Q; 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?
Answer: 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.
Give only half of recommended dose of Adenosine.
Reference:
Historical perspective of the word Sepsis - Intensive Care Medicine(2006), Volume 32, Number 12, page 2077
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.
The guidelines are published in the June 8 issue of Neurology.
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.
Click here to get full update.
Answer: 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.
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.
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).In recent years, 'Lazarus Syndrome' has also been use for HIV/AIDS patients who feel having new chance of living with new HIV medications.
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.
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.
"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.
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.
Death is forever, and so is guilt; I want to make certain the dead don’t take the living with them"
Taken from blog of GruntDoc
Answer: 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.
Clinical significance: 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.
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.
SLUDGE: salivation, lacrimation, urination, diarrhea, GI upset, emesis
DUMBELS: diaphoresis and diarrhea; urination; miosis; bradycardia, bronchospasm, bronchorrhea; emesis; excess lacrimation; and salivation.
Pleural calcification occurs in about 50% with asbestos-related disease, especially along the diaphragmatic pleura. (White arrow)The overall appearance of the plaque has been likened to a holly leaf. (Black arrows) point to many of the calcified pleural plaques.
