Stone heart syndrome
Brief Review
Global ischemic contracture of the heart resulting in a firm myocardium and loss of intracavitary volume is termed stone heart syndrome.1 Physiologists have long described cardiac arrest in systole with calcium which is also considered as the danger of with intravenous calcium in the presence of digoxin toxicity (digitoxicity). Stone heart syndrome was described as a complication of cardiopulmonary bypass in the early years of cardiac surgery as an inability to successful resuscitation.2 This complication of cardiopulmonary bypass has largely been prevented in later years with good cardioplegia.
Prevention ...
Source: Cardiophile MD - December 17, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs
CCC Update 009
Here is a quick overview of the major updates and revisions to the LITFL Critical Care Compendium since CCC Update 008.Check these out:Airway and cervical spine injuriesPeople can get pretty twitchy about intubating patients with suspected cervical spine injuries. Apply MILS, use a bougie and perform rapid sequence intubation. What’s so hard about that?… Airway management in Major TraumaAn overview of the issues affecting airway management in major trauma, including the indications for intubation the possible causes of airway compromise in this setting.Antimicrobial stewardshipUpdated with a recent systematic rev...
Source: Life in the Fast Lane - December 15, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Critical Care Compendium Emergency Medicine FCICM Fellowship Intensive Care CCC update FCICM exam Source Type: blogs
Research and Reviews in the Fastlane 059
This study looked at national survey data from 2009-2010 of patients >18 y/o presenting to the ED (n=44,448 visits) and found that cardiac enzyme testing was performed in 16.9% of visits, including in 8.2% of visits lacking ACS-related symptoms (which includes things like nausea, vomiting, abdominal pain, dyspnea, etc). This begs the question, why then, was a troponin (or ck-mb) ordered? It’s probably not changing management. In an era in which we’re discovering that there are harms to downstream testing, this study calls out just how trigger happy we may be. As more sensitive cardiac assays are used, this m...
Source: Life in the Fast Lane - November 26, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE airway brain failure critical care Emergency Medicine General Surgery hypothermia Intensive Care prehospital recommendations Review Trauma Source Type: blogs
Post operative cardiac arrhythmias
Post operative cardiac arrhythmias are a major cause of morbidity and mortality, more so following surgery for congenital heart disease. Tolerability of arrhythmia is less in the postoperative period than for similar arrhythmia in the preoperative period. Hemodynamic instability is more likely due to the possibility of myocardial dysfunction. Cardiopulmonary bypass, injury to the conduction system during surgery, metabolic and electrolyte abnormalities, especially hypokalemia and hypomagnesemia contribute to the increased incidence of postoperative arrhythmias. Stress of the surgery with enhanced sympathetic tone and use ...
Source: Cardiophile MD - November 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery ECG / Electrophysiology Source Type: blogs
Cardiology MCQ: Hypothermia for post op arrhythmia
Hypothermia for post op arrhythmia is used in case of:
a) Complete heart block
b) Atrial fibrillation
c) Junctional ectopic tachycardia
d) None of the above
Correct answer: c) Junctional ectopic tachycardia
Hypothermia for post op arrhythmia is used in case of junctional ectopic tachycardia (JET). JET is a unique postoperative arrhythmia, especially seen in children after surgery for congenital heart disease and it is often difficult to treat. It is likely to recur after cardioversion as it is due to enhanced automaticity. Sedation and cooling (hypothermia) are helpful.
Postoperative cardiac arrhythmias are a major cause o...
Source: Cardiophile MD - November 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
Research and Reviews in the Fastlane 057
This study compared bivalirudin to unfractionated heparin with the primary combined endpoint of death, CVA, reinfarction and target lesion revascularization. In spite of the fact that the trial was designed to favor bivalirudin (open-label), the authors found an increased rate in the primary outcome in the bivalirudin group (8.7% vs. 5.7%). Further proof that just because a drug is new, doesn’t mean it’s better.
Recommended by: Anand Swaminathan
Trauma, PediatricsAltgärde J, Redéen S, Hilding N, Drott P. Horse-related trauma in children and adults during a two year period. Scand J Trauma Resusc Emerg Med. 2...
Source: Life in the Fast Lane - November 10, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma Wilderness Medicine airway brain failure critical care General Surgery hypothermia Intensive Care prehospital recommendations Review Source Type: blogs
Read this ECG
What is the diagnosis here?The computer read was ****Acute STEMI****What is really going on?See Answer BelowThis is a trauma patient (motor vehicle collision) who arrived with a temperature of 27 degrees Celsius. Among many injuries was a traumatic diaphragmatic hernia, which may also affect the ECG. The prominent features are: relative bradycardia (one would expect in this ill trauma patient) and Osborn Waves in V3-V6. The most common finding in hypothermia is atrial fibrillation with a slow ventricular response (not seen here). The computerized QTc was 489 ms (accurate).After warming, another ECG was re...
Source: Dr. Smith's ECG Blog - November 8, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cardiology MCQ 372: Hypothermia for post op arrhythmia
Hypothermia is used for treatment of which post operative arrhythmia?
a) Complete heart block
b) Atrial fibrillation
c) Junctional ectopic tachycardia
d) None of the above
["Click here for the answer with explanation", "Correct Answer:"]
c) Junctional ectopic tachycardia
Junctional ectopic tachycardia (JET) is a unique postoperative arrhythmia, especially in children after cardiac surgery. JET is often difficult to treat. It is likely to recur after cardioversion. Sedation and cooling (hypothermia) are helpful. Read more on post operative cardiac arrhythmias…
The post Cardiology MCQ 372: Hypothermia for post...
Source: Cardiophile MD - November 2, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
Cardiology MCQ 373: Hypothermia for post op arrhythmia
Hypothermia is used for treatment of which post operative arrhythmia?
a) Complete heart block
b) Atrial fibrillation
c) Junctional ectopic tachycardia
d) None of the above
["Click here for the answer with explanation", "Correct Answer:"]
c) Junctional ectopic tachycardia
Junctional ectopic tachycardia (JET) is a unique postoperative arrhythmia, especially in children after cardiac surgery. JET is often difficult to treat. It is likely to recur after cardioversion. Sedation and cooling (hypothermia) are helpful. Read more on post operative cardiac arrhythmias…
The post Cardiology MCQ 373: Hypothermia for post...
Source: Cardiophile MD - November 2, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
Research and Reviews in the Fastlane 052
This study looked at compliance with discharge instructions. Surprisingly (or maybe not so), 39% of pediatric patients returned to play (RTP) on the day of the injury. RTP is widely recognized as a risk for recurrent and more severe concussions as well as significant morbidity. It is the duty of the Emergency Physician to stress the importance of discharge instructions as well as the importance of appropriate follow up.
Recommended by: Anand Swaminathan
PediatricsSingleton T et al. Emergency department care for patients with hemophilia and von Willebrand disease. J Emerg Med. 2010; 39(2): 158-65. PMID: 18757163
Bleeding...
Source: Life in the Fast Lane - October 9, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Anaesthetics Cardiology Clinical Research Education Emergency Medicine Haematology Infectious Disease Intensive Care International Emergency Medicine Microbiology Neurosurgery Obstetrics / Gynecology Ophthalmology Source Type: blogs
Research and Reviews in the Fastlane 051
Welcome to the 51st edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 10 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out...
Source: Life in the Fast Lane - October 6, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Gastroenterology Infectious Disease Intensive Care Pre-hospital / Retrieval Respiratory Resuscitation critical care literature R&R in the FASTLANE recommendations Research an Source Type: blogs
Who should be receiving therapeutic hypothermia?
Thanks to the popularity of medical television shows, most people have witnessed hundreds of fictional cardiac arrests in their lifetime. In most of these scenes, the patient loses consciousness, and the medical team rushes to the bedside:
“He’s in v-fib.”
“Get me the paddles.”
The team performs urgent chest compressions for a few seconds. Then they place the metal paddles on the victim’s chest:
“Clear!” Kathump.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 17, 2014 Category: Journals (General) Authors: Peter Ubel, MD Tags: Conditions Emergency Neurology Source Type: blogs
Joan Rivers Out of ICU and “Comfortable” Likely Ominous
Although we are not participating in the care of comedy legend Joan Rivers, we have noted news reports that her daughter Melissa has said her mother is out of the ICU and being kept comfortable.
Rivers was hospitalized six days ago after suffering cardiac arrest and a prolonged anoxic period (brain without oxygen.) She was placed in a hypothermic coma (lowered body temperature) as is standard for the first 24-48 hours after arrest in an attempt to salvage brain and cardiac function.
However, reading between the lines of this recent statement, this is likely an ominous development and could signal the start of a comfort car...
Source: Inside Surgery - September 4, 2014 Category: Surgery Authors: Editor Tags: Anesthesia Medical News Wire Uncategorized ativan comfort care dying ICU Joan Rivers morphine Source Type: blogs
Research and Reviews in the Fastlane 046
This study looked at initiating cooling prehospital after out of hospital cardiac arrest with resuscitation. No surprise, these patients cooled faster, reaching 34 degrees > 1 hour faster! Unfortunately, this early cooling did not show a benefit in survival or neurologic outcome. This was true for both VF and non-VF arrest. Prehospital cooling reduced core temperature by hospital arrival and reduced the time to reach a temperature of 34°C, but did not improve survival or neurological status among patients resuscitated from prehospital VF or those without VF
Recommended by: Salim Rezaie, Zach Repanshek
The R&R i...
Source: Life in the Fast Lane - September 1, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Clinical Research Emergency Medicine R&R in the FASTLANE critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs
Out of hospital cardiac arrest
is an important mechanism of death through out the world and the survival rates are poor even in those who are resuscitated [Berdowski J et al. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation,2010: 81:1479–1487]. Survival to discharge range from two percent in Asia to eleven percent in Australia, with Europe and North America coming in between.
It is well known that the critical links in the chain of survival for out of hospital cardiac arrest (or for any cardiac arrest for that matter) are early activation of emergency response, early c...
Source: Cardiophile MD - August 26, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
