Wednesday October 14, 2009


Q: What is "cryo reduced plasma"?

A; One unit of cryoprecipitate is derived from one unit of fresh frozen plasma (FFP). Left over FFP, after removal of cryoprecipitate is called supernatant plasma or CRYO-REDUCED PLASMA.Clinical Significance: Cryo-reduced plasma is used as a treatment in plasmapheresis for TTP, not responding to regular plasma exchange with FFP. Some physicians even use it as first line for plasmapheresis/Therapeutic Plasma Exchange (TPE) for a patient with Thrombotic Thrombocytopenic Purpura (TTP).

Tuesday October 13, 2009


Q: Claviprex (clevidipine butyrate) is a newly approved IV medication for acute hypertension control as a continuous infusion. It is a lipid based drug (like propofol). How many calories it provides per cc via lipid?

Answer: Claviprex (clevidipine butyrate) provides about 2 kilocalories per cc to patient. In contrast, Diprivan (propofol) provides 1.1 kilocalories per ml to patient.

Monday October 12, 2009
Acetaminophen overdose Nomogram

Sunday October 11, 2009


Q: While performing cardioversion for atrial flutter, synchronization of electric shock should occur with (Select one)

A) P wave in EKG
B) QRS comples in EKG
C) R wave in EKG
D) T wave in EKG
E) ST segment in EKG


Answer: While performing cardioversion for atrial flutter, synchronization of electric shock should occur to R waves.

Saturday October 10, 2009
What is Lazarus Syndrome

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. 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.

Friday October 9, 2009
Increases in Endotracheal Tube Resistance Are Unpredictable Relative to Duration of Intubation


Background: Accumulated secretions after intubation can affect the resistance of an endotracheal tube (ETT). Our objective was to measure extubated patient tubes and size-matched controls to evaluate differences in resistance.

Methods: New ETTs, with internal diameters of 7.0 through 8.5 mm, were tested as controls to establish the resistance of each size group as measured by pressure drop. Measurements were obtained using a mass flowmeter and pressure transducer. Pressure drop was measured at three flow rates.

Seventy-one patient ETTs were evaluated after extubation by an identical method and compared with controls.

Results:

• In each control group, pressure drop was tightly clustered with low variation and no overlap between sizes.
• A total of 73 to 79% of the patient ETTs had a pressure drop of more than 3 SDs of size-matched controls at all flow rates.
• Pressure drop in 48 to 56% (across three flow rates) of extubated tubes was equivalent to the next smaller size of controls.
• At 60 and 90 L/min, 10% and 15% of patient tubes, respectively, had the pressure drop of a control tube three sizes smaller.
• The pressure drop was unpredictable relative to the duration of intubation.

Conclusions:

• Organized secretions can significantly increase resistance as measured by the pressure drop of ETTs.
• The degree of change was highly variable, occurs in all sizes, and was unrelated to the duration of intubation.
• The performance of an ETT may be comparable to new tubes one to four sizes smaller.
• This may impact the tolerance of ventilator weaning.
  
  
  

References: Click to get abstract/article


Increases in Endotracheal Tube Resistance Are Unpredictable Relative to Duration of Intubation - CHEST October 2009 vol. 136 no. 4 1006-1013

Thursday October 8, 2009
Hemodialysis in Salicylate overdose with normal level

Hemodialysis is recommended in salicylate overdose patients with a level at or above 100 mg/dL (cut it to half if history suggest chronic ingestion). But if there is any sign of neurological manifestation, dialysis is indicated despite normal level.
Salicylate cause "neuroglycopenia" (lower CNS glucose level) despite normal serum glucose. As patient gets more and more acidotic, salicylate enters CNS and by direct effect cause neuroglycopenia.

7 indications of Hemodialysis in Salicylate poisoning

1. Mental status change
2. Pulmonary edema
3. Cerebral edema
4. Associated or with renal failure
5. Level at or above 100 mg/dL(half if chronic ingestion)
6. If fluid overload prevents alkalinization.
7. Patient continue to deteriorate clinically.
   
   

References: Click to get abstract/article

1. Toxicity, Salicylate - please register free at emedicine.com

2.An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose -Emerg Med J 2002; 19:206-209