Tuesday February 10, 2009
Q: In Hypothermia induced Ventricular fibrillation which cardiac medicine is preferred and which one may harm the patient?
Answer: Bretylium (5 mg/kg initially) is recommended for any hypothermic patient manifesting significant new frank dysrhythmia. However, bretylium has a worldwide shortage and may not be available. Relying on Amiodarone or Lidocaine are the next choices.
Procainamide may induce more ventricular fibrillation and should be avoided.
Defibrillation should also be performed simultaneously. Defibrillate at 2 J/kg (or the biphasic equivalent) if patient remains in ventricular fibrillation or ventricular tachycardia. Success rates of defibrillation are low if the core temperature is less than 32°C and should be performed with rise in body temperature. Actually, because many arrhythmias convert spontaneously upon rewarming, aggressive therapy of minor arrhythmias is not warranted. Transient ventricular arrhythmias should be ignored. This also is true of bradycardia or atrial arrhythmias.
The cornerstone of treatment is rewarming the patient.
Tuesday, February 10, 2009
Monday, February 9, 2009
Monday February 9, 2009
Case: 68 year old male presented to ER with left sided weakness and CVA (stroke) is suspected. Patient has chronic history of atrial fibrillation and is on coumadin 4 mg every day and record shows previously consistent therapeutic INR of 2.6 but today patient's INR is 1.4. According to wife, patient is very compliant with his medicines, rather he is very health conscious and lately start doing more healthy diet consist of frequent green tea, fish oil, ginseng, canola oil etc.
Answer: Green Tea carries a huge amount of Vitamin K. It is also present in clinically significant amount in other healthy diets and herbals like fish oil, ginseng, canola oil etc.
Related Web site: WarfarinDosing.org
Its a free Web site to help doctors begin warfarin therapy by estimating the therapeutic dose in patients new to warfarin. This site is supported by the Barnes-Jewish Hospital at Washington University Medical Center, the NIH, and donations. Estimates are based on clinical factors and (when available) genotypes of two genes: cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1).
Case: 68 year old male presented to ER with left sided weakness and CVA (stroke) is suspected. Patient has chronic history of atrial fibrillation and is on coumadin 4 mg every day and record shows previously consistent therapeutic INR of 2.6 but today patient's INR is 1.4. According to wife, patient is very compliant with his medicines, rather he is very health conscious and lately start doing more healthy diet consist of frequent green tea, fish oil, ginseng, canola oil etc.
Answer: Green Tea carries a huge amount of Vitamin K. It is also present in clinically significant amount in other healthy diets and herbals like fish oil, ginseng, canola oil etc.
Related Web site: WarfarinDosing.org
Its a free Web site to help doctors begin warfarin therapy by estimating the therapeutic dose in patients new to warfarin. This site is supported by the Barnes-Jewish Hospital at Washington University Medical Center, the NIH, and donations. Estimates are based on clinical factors and (when available) genotypes of two genes: cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1).
Sunday, February 8, 2009
Sunday February 8, 2009
Case: 48 year old male presented to ER with Shortness of Breath. CXR showed massive left sided pleural effusion. ER physician inserted chest tube but to surprise white milky fluid get drained from chest. You made diagnosis of "Nontraumatic" Chylothorax. What are the 5 major causes of "Nontraumatic" Chylothorax?
Answer:
Pseudochylothorax: Chylothorax must be distinguished from pseudochylothorax, or cholesterol pleurisy, which results from accumulation of cholesterol crystals in a chronic existing effusion. The most common cause of pseudochylothorax is chronic rheumatoid pleurisy, followed by tuberculosis and poorly treated empyema.
Case: 48 year old male presented to ER with Shortness of Breath. CXR showed massive left sided pleural effusion. ER physician inserted chest tube but to surprise white milky fluid get drained from chest. You made diagnosis of "Nontraumatic" Chylothorax. What are the 5 major causes of "Nontraumatic" Chylothorax?
Answer:
- Lymphoma
- cirrhosis,
- tuberculosis,
- sarcoidosis,
- amyloidosis
Pseudochylothorax: Chylothorax must be distinguished from pseudochylothorax, or cholesterol pleurisy, which results from accumulation of cholesterol crystals in a chronic existing effusion. The most common cause of pseudochylothorax is chronic rheumatoid pleurisy, followed by tuberculosis and poorly treated empyema.
Saturday, February 7, 2009
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