"> - Nephrol Dial Transplant (2004) 19: 1333-1334</span><br /><br /><span style="font-size:78%;color:#003333;">3. Slow-release potassium overdose: Is there a role for magnesium? Emergency Medicine 1999;11:263–71</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-38738729046926317822007-07-28T09:03:00.000-07:002007-07-27T21:05:24.301-07:00<strong><span style="color:#000066;">Saturday July 28, 2007<br /></span><span style="color:#990000;">Arterial and venous latate level</span><br /><br /><span style="color:#000000;">Arterial lactate level is preferable to venous lactate level but it is not always feasible to have arterial lactate level.To estimate accurate arterial level, following formula can be used</span><br /><br /><span style="color:#003333;"><em>Arterial lactate in mmol/L = 0.889 (venous lactate in mmol/L) + 0.076</em></span><br /><br /><span style="color:#000000;">Please note this formula is in mmol/L. (In USA we use mg/dl). The unit conversion from mg to mmol is 1 mg/dl = 0.11 mmol/L.</span><br /><br /><br /></strong><span style="font-size:78%;color:#003333;">Reference:<br /><br />Lavery RF, Livingston DH, et al. The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg. 2000; 190: 656-664.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-58467556166592705472007-07-27T11:07:00.000-07:002007-07-27T11:09:18.150-07:00<strong><span style="color:#000066;">Friday July 27, 2007</span></strong><br /><span style="color:#990000;"><strong>What does EVH means when its written with CABG (coronary artery bypass grafting) ?</strong></span><br /><br /><strong><span style="color:#000000;">EVH means endoscopic vessel harvesting, which is a more refined method of removing, or harvesting, a vein from body to use as a graft during bypass surgery. Via an "endoscope", surgeon view the veins inside the leg and makes only one to three small incisions. The surgeon then removes a vein through one of the incisions. Compared to traditional vessel harvesting, EVH uses smaller incisions and may lead to less pain, faster healing, and smaller scars. It may be of extreme benefit in diabetic population, prone to infections, peripheral vascular disease and neuropathy. </span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;">To note, EVH takes significantly longer time compared to the traditional harvesting technique. Also, it has been said that carbon dioxide (CO2) insufflation used during EVH to facilitate the procedure may cause CO2 embolism but so far no significant data has shown reports of massive CO2 embolism with significant hemodynamic alterations.</span></strong><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSa67dK6GyGxMcwwXIc-IEHaBG4Nyf17P2xTOc6JgQat_OjReKBPT6ct_hEn0ZXm4wXnJcHwqDzt3avATRYLHcegs3CdJKU1cTNgOS43Drur3UOLZ3Oi-h0BGB5LkXALEvwxDwd8BgeU0/s1600-h/evh1.jpg"><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSa67dK6GyGxMcwwXIc-IEHaBG4Nyf17P2xTOc6JgQat_OjReKBPT6ct_hEn0ZXm4wXnJcHwqDzt3avATRYLHcegs3CdJKU1cTNgOS43Drur3UOLZ3Oi-h0BGB5LkXALEvwxDwd8BgeU0/s1600-h/evh1.jpg"><img id="BLOGGER_PHOTO_ID_5091939955598069474" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSa67dK6GyGxMcwwXIc-IEHaBG4Nyf17P2xTOc6JgQat_OjReKBPT6ct_hEn0ZXm4wXnJcHwqDzt3avATRYLHcegs3CdJKU1cTNgOS43Drur3UOLZ3Oi-h0BGB5LkXALEvwxDwd8BgeU0/s400/evh1.jpg" border="0" /></a><br /><br /><br /><span style="font-size:78%;color:#003333;">References: Click to see abstract/article</span><br /><br /><span style="font-size:78%;color:#003333;">1. </span><a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&amp;amp;db=PubMed&amp;amp;list_uids=12077689&amp;amp;dopt=AbstractPlus" target="_blank"><span style="font-size:78%;color:#003333;">Endoscopic saphenous vein harvesting for CABG -- a randomized, prospective trial.</span></a><span style="font-size:78%;color:#003333;"> Thorac Cardiovasc Surg. 2002 Jun;50(3):160-3<br /><br />2. </span><a href="http://ats.ctsnetjournals.org/cgi/content/abstract/81/5/1697" target="_blank"><span style="font-size:78%;color:#003333;">Reduction of Carbon Dioxide Embolism for Endoscopic Saphenous Vein Harvesting</span></a><span style="font-size:78%;color:#003333;"> - Thorac Surg 2006;81:1697-1699</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-58671718413416557272007-07-26T15:13:00.000-07:002007-07-26T15:15:17.599-07:00<strong><span style="color:#000066;">Thursday July 26, 2007</span><br /><span style="color:#990000;">Amiodarone Neurotoxicity !!</span></strong><br /><strong></strong><br /><strong><span style="color:#000000;">Amiodarone neurotoxicity has been reported in up to 40% and may easily get miss or misdiagnose when an elderly patient presents with multiple symptoms. Major manifestation are peripheral neuropathy causing proximal motor weakness, ataxia and fine resting tremor. It may also present as neuromyopathy. A case has been described with autonomic dysfunction presented as incapacitating orthostatic hypotension. Cases has been reported with Amiodarone-Induced Delirium . Most neurotoxicities are dose related and resolved with discontinuation of Amiodarone. Being an intensivist it may be important to keep this very common dose related toxicity in mind while evaluating patient with neurologic symptoms.</span></strong><br /><strong></strong><br /><strong><span style="color:#003333;">Related pearl :</span> </strong><a href="http://icuroom-pearls.blogspot.com/2005/11/amiodarone.html" target="_blank"><span style="color:#660000;"><strong>Amiodarone pulmonary toxicity</strong></span></a><span style="color:#660000;"><strong>.</strong></span><br /><br /><br /><span style="font-size:78%;color:#003333;">References: Click to see abstract/article</span><br /><br /><span style="font-size:78%;color:#003333;">1. </span><a href="http://www.jcnmd.com/pt/re/jclnnmd/abstract.00131402-200203000-00001.htm;jsessionid=DZp9wxa3EKCYADYSPVLIz3dhzXlfXNhuGt0J2tCu9ZOK2WjOeonL!2053693457!-949856144!9001!-1" target="_blank"><span style="font-size:78%;color:#003333;">Amiodarone-Induced Neuromyopathy: Three Cases and a Review of the Literature</span></a><span style="font-size:78%;color:#003333;"> - Journal of Clinical Neuromuscular Disease. 3(3):97-105, March 2002.</span><br /><span style="font-size:78%;color:#003333;"><br />2. </span><a href="http://www.ajconline.org/article/PIIS0002914905013536/abstract" target="_blank"><span style="font-size:78%;color:#003333;">Severe Ataxia Caused by Amiodarone</span></a><span style="font-size:78%;color:#003333;"> - Volume 96, Issue 10, Pages 1463-1464 (15 November 2005) - Am J of Card</span><br /></span><span style="font-size:78%;color:#003333;"><br />3. </span><a href="http://pmj.bmjjournals.com/cgi/content/abstract/82/963/73" target="_blank"><span style="font-size:78%;color:#003333;">Amiodarone toxicity presenting as pulmonary mass and peripheral neuropathy: the continuing diagnostic challenge</span></a><span style="font-size:78%;color:#003333;"> - Postgraduate Medical Journal 2006;82:73-75</span><br /></span><span style="font-size:78%;color:#003333;"><br />4. </span><a href="http://www.aafp.org/afp/20031201/2189.pdf" target="_blank"><span style="font-size:78%;color:#003333;">Amiodarone: Guidelines for Use and Monitoring</span></a><span style="font-size:78%;color:#003333;"> - aafp.org - Vol 68, No. 11, Dec., 2003 -pdf</span><br /></span><span style="font-size:78%;color:#003333;"><br />5. </span><a href="http://archinte.ama-assn.org/cgi/content/abstract/147/10/1805" target="_blank"><span style="font-size:78%;color:#003333;">Atypical pulmonary and neurologic complications of amiodarone in the same patient. Report of a case and review of the literature</span></a><span style="font-size:78%;color:#003333;"> - Vol. 147 No. 10, October 1, 1987 - Archive of Int Med.</span><br /></span><span style="font-size:78%;color:#003333;"><br />6. </span><a href="http://ajp.psychiatryonline.org/cgi/content/full/156/7/1119" target="_blank"><span style="font-size:78%;color:#003333;">Amiodarone-Induced Delirium</span></a><span style="font-size:78%;color:#003333;"> - Am J Psychiatry 156:1119, July 1999</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-67371242464942081812007-07-25T15:51:00.000-07:002007-07-25T15:53:05.530-07:00<strong><span style="color:#000066;">Wednesday July 25, 2007</span><br /><span style="color:#990000;">pRBC transfusion and hyperkalemia</span><br /><br /><span style="color:#000000;">Hyperkalemia from blood transfusion is an under-recognised entity in ICUs but over time there is more realization about it. One recent study underscores the same peril from transfusion</span></strong> <span style="font-size:78%;">1.</span><br /><strong><br /><span style="color:#000000;">A total of 131 patients were studied during the initial 12 hours after admission for noncrush trauma. 2 independent risk factors for hyperkalemia were </span></strong><br /><strong></strong><br /><strong><ul><li><span style="color:#000000;">an ER plasma potassium level of 4.0 mmol/L or higher, and </span></li><li><span style="color:#000000;">transfusion of cell- or plasma-based products </span></li></ul><span style="color:#000000;"></span></strong><br /><br /><strong><span style="color:#003333;">Related previous pearl:</span></strong> <br /></span></strong><a href="http://january07-icuroom.blogspot.com/2007_01_15_archive.html" target="_blank"><strong><span style="color:#660000;">Transfusion-associated hyperkalemia in renal failure patients</span></strong></a><br /><br /><br /><span style="font-size:78%;color:#003333;">Reference: click to get abstract<br />1. </span><a href="http://cjasn.asnjournals.org/cgi/content/abstract/2/2/313" target="_blank"><span style="font-size:78%;color:#003333;">Resuscitative Hyperkalemia in Noncrush Trauma: A Prospective, Observational Study</span></a><span style="font-size:78%;color:#003333;"> - Clin J Am Soc Nephrol.2007; 2: 313-319</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-81415270761412600132007-07-24T12:38:00.000-07:002007-07-25T06:32:07.189-07:00<strong><span style="color:#000000;"><span style="color:#000066;">Tuesday July 24, 2007</span><br /><span style="color:#990000;">Do we need nicotine replacement therapy in ICU ?<br /></span><br /><br /></span><span style="color:#000000;">Putting nicotine patch in patients with smoking history is a common practice in ICUs. But do we really need it ?<br /><br />It was a retrospective study of 90 patients (smokers with application of nicotine replacement treatment) compared with 90 control patients (smokers who did not receive nicotine replacement therapy). Patients were adjusted based on the severity of illness and then age.<br /><br />Outcome was measured by </span></strong><br /><strong></strong><br /><strong><span style="color:#000000;"><ul><li>hospital mortality and</li><li>28-day ICU day</li></ul><p>Results: </p><ul><li>The observed hospital mortality rate was 20% in the cases vs. 7% in the control group ! (p = .0085).<br /></li><li>When adjusted for the severity of illness and invasive mechanical ventilation, nicotine replacement therapy was independently associated with increased mortality.<br /></li></ul><p><span style="color:#003333;">Discussion (taken from study):</span> Activation of the sympathetic nervous system is the main mechanism by which nicotine leads to cardiovascular disease. The sympathomimetic effect of nicotine is independent of the level of nicotine exposure. The hemodynamic effects of nicotine include increased heart rate, blood pressure, and myocardial contractility. It also may cause constriction of coronary arteries. Although these hemodynamic effects have not been shown to be associated with poor outcome in healthy volunteers and those with stable coronary artery disease, they may be detrimental in critically ill patients. Its effect of increasing myocardial oxygen consumption during times of reduced oxygen delivery may lead to adverse outcome in critically ill patients.</span></strong></p><span style="color:#000000;"><br /></span><br /><br /><span style="color:#003333;"><br /><span style="font-size:78%;">Reference: click to get abstract</span></span><p><span style="font-size:78%;color:#003333;">1. </span><a href="http://www.ccmjournal.com/pt/re/ccm/abstract.00003246-200706000-00010.htm;jsessionid=GlvCKkz5bS92JJTGHg5MY6vfrf6NpWMQzPXZQPrTdMmnXy2V3SR9!1683421839!181195628!8091!-1" target="_blank"><span style="font-size:78%;color:#003333;">The association of nicotine replacement therapy with mortality in a medical intensive care unit.</span></a><span style="font-size:78%;color:#003333;"> Critical Care Medicine. 35(6):1517-1521, June 2007.</span></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-90900893409722501832007-07-22T09:06:00.000-07:002007-07-22T09:07:54.882-07:00<strong><span style="color:#000066;">Sunday July 22, 2007<br /></span><span style="color:#990000;">Sign-out Mortality !</span></strong><br /><strong></strong><br /><strong><span style="color:#000000;">Regular evening work (sign-out) round is an integral part of all tertiary/teaching ICUs in USA but unfortunately as we transit to private practice or community hospital enviroment, we tend to loose this wonderful tradition. Ever thought of poor sign-out to your colleague as a patient safety issue? A group pf physicians from Chicago have published their study in Quality and Safety in Health Care.26 interns caring for 82 patients were interviewed after receiving sign-out from another intern. 25 discrete incidents, all the result of communication failures during the preceding patient sign-out, and 21 worst events were described. Omitted content (such as medications, active problems, pending tests) or failure-prone communication processes (such as lack of face-to-face discussion) emerged as major categories of failed communication. Ever think of sign-out as a procedure?</span></strong><br /><strong></strong><br /><br /><span style="font-size:85%;color:#000000;"><strong>Read interesting article related to this topic</strong></span><a href="http://www.webmm.ahrq.gov/case.aspx?caseID=70" target="_blank"><span style="font-size:85%;color:#000000;"><strong> <span style="color:#660000;">Glucose Roller Coaster</span></strong></span></a><span style="font-size:85%;"><strong><span style="color:#000000;"> with sample signout sheet at the AHRQ WebM&M website, from Bradley A. Sharpe, MD, University of California, San Francisco .</span></strong><br /></span><br /><br /><span style="font-size:78%;color:#003333;">Reference: click to get abstract</span><br /><br /><a href="http://qhc.bmjjournals.com/cgi/content/abstract/14/6/401" target="_blank"><span style="font-size:78%;color:#003333;">Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis</span></a><span style="font-size:78%;color:#003333;"> - Quality and Safety in Health Care 2005;14:401-407</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-3023367253060404652007-07-21T12:32:00.000-07:002007-07-21T12:33:15.167-07:00<strong><span style="color:#000066;">Saturday July 21, 2007<br /></span><span style="color:#990000;">ever heard of carbicarb !!</span></strong><br /><strong></strong><br /><strong>Unfortunately Carbicarb is not available in USA but available in canada. It is a combination of sodium bicarbonate and sodium carbonate. It has been in use for about 20 years with good track record.<br /><br />It has advantage over 'soda-bicarb' (NaHCO3) of not undergoing significant breakdown into CO2 and H2O. Also it is more predictable in raising PH. The dose is<br /><br /><br /></strong><strong></strong><div align="center"><strong>0.2 x base deficit = mEq Sodium<br /></strong><br /> </div><div align="left"><br /><strong><span style="color:#003333;">Related previous pearl:</span></strong> <a href="http://icuroom-pearls-0806.blogspot.com/2006_08_21_archive.html" target="_blank"><strong><span style="color:#660000;">THAM</span></strong></a><br /><br /><br /><br /><span style="color:#003333;"><br /></span><span style="font-size:78%;color:#003333;">Reference: click to get abstract<br /><br />1. </span><a href="http://circ.ahajournals.org/cgi/content/abstract/77/1/227" target="_blank"><span style="font-size:78%;color:#003333;">Improved hemodynamic function during hypoxia with Carbicarb, a new agent for the management of acidosis</span></a><span style="font-size:78%;color:#003333;"> Circulation, Vol 77, 227-233, Copyright © 1988<br />2. </span><a href="http://www.chestjournal.org/cgi/content/abstract/104/3/913" target="_blank"><span style="font-size:78%;color:#003333;">Carbicarb, sodium bicarbonate, and sodium chloride in hypoxic lactic acidosis. Effect on arterial blood gases, lactate concentrations, hemodynamic variables, and myocardial intracellular pH</span></a><span style="font-size:78%;color:#003333;"> Chest, Vol 104, 913-918, Copyright © 1993</span> </div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-31092570361062952812007-07-20T14:32:00.000-07:002007-07-20T14:33:35.176-07:00<strong><span style="color:#000066;">Friday July 20, 2007</span><br /><span style="color:#990000;">Colonic Necrosis - unusual complication of Kayexalate-Sorbitol</span></strong><br /><strong></strong><br /><strong><span style="color:#000000;">We are using sodium polystyrene sulfonate (SPS or Kayexalate) since last 45 years with great confidence. It is a common practice to add sorbitol to dissolve Kayexalate mainly to avoid fecal impaction or possible bowel obstruction. (Kayexalate binds intraluminal calcium and may cause constipation, fecal impaction or bowel obstruction). One of the relatively unknown complication of Kayexalate-sorbitol combination is colonic necrosis, although has been reported in literature earlier. The exact reason for colonic necrosis is not clear but the diagnosis can be made by the pathologic examination of post-operative specimen or material from endoscopic biopsy and may require specialized expertise and special stains. Sorbitol part is taught to be responsible for complication. </span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;">Intensivists need to be wary of possible complication of acute abdomen after administration of kayexalate-sorbitol in 1% of cases, particularly in first 24-36 hours.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-50252549782310856732007-07-19T11:28:00.000-07:002007-07-19T11:29:09.410-07:00<strong><span style="color:#000066;"></span></strong><br /><strong><span style="color:#000066;">Thursday July 19, 2007</span><br /><span style="color:#990000;">Preparation of </span></strong><a name="NOREPINEPHRINE"><strong><span style="color:#990000;">NOREPINEPHRINE</span></strong></a><strong><br /><br /></strong><a name="NOREPINEPHRINE"><strong><span style="color:#000000;">NOREPINEPHRINE</span></strong></a><strong><span style="color:#000000;"> (LEVOPHED) drip should be prepared in dextrose containing solution (D-5). </span></strong><a name="NOREPINEPHRINE"><strong><span style="color:#000000;">NOREPINEPHRINE</span></strong></a><strong><span style="color:#000000;"> (LEVOPHED) is less stable in normal saline and loose its potency from oxidation over hours. Dextrose containg solution is preferred as the dextrose protects against oxidation of the norepinephrine and keep it active and stable.</span></strong><br /><strong></strong><br /><strong></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-15823716737886499202007-07-18T06:16:00.000-07:002007-07-18T06:19:04.984-07:00<strong><span style="color:#000066;">Wednesday July 18, 2007<br /></span><span style="color:#990000;">Xigris needs dedicated line</span></strong><br /><strong></strong><br /><strong><span style="color:#000000;">Before you write order for Xigris (APC), beaware that its infusion requires dedicated IV line, either peripheral or dedicated port of central line. The other solutions that can be administered through the same line are 0.9 NS, .45 NS, LR solution, D-5 or D5 with NS solutions.</span></strong><br /><strong></strong><br /><strong></strong><br /><span style="font-size:78%;color:#003333;">Reference: Rxlist.com</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-75118332318733679512007-07-17T10:26:00.000-07:002007-07-17T10:28:49.882-07:00<strong><span style="color:#000066;">Tuesday July 17, 2007</span></strong><br /><strong><span style="color:#990000;">APC at one glance</span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><span style="color:#000000;"><strong><span style="color:#000000;">Activated Protein C (Xigris) entered Critical Care Medicine culture with a big bang but over time its efficiency and safety has been questioned but still it is a valuable tool in intensivists' arsenals. Below is a nice picture showing various actions for APC application.</span><br /><br /></strong></span><span style="color:#000000;">TF = tissue factor<br />IL-1 = interleukin 1<br />IL-6 = interleukin 6<br />TNF-alpha = tumor necrosis factor alpha<br />PAR-1 = protease activated receptor 1<br />EPCR = endothelial protein C receptor<br />TM = thrombomodulin<br /></span><br /><br /><img id="BLOGGER_PHOTO_ID_5088218577549881618" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyEXA_PSbeIGQryFhzrZG1C9-oAPWhzW7y5gjrrFo-ufuRSBkRBD3EjabUwMy9ZRpFqWCF7SzfUqVj5hmf_e4f8drA-fPnF62iPP3jttHy6u3INazgCbnAM8yo8qywZx4zOvxnZdzsFo0/s400/apc.jpg" border="0" /><span style="font-size:85%;color:#000000;"><em> Click to get bigger image<br /></em></span><br /><span style="font-size:78%;color:#003333;"><br />source: Frontiers in Bioscience 11, 2381-2399, September 1, 2006</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-11151051414423762762007-07-16T11:26:00.000-07:002007-07-16T11:27:36.701-07:00<strong><span style="color:#000066;">Monday July 16, 2007<br /></span><span style="color:#000000;"><span style="color:#990000;">Zolpidem-Induced Delirium</span> </span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;">Relatively Zolpidem (Ambien) is a safe medicine and recently has been the drug of choice in critical care units to induce sleep. But it is important to be aware of reported cases of Ambien related psychosis, delirium and mania. Atleast one case is reported with visual perception distortion after a single dose of zolpidem. One way to combat the problem is to decrease the prescribing dose particularly in elderly population and in hypoalbuminemia (5 mg instead of 10 mg). Also, female population has been reported to have more plasma level with same dose. Also note that Zolpidem metabolized through liver so it may be necessary to decrease the dose in liver insufficiency.</span></strong><br /><br /><br /><strong><span style="color:#003333;">Related previous pearls:</span></strong> <a href="http://icuroom-pearls.blogspot.com/2005/12/ss.html"><span style="color:#660000;"><strong>SEROTONIN SYNDROME</strong></span></a><br /><br /><br /><p> </p><span style="font-size:78%;"></span><br /><span style="font-size:78%;color:#003333;">References: click to get abstract/article</span><br /><span style="font-size:78%;"><br /><span style="color:#003333;">1. </span></span><a href="http://www.theannals.com/cgi/content/abstract/35/12/1562" target="_blank"><span style="font-size:78%;color:#003333;">Delirium associated with zolpidem</span></a><span style="font-size:78%;color:#003333;"> - The Annals of Pharmacotherapy: Vol. 35, No. 12, pp. 1562-1564<br />2. </span><a href="http://psy.psychiatryonline.org/cgi/content/full/45/1/88" target="_blank"><span style="font-size:78%;color:#003333;">Zolpidem-Induced Delirium With Mania in an Elderly Woman</span></a><span style="font-size:78%;color:#003333;"> - Psychosomatics 45:88-89, February 2004<br />3. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=8937915&dopt=Abstract" target="_blank"><span style="font-size:78%;color:#003333;">Zolpidem-induced agitation and disorganization</span></a><span style="font-size:78%;color:#003333;">. - Gen Hosp Psychiatry. 1996 Nov;18(6):452-3. (pubmed)<br />4. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=8807033&dopt=Abstract" target="_blank"><span style="font-size:78%;color:#003333;">Zolpidem-induced psychosis</span></a><span style="font-size:78%;color:#003333;">. - Ann Clin Psychiatry.1996 Jun;8(2):89-91. (pubmed)<br />5. Clinical pharmacokinetics of zolpidem in various physiological and pathological conditions, in Imidazopyridines in Sleep Disorders. Edited by Sauvanet JP, Langer SZ, Morselli PL. New York, Raven Press, 1988, pp 155–163<br />6. </span><a href="http://www.theannals.com/cgi/content/abstract/37/5/683" target="_blank"><span style="font-size:78%;color:#003333;">Zolpidem-Induced Distortion in Visual Perception</span></a><span style="font-size:78%;color:#003333;"> - The Annals of Pharmacotherapy: Vol. 37, No. 5, pp. 683-686</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-17251834995249696262007-07-15T20:31:00.000-07:002007-09-18T16:19:06.931-07:00<p><span style="color:#000000;"><strong><span style="color:#000066;">Sunday July 15, 2007</span><br /><br /><br /><span style="color:#660000;">Q:</span> <span style="color:#003333;"><em>One unit of platelet transfusion expect to increase platelet count by how much ?</em></span><br /><br /><span style="color:#660000;">Answer;</span> <span style="color:#000000;">Each unit of platelet transfusion is expected to increase platelet count by 7 - 10,000 / uL. Platelet transfusion is usually given as 6 or 10 units together.</span></strong></span></p><p><strong></strong></p><p></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-19131621786652565402007-07-14T21:17:00.000-07:002007-09-18T16:19:33.589-07:00<strong><span style="color:#003333;">Saturday July 14, 2007<br /></span><span style="color:#990000;">Norepinephrine friend or foe? - probably friend !<br /></span><br />As we discussed earlier on this forum (see below related pearls) that overall trend is to use norepinephrine instead of dopamine as first line vasopressor in ICUs.<br /><br />One step further, in july 2007 issue of Crititical Care medicine 1, laboratory investigation published regarding comparative effects of early versus delayed use of norepinephrine in resuscitated endotoxic shock.<br /><br />5 groups (each group with 7 rats) were anesthetized, mechanically ventilated, paralyzed, and instrumented to measure mean arterial pressure, heart rate, pulse pressure variation, aortic and mesenteric blood flow, muscle and liver tissue oxygen pressure, blood gas, and lactate. 5 groups were</strong><br /><strong><ol><li>endotoxin alone (Endo), </li><li>endotoxin plus norepinephrine (Endo/NE), </li><li>endotoxin plus fluid therapy alone (ENDO/Fl), </li><li>endotoxin plus fluid therapy plus late catecholamine (Endo/Fl/Late NE), and </li><li>endotoxin plus fluid therapy plus simultaneous norepinephrine administration (Endo/Fl/Early NE)</li></ol><br /><span style="color:#000066;">Results: </span><br /><span style="color:#000066;"><ul><li></span>Mean arterial pressure increased to baseline values only in the catecholamine-treated group (p < .05). </li><li>In ENDO/Fl, Endo/Fl/Late NE, and Endo/Fl/Early NE, aortic blood flow was maintained. </li><li>Mesenteric blood flow was maintained at baseline values only in the catecholamine-treated groups </li><li>Mesenteric/aortic blood flow ratio was higher in the early catecholamine group (p < .05)</li><li>Endo and ENDO/Fl were associated with a marked decrease in liver Po2, which was maintained in catecholamine-treated groups (p < .01)</li><li>Plasma lactate was lower in the Endo/Fl/Early NE group<br />Volume resuscitation was higher in Endo and</li><li>Endo/Fl/Late NE groups with 28 ± 6 and 27 ± 4 mL, respectively, when compared with the Endo/Fl/Early NE group (19 ± 3 mL) (p < .05)</li></ul><br /><br /><span style="color:#003333;">Conclusions:</span> The use of norepinephrine was associated with improved mean arterial pressure, sustained aortic and mesenteric blood flow, and better tissue oxygenation when compared with fluid resuscitation alone, irrespective of time of administration. The early use of norepinephrine plus volume expansion was associated with a higher proportion of blood flow redistributed to the mesenteric area, lower lactate levels, and less infused volume. Thus, the early use of norepinephrine is safe and may decrease the need for volume resuscitation<br /><br /><br /></strong><br /><strong><span style="color:#003333;">Previous Related pearls<br /></span></strong><br /><a href="http://icuroom-pearls.blogspot.com/2006/02/nod.html" target="_blank"><span style="color:#660000;">Norepinephrine or Dopamine ?</span></a><span style="color:#660000;"> ,</span><br /></strong><span style="color:#660000;"></span><br /><a href="http://icuroom-pearls.blogspot.com/2005/12/rdn.html" target="_blank"><span style="color:#660000;">Renal Dose Norepinephrine !</span></a><br /><span style="color:#660000;"><br /></span><a href="http://icuroom-pearls-0806.blogspot.com/2006_08_23_archive.html" target="_blank"><span style="color:#660000;">Is Dopamine phasing out?</span></a><br /><br /><span style="color:#003333;"><br /><br /><br /></span><span style="font-size:78%;color:#003333;">Reference: click to get abstract/article<br /><br />1. </span><a href="http://www.ccmjournal.com/pt/re/ccm/abstract.00003246-200707000-00018.htm;jsessionid=GYSLQPK4yrNJJMC1p5gFtJLL2Z6V2RFcN2LgDvfpBzNv9GVGQTyQ!675572714!181195628!8091!-1" target="_blank"><span style="font-size:78%;color:#003333;">Comparative effects of early versus delayed use of norepinephrine in resuscitated endotoxic shock</span></a><span style="font-size:78%;color:#003333;"> - Laboratory Investigations, Critical Care Medicine. 35(7):1736-1740, July 2007.<br />2. </span><a href="http://www.chestjournal.org/cgi/content/full/126/2/335" target="_blank"><span style="font-size:78%;color:#003333;">Renal Dose Norepinephrine!</span></a><span style="font-size:78%;color:#003333;"> - Chest. 2004;126:335-337<br />3. </span><a href="http://www.chestjournal.org/cgi/content/full/126/2/534" target="_blank"><span style="font-size:78%;color:#003333;">Renal Effects of Norepinephrine in Septic and Nonseptic Patients</span></a><span style="font-size:78%;color:#003333;"> - Chest. 2004;126:534-539<br />4. </span><a href="http://ccforum.com/content/5/6/294" target="_blank"><span style="font-size:78%;color:#003333;">Noradrenaline and the kidney: friends or foes?</span></a><span style="font-size:78%;color:#003333;"> - Crit Care 2001, 5:294-298<br />5. </span><a href="http://www.ccmjournal.com/pt/re/ccm/abstract.00003246-200411001-00004.htm;jsessionid=DlJoL2M4JNWVikstoRUjtvW1LbqlUIjyed42HwUePChEpjq9xJ1Z!-85436088!-949856145!9001!-1" target="_blank"><span style="font-size:78%;color:#003333;">Vasopressor and inotropic support in septic shock: An evidence-based review</span></a><span style="font-size:78%;color:#003333;">. - Critical Care Medicine. 32(11) Supplement:S455-S465, November 2004</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-55519999880202238102007-07-13T05:42:00.000-07:002007-07-13T10:11:56.510-07:00<strong><span style="color:#000000;"><span style="color:#000066;">Friday July 13, 2007</span></span></strong><br /><strong><span style="color:#660000;">cryo reduced plasma</span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;"><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">W</span></em><em><span style="color:#003333;">hat is "cryo reduced plasma"?<br /></span></em><br /><span style="color:#660000;">A;</span> O<span style="color:#000000;">ne unit of cryoprecipitate is derived from one unit of fresh frozen plasma (FFP). Left over FFP, after removal of cryoprecipitate is called supernatant plasma or CRYO-REDUCED PLASMA.</span><br /><br /><br /><span style="color:#003333;">Clinical Significance:</span> Cryo-reduced plasma is used as a treatment in plasmapheresis for TTP, not responding to regular plasma exchange with FFP. Some physicians even use it as first line for plasmapheresis/Therapeutic Plasma Exchange (TPE) for a patient with Thrombotic Thrombocytopenic Purpura (TTP).</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-59544652602730761622007-07-12T10:58:00.000-07:002007-07-12T11:00:53.788-07:00<span style="color:#000000;"><strong><span style="color:#000066;">Thursday July 12, 2007</span><br /><span style="color:#990000;">Xenical (alli) and other life saving drugs</span> </strong></span><br /><span style="color:#000000;"><br /><strong>Anti-obesity drug Xenical (</strong></span><a href="http://www.myalli.com/" target="_blank"><span style="color:#660000;"><strong>Alli</strong></span></a><span style="color:#000000;"><strong> or </strong></span><a href="http://www.rocheusa.com/products/xenical/" target="_blank"><span style="color:#660000;"><strong>orlistat</strong></span></a><span style="color:#000000;"><strong>) went over the counter with a big bang. Counters get cleared at major stores and pharmacies within hours.<br /><br />It may be of importance to know its possible effect with warfarin (coumadin), cyclosporin and amiodarone. Alli is a reversible inhibitor of lipases. It forms a covalent bond with gastric and pancreatic lipases. The inactivated enzymes are thus unavailable to hydrolyze dietary fat in the form of triglycerides into absorbable free fatty acids and monoglycerides. As a side effect deficiency of fat-soluble vitamins like Vitamin A, D, E and K may occur. Recommendation is to take a multi-vitamin two hours before Alli. Patients on coumadin (warfarin) may have potential of bleed due to increase INR (as absorption of Vitamin K is decrease). We cannot find any mention in literature describing any such real case so far but frequent INR check is recommended for safety. Also to remember, Xenical can decrease the amount of cyclosporine and 25-30% reduction in systemic exposure to Amiodarone.<br /><br /></strong></span><span style="color:#003333;"></span><br /></span><span style="color:#003333;">References: Click to see abstract/article </span><br /><br /><span style="color:#003333;">1. </span><a href="http://www.rxlist.com/cgi/generic/orlistat_cp.htm" target="_self"><span style="color:#003333;">Mechanism of Action - Orlistat</span></a><span style="color:#003333;"> - Rxlist.com </span><br /><span style="color:#003333;">2.</span><a href="http://www.rocheusa.com/products/xenical/ppi.pdf" target="_blank"><span style="color:#003333;">Important Patient Information Patient Information about XENICAL</span></a><span style="color:#003333;"> - rocheusa.com</span><br /><span style="color:#003333;">3.</span><a class="l" href="http://www.roche-australia.com/downloads/xenical-pi.cfm?action=get" target="_blank"><span style="color:#003333;">XENICAL</span></a><span style="color:#003333;"> - roche-australia.com</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-90901015843650012572007-07-11T07:05:00.000-07:002007-07-11T07:06:51.001-07:00<strong><span style="color:#000066;">Wednesday July 11, 2007<br /></span><span style="color:#990000;">Iodide in Thyroid Storm</span></strong><a href="http://icuroom-pearls.blogspot.com/2006/03/cuff-leak-test.html" target="_blank"></a><br /><br /><strong>Q; <em><span style="color:#003333;">How long should you wait to administer iodide after giving antithyroid medication in the management of thyroid storm ?</span></em></strong><br /><strong></strong><br /><strong>A; </strong><strong><span style="color:#000000;">Atleast one hour.Oral or rectal iodide compounds block release of thyroid hormones after starting antithyroid drug therapy. But if given early in management (before antithyroid medication become effective) it can get utilize in the synthesis of new thyroid hormone.<br /></span><br /><br /><span style="color:#000000;">Read nicely written review on </span></strong><a href="http://www.emedmag.com/html/pre/cov/covers/021503.asp" target="_blank"><strong><span style="color:#000000;"><span style="color:#660000;">Thyroid Storm</span> </span></strong></a><span style="color:#000000;"><strong>(and Myxedema coma) by Nikolaos Stathatos, MD, and Leonard Wartofsky, MD from Washington Hospital Center in Washington, D.C.</strong> - ref.: emedmag.com, 02/15/2003 issue.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-76953331028335935662007-07-10T10:25:00.000-07:002007-07-10T12:49:12.608-07:00<p><strong><span style="color:#000066;">Tuesday July 10, 2007</span><br /><span style="color:#990000;">Gadolinium based contrast agent (GBCA) and renal insufficiency</span><br /><br /><span style="color:#000000;">During MRI and MRA scans, a Gadolinium based contrast agent (GBCA) is used for more refined films. New evidences suggest that Gadolinium based contrast agents are associated with Nephrogenic Systemic Fibrosis (NSF) or Nephrogenic Fibrosing Dermopathy (NFD). Interestingly, the effect may be delayed upto 18 months after exposure !!</span></strong></p><p><strong><span style="color:#000000;">NSF may result in fatal or debilitating systemic fibrosis affecting the skin, muscle, and internal organs. Patients with renal dysfunction are at very high risk for NSF. In dialysis dependent patients, it is recommended to consider prompt hemodialysis following GBCA administration and upto 3 frequent sessions of dialysis. (Does it work ?). NSF is well documented following exposure to a GBCA in patients with</span></strong></p><ul><li><strong><span style="color:#000000;">acute or chronic severe renal insufficiency <em>(GFR less than 30)</em> * </span></strong></li><li><strong><span style="color:#000000;">patients with acute renal insufficiency of any severity due to the hepato-renal syndrome or </span></strong></li><li><strong><span style="color:#000000;">in the peri-operative liver transplantation period</span></strong></li></ul><p><br /><span style="color:#000000;">*To date, there has not been a report of NSF in a patient with normal renal function or mild to moderate renal insufficiency following GBCA exposure<br /></span><strong><span style="color:#000000;"><br />Among the factors that may increase the risk for NSF are repeated or higher than recommended doses of a GBCA. The dose of gadolinium-based contrast agent given to patients undergoing an MRA is often higher and have higher risk of developing the condition.<br /><br />The signs and symptoms of NSF includes itching, reddened or darkened patches on skin; and/or skin swelling, hardening and/or tightening. Yellow raised spots on the whites of the eyes. Joint stiffness and/or muscle weakness. In addition, patients may develop widespread fibrosis of other organs. A skin biopsy is necessary to confirm the diagnosis.<br /><br />There is no treatment for NSF.<br /><br />FDA has recently advised detailed box warning which can be read</span><span style="color:#660000;"> </span></strong><a href="http://www.fda.gov/cder/drug/InfoSheets/HCP/gcca_200705.htm" target="_blank"><strong><span style="color:#660000;">here</span></strong></a><strong><span style="color:#660000;">.<br /></span></strong></p><a href="http://www.fda.gov/cder/drug/infopage/gcca/default.htm" target="_blank" rel="nofollow"></a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-90630713156734946032007-07-09T08:39:00.000-07:002007-07-09T08:42:24.795-07:00<span style="color:#000066;"><strong>Monday July 09, 2007<br /></strong></span><strong><span style="color:#990000;">Male vs Female blood product transfusion (Plasma and apheresis platelets) !<br /></span><br /><span style="color:#000000;">Interesting study published in July 2007 issue of Critical Care Medicine</span></strong><span style="color:#000000;"> <span style="font-size:78%;">1 </span></span><span style="color:#000000;"><strong>comparing transfusion from male-only versus female donors.<br /><br />In this retrospective case-control study, 112 patients who received high plasma volume components (more than 2 units of fresh frozen plasma or apheresis platelets) from male-only donors were identified and compared them with from female donors. - patients matched by severity of illness, postoperative state, and number of transfusions. Baseline characteristics, ALI risk factors, and development of ALI were similar between the two groups.<br />Results: </strong><br /></span><ul><li><strong><span style="color:#000000;">Arterial oxygenation (Pao2/Fio2) worsened after the female (p = .008) but not after male-only donor product transfusion (p = .325). </span></strong></li><li><strong><span style="color:#000000;">Male-only component recipients had more ventilator-free days (median 28 vs. 27, p = .006) and </span></strong></li><li><strong><span style="color:#000000;">a trend toward lower hospital mortality rates (14% vs. 24%, p = .054). </span></strong></li><li><strong><span style="color:#000000;">no significant difference in development of ALI after transfusion.</span></strong></li></ul><br /><strong><span style="color:#000000;">Study concluded that in critically ill recipients of high plasma volume components, gas exchange worsened significantly after transfusion of female but not male donor components.</span> </strong><br /><strong><br /><br /></strong><span style="font-size:78%;color:#003333;">Reference: Click to get article/abstract</span><br /><br /><a href="http://www.ccmjournal.com/pt/re/ccm/abstract.00003246-200707000-00002.htm;jsessionid=GQjcJYty2cnchDscv22QfMg2JLbKpZcYn234WSm4MtwNQMbhSQGN!370594218!181195629!8091!-1" target="_blank"><span style="font-size:78%;color:#003333;">Transfusion from male-only versus female donors in critically ill recipients of high plasma volume components</span></a><span style="font-size:78%;color:#003333;"> - Critical Care Medicine. 35(7):1645-1648, July 2007.</span><br /><br /><strong><span style="color:#000066;"><br />Few Previous Related Pearls:</span> </strong><br /><strong><br /></strong><a href="http://may-2007-icuroom.blogspot.com/2007_05_17_archive.html" target="_blank"><strong><span style="color:#660000;">FFP and platelet transfusion may be associated more with ALI/ARDS than pRBC transfusion</span></strong></a><br /></strong><br /><a href="http://march-2007-icuroom.blogspot.com/2007_03_22_archive.html" target="_blank"><strong><span style="color:#660000;">Why we call it cryoprecipitate? </span></strong></a><br /><br /><a href="http://icuroom-pearls.blogspot.com/2006/03/howmuchffp.html" target="_blank"><strong><span style="color:#660000;">How much FFP?</span></strong></a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-69193350291863524102007-07-08T05:53:00.000-07:002007-07-08T05:55:20.483-07:00<span style="color:#000000;"><strong><span style="color:#000066;">Sunday July 08, 2007</span><br /><span style="color:#990000;">iPods may interfere with pacemakers</span><br /><br /></strong><span style="color:#003333;">Orginally reported at Reuters Health by By Megan Rauscher</span><br /><strong><br />Apple iPod MP3 music players may interfere with the functioning of implanted pacemakers, according to research reported at the Heart Rhythm Society's 28th annual scientific sessions in Denver, Colorado few weeks ago.</strong></span><br /><span style="color:#000000;"><strong><br />...............In their study, Dr. Krit Jongnarangsin of the University of Michigan, Ann Arbor and colleagues looked at the effect of four different iPod models (third generation, photo, video and Nano iPods) on implantable pacemaker function in 100 patients. A technician monitored intracardiac electrograms and a surface ECG while each iPod was held near the chest for 5 to 10 seconds in the on and off position.<br /><br />The iPods, when held two inches from the patients' chest and as far as 18 inches, "interfered with pacemaker function in about one third of patients," Dr. Jongnarangsin noted in a telephone interview with Reuters Health. Pacemaker oversensing -- defined as spurious atrial/ventricular sensed events on the marker channel associated with atrial/ventricular inhibition, mode switching or high atrial/ventricular rates on rate histograms - was seen in 19% of patients.<br /><br />Telemetry interference -- defined as any other interference that did not affect pacing function and was not detected by pacemaker interrogation -- occurred in 32%, and pacemaker inhibition in 1%. Oversensing and telemetry interference occurred more often with third generation iPods and the photo iPod than with the video and Nano iPod.<br /><br />The observed iPod interference did not cause any clinical symptoms. "However, in one patient the iPod transiently inhibited pacemaker function," Dr. Jongnarangsin pointed out.<br /><br />There is a concern, he added, that iPod interference might lead to an incorrect diagnosis of abnormal heart rhythm. "If we don't take into account that the patient has an iPod close to the pacemaker, we may assume that the patient has an abnormal heart rate rhythm," Dr. Jongnarangsin said.<br /><br />"We need more information and more studies on iPod interference in pacemaker function," he concluded.</strong></span><br /></strong></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-553967546238194602007-07-06T22:59:00.000-07:002007-07-07T10:42:52.359-07:00<p><strong><span style="color:#000000;"><span style="color:#000066;">Saturday July 07, 2007</span><br /><br /><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">Name atleast 3 causes of false postive result of prolonged PTT ?</span></em><br /><br /></span><span style="color:#660000;"><br />Answer:</span></strong><strong><span style="color:#000000;"></p><ul><li>Underfilled collecting tube (causing more than required citrate anticoagulant in tube)</li><li>Delay in performing assay (breakdown of cells)</li><li>Polycythemia (causing relatively less plasma volume)</span></strong></li></ul>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5557265969977641761.post-57886828353408334502007-07-06T10:20:00.000-07:002007-07-06T10:21:13.675-07:00<span style="color:#000000;"><strong><span style="color:#000066;">Friday July 06, 2007<br /></span><span style="color:#990000;">Treating cocaine induced hypertension<br /></span><br /><br />Cocaine induced hypertension is due to alpha-mediated vasoconstriction. Beta-blockers are advised to be avoided in the setting of cocaine toxicity because they may result in unopposed alpha effects of cocaine and may further increase the blood pressure. There are also some reports of seizures with B-blocker is such situation. </strong></span><br /><span style="color:#000000;"><strong><br />Calcium channel blockers dilate splanchnic vessels and thereby increasing absorption of ingested cocaine from the gastrointestinal tract, which may become disastrous in body packers. Nifedipine is also reported to potentiate the incidence of seizures and death after cocaine administration and should be avoided in the treatment of cocaine-induced hypertension.<br /><br />Benzodiazepines is the first line of treatment in cocaine-induced hypertension. And if benzodiazepines fail to control hypertension, vasodilators, as nitroprusside and nitroglycerin should be use. And if vasodilators doesn't works, alpha-blockers, such as phentolamine is the next choice.</strong></span><br /></strong></span>Unknownnoreply@blogger.com0