Stellate Ganglion Nerve Block by Point-of-Care Ultrasonography for Treatment of Refractory Infarction-Induced Ventricular Fibrillation

We report the case of a 65-year-old man brought in by ambulance who complained of chest pain and received an out-of-hospital ECG suggestive of anterior-wall ST-segment elevation myocardial infarction. Shortly after arrival, the patient became unresponsive, with no palpable pulse, and was found to be in ventricular fibrillation. The patient’s ventricular fibrillation persisted despite repeated attempts at standard and double sequential defibrillation, multiple rounds of epinephrine, and amiodarone, magnesium, and bicarbonate. After these interventions were exhausted, a stellate ganglion blockade was conducted after an ultrasonographically guided paratracheal approach. Return of spontaneous circulation was noted after the next defibrillation and pulse check, achieved after a total of 42 minutes of active cardiopulmonary resuscitation. The patient ultimately had both sufficient neurologic activity and hemodynamic recovery for emergency percutaneous coronary intervention of the culprit left anterior descending artery. This positive outcome is multifactorial but suggests sympathetic blockade as a possible adjunctive therapy in the setting of sustained pulseless ventricular storm.
Source: Annals of Emergency Medicine - Category: Emergency Medicine Source Type: research

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In conclusion, HFD-induced hypertension is not driven by increased sympathetic neurotransmission to MA in male and female Dahl ss rats. PMID: 31731103 [PubMed - in process]
Source: Autonomic Neuroscience - Category: Neuroscience Authors: Tags: Auton Neurosci Source Type: research
We report an optic atrophy spectrum disorder, including retinal macular dystrophy and kidney insufficiency leading to transplantation, associated with mitochondrial DNA (mtDNA) depletion without accumulation of multiple deletions. By whole-exome sequencing, we identified mutations affecting the mitochondrial single-strand binding protein (SSBP1) in 4 families with dominant and 1 with recessive inheritance. We show that SSBP1 mutations in patient-derived fibroblasts variably affect the amount of SSBP1 protein and alter multimer formation, but not the binding to ssDNA. SSBP1 mutations impaired mtDNA, nucleoids, and 7S-DNA am...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
Mitochondrial dysfunction or loss is evident in neurodegenerative diseases. Furthermore, mitochondrial DNA (mtDNA) mutations associated with NADH dehydrogenase subunits and nuclear gene mutations that affect mitochondrial function result in optic neuropathies. In this issue of the JCI, Del Dotto et al. and Piro-Mégy et al. identify heterozygous mutations in nuclear-encoded mitochondrial single-strand binding protein 1 (SSBP1) in patients with apparently dominant optic neuropathy with or without extraocular phenotypes. Both research groups reported similar mitochondrial findings in response to SSBP1 mutations. Howeve...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
CONCLUSION: Our analysis found that patients had excellent outcomes across multiple PROM metrics. Future work can build on these results with large patient populations over longer follow-up intervals. Nevertheless, these results provide the foundation and evidence to support the continued use of this innovative technology for total knee arthroplasties. PMID: 31732961 [PubMed - as supplied by publisher]
Source: Surgical Technology International - Category: Surgery Tags: Surg Technol Int Source Type: research
Authors: Wang J, Chen Z Abstract Pain is a salient and complex sensory experience with important affective and cognitive dimensions. The current definition of pain relies on subjective reports in both humans and experimental animals. Such definition lacks basic mechanistic insights and can lead to a high degree of variability. Research on biomarkers for pain has previously focused on genetic analysis. However, recent advances in human neuroimaging and research in animal models have begun to show the promise of a circuit-based neural signature for pain. At the treatment level, pharmacological therapy for pain remain...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
Anyone got some good websites for a pharmacist to brush up on critical care and emergency med topics? I've been working overnights inpatient the last 3 months, and I've been noticing these topics are the main things that the residents call down to ask about. Eg: recently learned that giving Calcium won't do much if the Magnesium is also low.
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Pharmacy Source Type: forums
Authors: Apostu D, Lucaciu O, Mester A, Oltean-Dan D, Baciut M, Baciut G, Bran S, Onisor F, Piciu A, Pasca RD, Maxim A, Benea H Abstract Articular cartilage has a complex structure and metabolism which allow for a proper movement within joints. Nevertheless, several systemically administered pharmacological agents have been proved to improve the anabolic response in the case of cartilage lesions. Alendronate, glucosamine, chondroitin sulfate, hyaluronic acid, collagen hydrolysate, vitamin C, vitamin D, aspirin and strontium ranelate have shown positive results in clinical trials. On the other hand, calcitonin, rise...
Source: Drug Metabolism Reviews - Category: Drugs & Pharmacology Tags: Drug Metab Rev Source Type: research
Authors: Girard BC, Lévy P Abstract PURPOSE: To determine the significance of dry eye syndrome in benign essential blepharospasm. DESIGN: Retrospective consecutive case series. PARTICIPANTS: One hundred and forty-four patients (288 eyes) with benign essential blepharospasm. METHODS: All subjects had Schirmer I tear tests. Those scores were analysed as a function of patient age, sex, and blepharospasm severity. MAIN OUTCOME MEASURES: Individual Schirmer-test scores in both eyes of all patients. RESULTS: A total of 144 eligible subjects (mean age±SD: 68.3±11.5 years; 76% femal...
Source: Journal Francais d Ophtalmologie - Category: Opthalmology Tags: J Fr Ophtalmol Source Type: research
Authors: Goemaere I, Banayan N, Borderie V, Bouheraoua N PMID: 31732267 [PubMed - as supplied by publisher]
Source: Journal Francais d Ophtalmologie - Category: Opthalmology Tags: J Fr Ophtalmol Source Type: research
CONCLUSION: Optic neuritis is a pathology frequently encountered in ophthalmology; a good knowledge of symptoms and clinical signs is essential for early diagnosis and optimal management. The identification of autoantibodies, including anti-MOG antibodies, is important for patient management and is part of the required testing for all cases of optic neuritis, in order to adapt the treatment of the acute episode and to provide maintenance therapy to avoid recurrence. PMID: 31732265 [PubMed - as supplied by publisher]
Source: Journal Francais d Ophtalmologie - Category: Opthalmology Tags: J Fr Ophtalmol Source Type: research
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