Cardiovascular surgeries with high risk of bleeding
:
Re-do surgeries
Surgeries in the setting of infective endocarditis
Coronary artery bypass grafting (CABG) after failed percutaneous coronary intervention (PCI) – bail out procedures
Aortic dissection
Open surgeries for thoracic and abdominal aorta (Source: Cardiophile MD)
Source: Cardiophile MD - January 9, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Hospital Quality Helps Explain Some Of The Racial Disparities In Outcomes After CABG
It has long been known that racial disparities exist in health care. A large body of research has found that nonwhite patients have worse outcomes than whites. But it has been difficult to understand the underlying reasons for these disparities. Now a new study offers evidence that, at least in the case of bypass surgery, a significant but by no means complete portion of this disparity is due to decreased access among nonwhites to high quality hospitals. In a paper published in JAMA Surgery, Govind Rangrass and colleagues analyzed Medicare data from 173,925 CABG patients. 8.6% of the More… (Source: CardioBrief)
Source: CardioBrief - January 8, 2014 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events Policy & Ethics Prevention, Epidemiology & Outcomes bypass surgery CABG Medicare racial disparities Source Type: blogs
Specific risk for bleeding with CABG
Coronary artery bypass grafting (CABG) surgery has a few specific factors to it which can cause bleeding:
a) Whole body heparinization therapy
b) Platelet dysfunction due to cardiopulmonary bypass pump
c) Altered fibrinolysis (Source: Cardiophile MD)
Source: Cardiophile MD - January 8, 2014 Category: Cardiology Authors: Johnson Francis Tags: Cardiac Surgery Coronary artery bypass grafting Source Type: blogs
I Only Smoke Two Cigarettes A Day (Good Smoking Humor).
For centuries, doctors have been taught to be suspicious of any patient that says, "I only smoke two cigarettes a day" or "I only drink two beers a day." No alcoholic drinks just two beers a day and no smoker smokes just two cigarettes a day. It just doesn't happen. Part of being an addict is to minimize their addiction. The Happy Hospitalist is always on guard for trickery and slight of words. After interrogation, many patients who claim to only drink two beers a day are found to top it off with 12 shots of whiskey. Other times, the two drinks are discovered to be bot...
Source: The Happy Hospitalist - January 8, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Ischemic Chest Pain and Hypertension: Use of Adjunctive Anti-ischemic Therapy
A middle aged male with several CAD risks has had several months of exertional angina relieved by rest and nitro. He had the onset of chest discomfort at rest and presented by ambulance about 3 hours later with "severe crushing chest pain," with a blood pressure of 200/100 and pulse of 100. The prehospital ECG cannot be found. Here is his initial ED ECG:Sinus rhythm, nearly tachycardia. Left axis deviation with QRS of 90 ms, R-wave peak time in aVL perhaps reaches 45 ms, so possible left anterior fascicular block. There is minimal ST depression (but also a wandering baseline) in V3-V6.Exam was...
Source: Dr. Smith's ECG Blog - January 7, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Why we persevere despite a poor prognosis
Last night, I responded to a code blue while working the night float at the hospital. The patient was a relatively young female who had just completed a coronary artery bypass procedure. Per training, I began compressing her chest to induce blood flow to the rest of her body.
As I pushed, the incision reopened and blood began spewing everywhere. I could feel her ribs giving and cracking from the force of my weight, yet she still remained asystolic for approximately 15 minutes. From the look in the eyes of the cardiothoracic surgeon running the code, her prognosis was not good.
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Source: Kevin, M.D. - Medical Weblog - December 29, 2013 Category: Family Physicians Tags: Education Heart Hospital Medical school Source Type: blogs
Did You Know?
There are numerous benefits to applying blood conservation principles in patient care, most often referred to as Patient Blood Management. For example:
Allogeneic transfusion is emerging as a potent risk factor for many complications commonly seen in hospitalized patients. – Mt. Sinai Journal of Medicine http://onlinelibrary.wiley.com/doi/10.1002/msj.21290/full
Donated blood doesn’t transfer oxygen from the blood to the body tissues as effectively as the patient’s own blood does. - Forbes http://www.forbes.com/sites/marijkevroomendurning/2013/08/14/blood-transfusions-after-surgery-multiple-units-...
Source: MSSPNexus Blog - December 26, 2013 Category: Health Managers Authors: rkschwab Tags: Blood Management Patient Safety patient blood management Source Type: blogs
From a prospective parent !
This is a guest post , which provides a great perspective on what infertile couples want from their IVF clinic !My journey so far is frustrating. Several medicated cycles, 2 failed IUI (2 cancelled IUI), 1 IVF and 2 FET (one canceled FET). All failed. But that is ok. It made me a better person, more informed person. I am more patient, humble and more confident about myself now. I now appreciate child birth as an absolute miracle of the nature. I appreciate my mother and all the women with children or who are ‘Child Free’, by choice or by circumstances or their condition. Do you wonde...
Source: The Patient's Doctor - December 9, 2013 Category: Obstetricians and Gynecologists Tags: Dr Malpani ivf patients Malpani Clinic prospective parent Source Type: blogs
Stents Lose In Comparisons With Surgery And Medical Therapy
Despite the enormous increase in the use of stents in recent decades, there is little or no good evidence comparing their use to the alternatives of CABG surgery or optimal medical therapy in patients also eligible for these strategies. Now two new meta-analyses published in JAMA Internal Medicine provide new evidence that the alternatives to PCI remain attractive and that some of the growth in PCI may have been unwarranted. … Click here to read the full post on Forbes. (Source: CardioBrief)
Source: CardioBrief - December 3, 2013 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery Policy & Ethics Boston Scientific CABG Coronary artery bypass surgery coronary artery disease European Society of Cardiology Medtronic myocardial infarction Percutaneous coronary intervention stents Source Type: blogs
What hospitals can learn from the Thanksgiving Day Parade
by Jenn Riggle
Thanksgiving is a time known for pilgrims, football and eating way too much turkey. It also marks the beginning of the holiday season with the Macy's Thanksgiving Day Parade.
While hospitals may not be in the business of selling sweaters and scarves, they can learn some marketing lessons from the grand dame of department stores.
Celebrate your community: The Thanksgiving Day parade is not only a celebration of the holiday season, it also celebrates New York City. Hospitals need to celebrate the communities they serve. It's been said healthcare is local. However, being a local hospital is more than calling...
Source: hospital impact - November 23, 2013 Category: Health Managers Authors: Wendy Johnson Source Type: blogs
You MUST recognize this pattern, even if it is not common
Disclaimer: I never state from where I get a case. They come from all over the world. Any case may or may not be from my own institution. Do not make any assumptions.Case: A non-English speaking woman in her 60's with h/o HTN, type II DM, hyperlipidemia, CAD s/p CABG 16 years prior, and end stage renal disease on dialysis presented to the ED at time 0. She had awoken 7 hours prior with severe headache followed by upper chest heaviness and vomited x 2. EMS placed an 18 gauge IV, gave 2 NTG, and aspirin. She stated the pain was not similar to a previous MI. BP was 200 systoli...
Source: Dr. Smith's ECG Blog - November 22, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care.
Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!).
These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs
Does anemia impact hospital readmission rates after CABG surgery?
Nadine Shehata and colleagues studied this question in a recently published article (abstract) in the August 2013 issue of Transfusion. This is a single-institution study of 2,102 patients who underwent CABG surgery at the University of Ottawa Hospital. 224 of... (Source: The Daily Sign-Out)
Source: The Daily Sign-Out - November 9, 2013 Category: Pathologists Authors: Mark D. Pool, M.D. Tags: Blood Banking Blood Management Blood Utilization Source Type: blogs
Best graft for coronary artery bypass grafting
(CABG) is:
a) Reversed saphenous vein
b) Left radial artery
c) Left internal mammary artery
d) None of the above
Correct answer: c) Left internal mammary artery (LIMA) is till date the best available vessel for CABG. It has good long term patency rate and provides a pulsatile flow. Saphenous vein graft are prone for degeneration and thrombosis. Left radial artery being a free graft unlike the in-situ LIMA graft, is inferior to LIMA graft, but probably superior to RSVG (reversed saphenous vein graft – or simply SVG). (Source: Cardiophile MD)
Source: Cardiophile MD - November 3, 2013 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance left radial graft LIMA reversed saphenous vein graft RSVG Source Type: blogs
New Insights Into Surgery Versus Stents For Diabetics With Multivessel Disease
Last year the large NHLBI FREEDOM trial demonstrated that bypass surgery was superior to PCI when treating diabetic patients who have multivessel coronary disease. CABG resulted in significant reductions in death and MI, but this was offset slightly by a higher rate of stroke in the CABG group. Now a new report from FREEDOM published in JAMA suggests that the reduction in important clinical endpoints may not translate into large differences in health status and quality of life. … Click here to read the full post on Forbes. (Source: CardioBrief)
Source: CardioBrief - October 17, 2013 Category: Cardiology Authors: Larry Husten Tags: Interventional Cardiology & Surgery People, Places & Events CABG Conventional PCI Coronary artery bypass surgery JAMA national heart lung and blood institute quality of life Source Type: blogs
