Sunday October 18, 2009
Clipping of Cerebral Aneurysm

Saturday October 17, 2009
Mechanism of Thrombocytopenia and Thrombosis in HIT (Heparin induced Thrombocytopenia)

Friday October 16, 2009
Bedside trick - suspecting tracheal aspiration!

One quick method of suspecting tracheal aspiration or atleast ruling out tracheal aspiration is checking glucose concentration by regular bedside glucose meters. A glucose concentration of more than 20 mg/dl of bloodless tracheal aspirate doesn't confirm but atleast enhance the suspicion of tracheal aspiration.

Though literature is full of conflicting data for this method but still it is a very quick, effective and easy way of suspecting or ruling out tracheal aspiration.



References: click to get abstracts / articles

1. Clinical implications of the glucose test strip method for early detection of pulmonary aspiration in nasogastric tube- fed patients - Taehan Kanho Hakhoe Chi. 2004 Dec;34(7):1215-23

2. Comparison of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults - Chest, Vol 103, 117-121

3. Glucose content of tracheal aspirates: Implications for the detection of tube feeding aspiration. Crit Care Med 1994; 22:1557-1562

4. Glucose Content of Tracheal Aspirates - Letter to the Editor - Critical Care Medicine: Volume 23(8) August 1995 pp 1451-1452

Thursday October 15, 2009


Q: How Hextend is different from regular 6% hetastarch in 0.9% NS?

Answer: 6% hetastarch in 0.9% NS contains 154 mEq/L of Sodium and 154 mEq/L of chloride along with 6% hetastarch.

Hextand is 6% Hetastarch in Lactated Electrolyte solution with following amounts of electrolytes

• Sodium (mEq/L) = 143
• Chloride (mEq/L) = 124
• Calcium (mEq/L) = 5
• Potassium (mEq/L) = 3
• Magnesium (mEq/L) = 0.9
• Dextrose/ Glucose Units (g/L) =0.99

Hextend also contains 28mEq/L lactate, which acts as a source of bicarbonate in patients with unimpaired lactate metabolism.

Related previous pearls:

Normosol is NOT just Normal Saline
Difference between Lactate Ringer's and Normal Saline solutions

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