tag:blogger.com,1999:blog-25693810678800299292024-03-14T06:30:24.555-07:00icuroom.net Aug.' 10 ArchiveUnknownnoreply@blogger.comBlogger29125tag:blogger.com,1999:blog-2569381067880029929.post-38372406105660701602010-08-31T06:23:00.000-07:002010-08-31T06:23:00.672-07:00<p><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></p><p><span style="color:#660000;">Answer:</span> <span style="color:#000000;">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></p><p><span style="color:#000000;">Give only half of recommended dose of Adenosine.</span></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-18781200951864133412010-08-29T09:11:00.000-07:002010-08-29T09:11:00.288-07:00<span style="color:#990000;">Q:</span> <em><span style="color:#003333;">Does Diuresis help in (Transfusion-related acute lung injury (TRALI)?<br /></span></em><br /><br /><span style="color:#660000;">Answer:</span> <span style="color:#000000;">Not really<br /><br />TRALI is associated with microvascular damage and not fluid overload, so diuretics are not really helpful and actually not recommended. Since the pulmonary edema in TRALI is not related to fluid overload or cardiac dysfunction, it is logical that maintenance of adequate circulating volume is more beneficial. Ventilatory assistance and circulatory support are the mainstays of treatment of TRALI. Diuretic use may be detrimental and could lead to hypotension.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-56246381860556744432010-08-28T23:09:00.000-07:002010-08-28T21:11:25.695-07:00<span style="color:#660000;">Q:</span><span style="color:#003333;"> <em>What could be the supporting finding on lab in (Transfusion-related acute lung injury (TRALI)?</em></span><br /><br /><br /><span style="color:#660000;">Answer</span>: <span style="color:#000000;">Laboratory findings may include unexpected haemoconcentration and a sudden fall in serum albumin. As in other causes of acute alveolar capillary leak, the pulmonary exudate in TRALI has a high albumin content. Peripheral blood neutropenia has been reported but neutrophilia is more common.</span><br /><br /><br /><br /><span style="color:#003300;">Reference:<br /><br /></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/10439802?dopt=Abstract"><span style="color:#003300;">The pathology of transfusion-related acute lung injury.</span></a><span style="color:#003300;"> Am J Clin Pathol 1999; 112: 216–21<br /></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-52695634681857131762010-08-27T07:18:00.000-07:002010-08-27T07:18:00.609-07:00<span style="color:#660000;"><strong>Q:</strong></span> <strong><em><span style="color:#003333;">One purpose of administrating local anesthesia (lidocaine) during Arterial line placement is to relieve pain for patient. What other purpose does it serve?<br /></span></em></strong><br /><strong><span style="color:#660000;">Answer:</span></strong> <strong><span style="color:#000000;">A subcutaneous infiltration of anesthetic around the puncture site also help in reducing vessel spasm beside providing pain relief to a patient.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-75188579448589485132010-08-26T00:41:00.000-07:002010-08-26T00:41:00.840-07:00<span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><div align="left"><span style="font-family:Arial,Helvetica,sans-serif;color:#000000;"><span style="color:#660000;"><span style="color:#000000;"><strong><span style="color:#660000;"><span style="color:#660000;"><span style="color:#990000;">Editors' note</span><strong><span style="color:#660000;">:</span><em><span style="color:#003300;"> On <a href="http://08-2010-icuroom.blogspot.com/2010_08_21_archive.html" target="_blank"><span style="color:#000066;">August 21, 2010</span></a>, we posted a pearl with conclusion that Norepinephrine is more stable in D5W rather than in NS. We received following study as counter argument from "Zach"! </span></em></strong></span></span></strong></span></span></span></div><div align="left"> </div><br /><div align="left"><span style="font-family:Arial,Helvetica,sans-serif;color:#000000;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#660000;"><strong><em><span style="color:#000066;">Can J Anaesth. 2008 Mar;55(3):163-7.<br /></span></em><br /></strong><strong><span style="color:#660000;">Stability of norepinephrine infusions prepared in dextrose and normal saline solutions.<br /></span><br /><span style="font-size:85%;"><em>Tremblay M, Lessard MR, Trépanier CA, Nicole PC, Nadeau L, Turcotte G. -</em>Department of Anesthesiology, Centre hospitalier affilié universitaire de Québec, Université Laval, Québec City, Québec, Canada.</span></strong></span></span></span></span><br /></div><div align="left"><span style="font-family:Arial,Helvetica,sans-serif;color:#000000;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#660000;"><strong><br /><br />PURPOSE: <span style="color:#000066;">Norepinephrine (NE) infusions are commonly used in the intensive care unit and in the operating room. Data on long term stability of NE solutions are lacking. This prospective study was designed to evaluate the stability of NE, in dextrose (5%) in water (D5W) and in normal saline (NS) solutions, for a period up to seven days.<br /></span><br />METHODS:<span style="color:#000066;"> We prepared norepinephrine solutions in quadruplicate, by aseptically diluting 1 mg NE in 250 mL of D5W or NS and 4 mg NE in 250 mL of D5W or NS (final concentrations, 4 microg x mL(-1) and 16 micro x mL(-1), respectively) and stored the solutions at room temperature under ambient light. We sampled the solutions, in duplicate, at times 0, 24, 48, 72, 120, and 168 hr and stored them at -80 degrees C for later assay. Norepinephrine concentrations were measured by high-performance liquid chromatography with electrochemical detection (coefficient of variation 4.6%). Statistical analysis was done by nonparametric, repeated measures ANOVA (Friedman test).</span><br /><br />RESULTS: <span style="color:#000066;">There was no significant decrease in NE concentration for either, NE 4 microg x mL(-1) in D5W or NS (P = 0.09 and 0.11, respectively) or for NE 16 microg x mL(-1) in D5W or NS (P = 0.18 and 0.40, respectively). The ratios of NE concentration at 168 hr, compared to baseline, were 95.7% and 96.4%, for NE 4 microg x mL(-1) in D5W and NS, respectively, and 104.5% and 96.4%, for NE 16 microg x mL(-1) in D5W and NS, respectively.</span><br /><br />CONCLUSION: <span style="BACKGROUND-COLOR: #ccffff;color:#000066;" >Norepinephrine solutions, in concentrations commonly used in the clinical setting, are chemically stable for seven days, at room temperature and under ambient light, when diluted either in D5W or NS.</span></strong> </span></span></span></span></div></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-15143585401628671902010-08-25T11:32:00.001-07:002010-08-25T11:32:46.354-07:00<strong><span style="color:#990000;">Soda-bicarb to prevent contrast induced nephropathy</span></strong><br /><strong></strong><br /><strong><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">How you write the order for soda bicarbonate infusion in preventing contrast induced nephropathy ?<br /></span></em><br /><span style="color:#660000;">A:</span> <span style="color:#000000;">Use 154meq/L of sodium bicarbonate (3 amps) in 1 litre of D5W.Give 3ml/kg/hr one hr prior to the exam.Give 1ml/kg/hr during the exam and for 6 hours after the exam.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-7196115549967770532010-08-24T07:38:00.000-07:002010-08-24T07:38:00.673-07:00<p><span style="color:#000000;"><span style="color:#660000;">Q;</span></span><span style="color:#003333;"><em> Succinylcholine is contraindicated (relatively) for intubation in which poisoining?</em></span></p><p><span style="color:#000000;"><span style="color:#660000;">Answer:</span> Organophosphate poisoning.Organophosphate may potentiate effects of succinylcholine. Succinylcholine is relatively contraindicated in Organophosphate poisoining</span></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-4719159628952300282010-08-23T00:41:00.000-07:002010-08-23T00:41:00.591-07:00<strong><span style="color:#990000;">Critical Care Humor</span><br /><br /><span style="color:#000000;">Never use needle on a patient if you have an empty stomach and a full bladder!<br /></span></strong><br /><em><span style="color:#000000;">(you never know what procedure may take)</span></em>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-63076118197066369342010-08-21T06:08:00.000-07:002010-08-21T06:08:00.077-07:00<span style="color:#990000;">Preparation of NOREPINEPHRINE</span><br /><br /><span style="color:#000000;">NOREPINEPHRINE (LEVOPHED) drip should be prepared in dextrose containing solution (D-5). NOREPINEPHRINE (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>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-2569381067880029929.post-26185686061736441942010-08-20T07:56:00.000-07:002010-08-20T07:56:00.176-07:00<span style="color:#000000;"><span style="color:#660000;">Q;</span> <em><span style="color:#003300;">24 year old female 2 weeks post partum developed severe headache of one week followed by seizure. While you start workup what would be your presumptive diagnosis and line of mangement?</span></em><br /><br /></span><br /><span style="color:#000000;"><span style="color:#660000;">Answer:</span> Postpartum cerebral vasospasm would be high on list<br /></span><br /><span style="color:#000000;">Cerebral angiography or Magnetic resonance imaging/angiography should be perform as soon as possible to rule out vasospasm. IV fluid should be started with atleast 125 cc/hour and goal to keep BP high. Treatment consist of hyperosmolar, hypervolemic therapy and nimodipine</span>.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-91760273260847452162010-08-19T00:44:00.000-07:002010-08-19T00:44:00.512-07:00<span style="color:#000000;"><strong><span style="color:#660000;">Neuro-Critical Care</span></strong><br /><br /><span style="color:#660000;">Q;</span> <em><span style="color:#003333;">Beside it's use in prevention of vasospasm in Subarachnoid hemorrhage - what could be the other less known uses of Nimodipine?<br /></span></em><br /><span style="color:#660000;">Answer:</span> </span><span style="color:#000000;">Though not as effective but it can be use as an alternative or an adjuvent to magnesium for seizure prophylaxis in women with severe preeclampsia.</span><br /><span style="color:#000000;"></span><br /><span style="color:#000000;">Also it has an adjuvent value in the treatment of intractable seizure.</span><br /><span style="color:#000000;"></span><br /><em><span style="color:#000000;">Please note that FDA warned against using Nimodipine capsules as IV.</span><br /><span style="color:#000000;"></span></em><br /><span style="color:#000000;">Nimodipine has been originally designed for the treatment of high blood pressure but is not used for this indication anymore.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-54919769351822746922010-08-18T00:52:00.000-07:002010-08-18T00:52:00.616-07:00<span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><div align="left"><strong><span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;color:#000000;"><span style="color:#660000;">Trivia!</span></span></strong></div><div align="left"><strong><span style="font-size:85%;color:#660000;"></span></strong><br /><span style="font-family:Arial,Helvetica,sans-serif;"><span style="color:#660000;">Q;</span> <em><span style="color:#003333;">Do you know the meaning of word "sepsis" (word origin)?</span></em><br /><br /><br /><span style="color:#660000;">Answer: <span style="color:#000066;"><span style="color:#000000;">Sepsis is derived from a Greek word <em>"sepo" </em>meaning “I rot”. Historically first time described in the poems of Homer</span>.</span></span></span><br /></div><p><span style="font-family:Arial,Helvetica,sans-serif;"><strong><span style="color:#660000;"><span style="font-size:78%;color:#003300;">Reference: </span></span></strong></span></p><p><span style="font-family:Arial,Helvetica,sans-serif;"><strong><span style="color:#660000;"><a href="http://www.springerlink.com/content/434318p2t6w3m822/" target="_blank"><span style="font-size:78%;color:#003300;">Historical perspective of the word Sepsis</span></a><span style="font-size:78%;"><span style="color:#003300;"> - Intensive Care Medicine(2006), Volume 32, Number 12, page <span class="pagination">2077</span></span></span></span></strong></span></p><p><span style="font-family:Arial,Helvetica,sans-serif;"><strong><span style="font-size:78%;color:#003300;"></span></strong></p></span></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-85270172206763746352010-08-17T08:51:00.000-07:002010-08-17T08:51:00.080-07:00<em><span style="color:#003333;"><span style="color:#660000;">Q;</span> After successful completion of Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for variceal bleeding - hepatic encephalopathy __________ ?</span></em><br /><br /><em><span style="color:#003333;">A) tends to get better</span></em><br /><em><span style="color:#003333;">B) tends to get worse</span></em><br /><em><span style="color:#003333;">C) It has nothing to do with TIPS</span></em><br /><br /><span style="color:#660000;"></span><br /><span style="color:#660000;">Answer</span> <span style="color:#000000;">is B</span><br /><span style="color:#000000;"></span><br /><span style="color:#000000;">Hepatic encephalopathy tends to get worse after successful completion of TIPS as due to shunting, blood flow to the liver is reduced, which might result in increase toxic substances reaching the brain without being metabolized first by the liver. It can be treated medically such as diet, lactulose or by narrowing of the shunt by insertion of a reducing stent.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-7987352962349500432010-08-16T02:49:00.000-07:002010-08-15T14:52:03.932-07:00<strong><span style="font-size:130%;color:#990000;">Back to Basic - MoA ACE inhibitors</span></strong><br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtDiSwDe7q9I2j5sH9xqtieznY39dfiFgjJCWtqrlY4ZJ1IsQnDQS-1QFO7lkxinPpXAV3xWom7Z3MJsjZ6_29e4RLVA3LFWG0l3fjZXie-hmjZPPBBboKRjygc6mN57e8lIo1zyKvQiL1/s1600/ACEmoa.gif"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 400px; DISPLAY: block; HEIGHT: 320px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5505757097939492418" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtDiSwDe7q9I2j5sH9xqtieznY39dfiFgjJCWtqrlY4ZJ1IsQnDQS-1QFO7lkxinPpXAV3xWom7Z3MJsjZ6_29e4RLVA3LFWG0l3fjZXie-hmjZPPBBboKRjygc6mN57e8lIo1zyKvQiL1/s400/ACEmoa.gif" /></a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-88094347169137943502010-08-15T02:35:00.000-07:002010-08-15T02:35:00.269-07:00<span style="font-size:130%;color:#660000;">Drug interaction<br /></span><br /><em><span style="color:#003333;"><span style="color:#660000;">Q</span>: Which 2 commonly used cardiac medicines may interact negatively?</span></em><br /><br /><span style="color:#660000;">Answer:</span> <span style="color:#000000;">Aspirin and ACE inhibitors</span><br /><br /><span style="color:#000000;">Effects of ACE inhibitors are attenuated by aspirin. </span><br /><br /><span style="color:#000000;">ACE inhibitors decrease angiotensin II production and inhibit breakdown of bradykinin. Bradykinin stimulates vasodilator prostaglandins via a cyclo-oxygenase–dependent pathway.</span><br /><span style="color:#000000;"><br />Aspirin inhibits cyclo-oxygenase-1 (COX-1), thereby reducing synthesis of vasodilatory prostaglandins.</span><br /><br /><span style="color:#000000;">Above interaction may be of more academic interest. In clinical practice - there are no firm guidelines for use of both drugs simultaneously</span>.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-24733194552450244422010-08-14T05:49:00.000-07:002010-08-14T05:49:00.393-07:00<span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><div align="left"><span style="font-size:130%;color:#990000;"><strong>New Brain Death Guidelines!</strong></span><span style="color:#660000;"></div><span style="color:#000000;"><span style="color:#660000;"><br /><p align="left"><span style="color:#000000;">The American Academy of Neurology has released new guidelines for determining brain death in adults. The recommendations provide step-by-step instructions to help guide clinical decision making.</span></p><p align="left"><span style="color:#003300;"><span style="color:#660000;"><span style="color:#990000;"><span style="color:#000000;">The guidelines are published in the June 8 issue of Neurology.</span></p><p><span style="color:#000000;">Among other the notable thing is that more than 1 exam is not required in the new brain death guidelines. Clinicians usually perform 2 exams. In new guidelines one time brain death exam is sufficient.</span></p><br /><p><span style="color:#000000;">Click </span><a href="http://www.neurology.org/cgi/content/full/74/23/1911" target="_blank"><span style="color:#660000;">here</span></a><span style="color:#000000;"> to get full update.</span></p></span></span></span></span></span></span></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-26869341334066644542010-08-13T00:01:00.000-07:002010-08-13T00:01:00.708-07:00<span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><div align="left"><span style="font-size:85%;">On Friday the 13th!</span></div><br /><div align="left"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#660000;"><span style="color:#003300;"><span style="color:#660000;"><span style="color:#990000;"><em>Q: <span style="color:#003300;">What is the possible explanation behind Lazarus Syndrome?</span></em></span></span></span></div><span style="color:#003300;"><span style="color:#660000;"><span style="color:#990000;"></span><br /><p align="left"><span style="color:#000000;"><span style="color:#000066;"><span style="color:#660000;"></span></span></span> </p><p align="left"><span style="color:#000000;"><span style="color:#000066;"><span style="color:#660000;">Answer</span><strong>:</strong> </span></span><span style="color:#000000;">Lazarus Syndrome is a generic term use in hospitals when patient shows sign of life after clinically declared dead, like a patient that develops vital signs after cessation of resusitative efforts or organ-donation team arrives to find a live person. </span></p><p align="left"><span style="color:#000000;">Possible explanation is that a chief factor is the buildup of pressure in the chest as a result of cardiopulmonary resuscitation (CPR). The relaxation of pressure after resuscitation efforts have ended is thought to allow the heart to expand, triggering the heart's electrical impulses and restarting the heartbeat.</span></p><p align="left"></span></span><span style="color:#000000;">The syndome is named after bible story in which Jesus brought back to life a dead person named Lazarus from his tomb. Term became very popular after publication of book "The Lazarus syndrome: Burial alive and other horrors of the undead" (Rodney Davies - 1978). </span></p><p align="left"><span style="color:#003300;"><span style="color:#660000;"><span style="color:#000000;">In recent years, 'Lazarus Syndrome' has also been use for HIV/AIDS patients who feel having new chance of living with new HIV medications.</span> </span></span></p></span></span></span></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-65195575819223002952010-08-12T00:17:00.000-07:002010-08-12T00:17:00.347-07:00<div align="left"><span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#660000;"><span style="color:#003300;"><span style="color:#660000;"><em>Q:</em></span> </span><span style="color:#003300;"><em>24 year old male presented with syncope. Patient has family history of sudden cardiac deaths in family and you strongly suspect </em><em>Brugada syndrome. Which drug can be use to elicit specific EKG patterns for diagnosis of Brugada syndrome?</em></span></div><div align="left"><br /><span style="color:#660000;"><em></em></span> </div><div align="left"><span style="color:#660000;"><em>Answer: </em> </span><span style="color:#003300;">Flecainide</span></div><div align="left"><br /></div><p align="left"><span style="color:#000000;">The Brugada syndrome is a genetic disorder characterised by abnormal EKG findings and an increased risk of sudden cardiac death particularly in young men without known underlying cardiac disease.</span></p><p align="left"><span style="color:#000000;">Brugada syndrome can be detected by observing characteristic patterns on an EKG, which may be present all the time, or in clinical suspicion can be elicited by the administration of Class IC antiarrhythmic drugs (like flecainide) that blocks sodium channels and causing appearance of ECG abnormalities.</span></p><div align="left"><span style="color:#000066;"><em>Review on </em><a href="http://emedicine.medscape.com/article/163751-overview" target="_blank"><span style="color:#660000;"><em>Brugada Syndrome</em></span></a><em> at</em> </span><span style="color:#003300;"><em>emedicine.com</em></span></div></span></span></span></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-2558641019173383372010-08-11T05:55:00.000-07:002010-08-11T05:55:00.059-07:00<span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><div align="left"><span style="font-size:85%;"><strong>The End of the Code</strong></span><span style="color:#660000;"><br /><span style="color:#000000;"><span style="color:#660000;"><br /><p><em><span style="color:#003300;">"When I was but an EMT lad in an ED I witnessed something I’ve incorporated into my own practice, and I think every doc should do it. When it’s ‘that time’, time to stop the resuscitation, in every instance I say something along the lines of “Okay, we’ve been coding this person for xx minutes, and there’s been (brief summary): does anyone here want to do anything else? If so, tell me now”. This does two things which are important for everyone in the room who isn’t dead: it makes them part of the decision making process, and it empowers them to very easily object should they wish, for whatever reason, to continue. “I’d like to give some (whatever)” is then totally fine, and they’re not having to object in a vague way that they’re not done yet with what can be a terrifically personal struggle to save someone none of us has met, or knows as anyone other than a patient. We give the whatever, and after a while, given the persistence of death, I’ll give my speech as many times as it takes (so far, twice has been all, but I’d be perfectly willing to go on for a long time), because it’s important for everyone involved to acknowledge that they did what they could, and to be comfortable with stopping.</span></em></p><p><em><span style="color:#003300;">Codes end, very occasionally with a happy outcome, more often than not with a patient under a sheet, but the people who were there need to feel like they had a chance to do all they could.</span></em></p><p><em><span style="color:#003300;">Death is forever, and so is guilt; I want to make certain the dead don’t take the living with them"</span></em></p><p>Taken from blog of <a href="http://gruntdoc.com/2007/03/the-end-of-the-code.html" target="_blank">GruntDoc</a></p></span></span></span></div></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-42016541160126457972010-08-10T06:44:00.000-07:002010-08-10T06:44:00.492-07:00<div align="left"><span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#660000;">Q:</span> <span style="color:#003333;"><em>Describe the significance of "Herald Bleeding" in</em> <span style="color:#003300;"><em>Primary aortoenteric fistula</em></span><span style="color:#000000;"> (</span><em>PAEF)?</em></span><br /></div></span></span><br /><p><span style="color:#660000;"><span style="color:#000000;"><em><span style="color:#660000;"></span></em></span></span> </p><p><span style="color:#660000;"><span style="color:#000000;"><em><span style="color:#660000;">Answer:</span></em> <span style="color:#000000;"> One of the known characteristic of PAEF is of a "herald" bleeding followed hours, days, or even weeks later by a catastrophic bleeding. The herald bleeding is the result of a small fistula tamponaded by thrombus formation. If the fistula continues to expand or the occluding thrombus is removed, massive hemorrhage results</span><span style="color:#000066;">. </span></span></span></p><p><span style="color:#000066;">C</span><span style="color:#000000;"><span style="color:#000066;"><em><span style="color:#003300;">linical significance:</span></em> </span></span><span style="color:#000000;">This is probably the only window of opportunity to salvage the patient before massive bleed takes over. Emergency exploratory laparotomy should be done as soon as the diagnosis is considered clinically. Mortality is 100% without surgical intervention.</span></p><p><span style="color:#000000;">Communications between the aorta and the intestine resulting from disease at either site are referred to as primary aortoenteric fistulas. Causes include untreated aortic aneurysm, infectious aortitis, erosion of the intestine by prosthetic vascular grafts, esophageal cancer etc. Refer other texts for more detailed descriptions<strong>.</strong></span></p></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-48076768073029560062010-08-09T00:14:00.000-07:002010-08-09T18:46:55.367-07:00<div align="left"><span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">Whats the best measure of titrating Atropine drip in Organophosphate poisoning?</span></em>
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<br /><div align="left"><span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><span style="color:#660000;"><span style="color:#000000;"><span style="color:#660000;"><strong>Answer:</strong></span> </span><span style="color:#000000;">Control of hypersecretions served as the best monitoring parameter for titration of the drip rate. Organophosphate (OP) toxicity itself is a clinical diagnosis. </span></span><span style="color:#000000;">There is no clinical lab value which can be followed except for above clinical objective finding. </span><span style="color:#000000;"><span style="color:#000066;"><span style="color:#000000;">Following mnemonic can be used to remember the muscarinic effects of organophosphates</span>.</span></span></div>
<br /><p align="left"><span style="color:#000000;"><span style="color:#000066;"><span style="color:#660000;"><em>SLUDGE</em></span><strong>:</strong> <span style="color:#000000;">salivation, lacrimation, urination, diarrhea, GI upset, emesis</span></span></span></p><p align="left"><span style="color:#000066;"><span style="color:#000000;"><span style="color:#000066;"><span style="color:#660000;"><em>DUMBELS</em><strong>:</strong></span> <span style="color:#000000;">diaphoresis and diarrhea; urination; miosis; bradycardia, bronchospasm, bronchorrhea; emesis; excess lacrimation; and salivation</span><strong>.</strong></span> </span></span></p>
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<br /><span style="color:#000000;"><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">Which vitamin deficiency may cause life threatening lactic acidosis?</span></em>
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<br /><span style="color:#000000;"><span style="color:#660000;">Answer:</span> Thiamine (Vitamin B1) deficiency</span>
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<br />Thiamine is part of the pyruvate-dehydrogenase (PDH) complex. Its deficiency inhibits pyruvate entry into mitochondria.
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<br /><em><span style="color:#003333;">Clinical implication:</span></em> It is important to add Thiamine on patients requring long term parentral nutrition (TPN).</span>
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<br /><span style="font-size:85%;">Reference: Click to get references</span></span><span style="font-size:85%;">
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<br /><span style="color:#003333;">1. </span></span><a href="http://www.ncbi.nlm.nih.gov/pubmed/1813718" target="_blank"><span style="font-size:85%;color:#003333;">Thiamine deficiency as a cause of life threatening lactic acidosis in total parenteral nutrition</span></a><span style="font-size:85%;"><span style="color:#003333;"> - Klin Wochenschr. 1991;69 Suppl 26:193-5.</span>
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<br /><span style="color:#003333;">2. </span></span><a href="http://www.mayoclinicproceedings.com/content/74/3/259.abstract" target="_blank"><span style="font-size:85%;color:#003333;">Metabolic acidosis and thiamine deficiency</span></a><span style="font-size:85%;"><span style="color:#003333;"> - Mayo clinic Proceedings, March 1999 vol. 74 no. 3 259-263 </span>
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<br /><span style="color:#003333;">3. </span></span><a href="http://pen.sagepub.com/cgi/content/abstract/15/1/105" target="_blank"><span style="font-size:85%;color:#003333;">Severe Lactic Acidosis Related to Acute Thiamine Deficiency</span></a><span style="font-size:85%;"><span style="color:#003333;"> - Journal of Parenteral and Enteral Nutrition, Vol. 15, No. 1, 105-109 (1991)</span>
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<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-43121859267336914382010-08-07T00:57:00.000-07:002010-08-11T19:20:06.169-07:00<span style="font-family:Arial,Helvetica,sans-serif;font-size:85%;"><span style="font-size:100%;"><span style="color:#000000;"><span style="color:#000000;"><div align="left"><br /><span style="color:#660000;">Q</span>:<span style="color:#003300;"><em> <span style="color:#003300;">Despite being an old player Sucralfate is still very well indicated in stress ulcer prophylaxis. What is the mechanism of action of sucralfate?</span></em></span></div><div align="left"></div><br /><div align="left"><span style="color:#003300;"><em><span style="color:#660000;"></span></em></span></div><div align="left"><span style="color:#003300;"><em><span style="color:#660000;">Answer</span>:</em> </span><span style="color:#000000;">Sucralfate act by multiple mechanisms </span></div><div align="left"><br /><span style="color:#000000;">1. Sucralfate acting locally that in an acidic environment , reacts with hydrochloric acid in the stomach to form a cross-linking, viscous, paste-like material capable of acting as an acid buffer for as long as 6 to 8 hours after a single dose. </span></div><div align="left"> </div><div align="left"><span style="color:#000000;">2. It also attaches to proteins on the surface of ulcers, such as albumin and fibrinogen, to form stable insoluble complexes. These complexes serve as protective barriers at the ulcer surface, preventing further damage from acid, pepsin, and bile<strong>. </strong></span></div><br /><div align="left"><span style="color:#000000;">3. It prevents back diffusion of hydrogen ions.</span></div><br /><div align="left"><span style="color:#000000;">4. It adsorbs both pepsin and bile acids. </span></div><br /><div align="left"><span style="color:#000000;">5. Sucralfate also stimulates the increase of prostaglandin E<sub><span style="font-size:85%;">2</span></sub>, epidermal growth factors (EGF), bFGF, and gastric mucus<strong>.</strong></span></div></span></span></span></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-20091863257954730082010-08-06T01:27:00.000-07:002010-08-05T17:40:12.437-07:00<span style="color:#000000;"><span style="color:#660000;">Q:</span><em><span style="color:#003300;"> How Dexilant (Dexlansoprazole) is different from other PPIs (Proton Pump Inhibitors)?<br /></span></em><br /><br /><span style="color:#330000;">Answer</span>: Dexilant has a DUAL DELAYED RELEASE mechanism. It contains two different types of granules for two releases of medicine. Dexilant works by releasing one shift of medicine within an hour of taking it to decrease the amount of acid in stomach. Around 4–5 hours later, Dexilant releases a second shift of medicine.<br /><br />How much advantage does it provide over other PPIs has yet to be determine in independent studies.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2569381067880029929.post-50504665664361714912010-08-05T06:16:00.000-07:002010-08-05T06:16:00.844-07:00<span style="color:#000000;"><span style="color:#000066;">Thursday August 5, 2010</span><br /><br /></span><br /><span style="color:#000000;"><span style="color:#660000;">Q:</span> <em><span style="color:#003333;">What is the difference between available synthetic thyroid hormone replacement and natural thyroid hormone replacement in market?</span></em><br /><br /></span><br /><span style="color:#000000;"><span style="color:#660000;">Answer</span>: <span style="color:#000000;"><span style="color:#000000;">Synthetic thyroid hormone contains T4 only and is therefore largely ineffective for patients unable to convert T4 to T3. Also some patients may develop allergy to synthetic thyroid hormone.<br /><br />Natural thyroid treatments hormones are still available. Armour Thyroid is the most popular brand available and is a natural, porcine-derived thyroid replacement containing both T4 and T3. The ratio of Thyroid T4 to T3 is 4.22:1.<br /></span><br />Armour thyroid is available in strengts as grains (1/4, 1/2, 1 grains).<br /><br />1 grain of Armour is approximately equal to 100 mcg of levothyroxine</span>.</span>Unknownnoreply@blogger.com0