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https://www.readbyqxmd.com/read/28518009/aeromedical-evacuation-using-extra-corporeal-life-support-after-resuscitated-cardiac-arrest
#1
David Gerard, Hervé Raffin, Guillaume Lebreton
BACKGROUND: Extra corporeal life support (ECLS) is presently first line therapy for refractory cardiogenic shock. Mobile circulatory support teams implant ECLS or extra corporeal membrane oxygenation (ECMO) in patients in the hospital without circulatory support. These patients are then transported to specialized centers. Here we report a case of sending a mobile circulatory support team abroad, followed by air ambulance evacuation, which, to our knowledge, has never been used as part of medical assistance abroad...
April 1, 2017: Aerospace Medicine and Human Performance
https://www.readbyqxmd.com/read/28515824/cardiogenic-shock-acute-severe-mitral-regurgitation-and-complete-heart-block-after-cavo-tricuspid-isthmus-atrial-flutter-ablation
#2
Thein Tun Aung, Edward Samuel Roberto, Kevin D Kravitz
Radiofrequency (RF) ablation is the first-line management of cavo-tricuspid isthmus dependent atrial flutter. It has been performed with 95% success rate. Adverse events are very rare. We report the first case of acute severe mitral regurgitation (MR) and complete heart block developed after successful atrial flutter ablation. A 62-year-old female with mild MR presented with palpitations. Surface electrocardiogram was suggestive of isthmus dependent atrial flutter. A duodecapolar mapping catheter showed an atrial flutter with cycle length of 280 ms...
April 2017: Cardiology Research
https://www.readbyqxmd.com/read/28512051/membranectomy-in-chronic-subdural-hematoma-a-meta-analysis
#3
REVIEW
Ronald Sahyouni, Hossein Mahboubi, Peter Tran, John S Roufail, Jefferson W Chen
OBJECTIVE: Initial management strategies of chronic subdural hematoma (cSDH) are controversial, and range from bedside twist-drill or burr hole drainage, to craniotomy with membranectomy (CWM). We aim to (1) perform a meta-analysis of the available data on the outcomes of CWM for treatment of cSDH in published English-language literature, and (2) evaluate collective outcomes of CWM with respect to morbidity, mortality, and recurrence rates. METHODS: A search of English-language literature performed in PubMed, Ovid, and Cochrane databases using keywords ("subdural hematoma" or "chronic subdural hematoma") and ("membrane" or "membranectomy") from inception to December 2016 was conducted...
May 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28510765/research-priorities-in-the-area-of-sleep-circadian-rhythm-and-aging-research-commentary-on-report-and-research-agenda-of-the-american-geriatrics-society-and-national-institute-on-aging-bedside-to-bench-conference-on-sleep-circadian-rhythms-and-aging-new-avenues
#4
https://www.readbyqxmd.com/read/28507284/melanoma-masquerading-as-a-zosteriform-rash
#5
Saif Ibrahim, Bashar Al-Turk, Ciel Harris, Farrah Al-Saffar, Sayf Said, Maheera Farsi, Jeffrey Winder, Christian Landa
BACKGROUND Primary care physicians and internal medicine specialists frequently encounter a variety of rashes. Many of these cases look and feel typical of common entities, resulting in the potential for misdiagnosis. CASE REPORT This is a case of a zosteriform rash where the surprising true diagnosis of metastatic melanoma was confirmed with bedside skin punch biopsy. Possible mechanisms involve direct cutaneous injury, neuronal, and dorsal root ganglia involvement in metastases. CONCLUSIONS Skin biopsy is indispensable especially when there is a lack of clinical response or deterioration in the clinical condition...
May 16, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28496376/changing-trends-in-residents-as-teachers-across-graduate-medical-education
#6
Morhaf Al Achkar, Mathew Hanauer, Elizabeth H Morrison, M Kelly Davies, Robert C Oh
BACKGROUND: Teaching residents how to teach is a critical part of residents' training in graduate medical education (GME). The purpose of this study was to assess the change in resident-as-teacher (RaT) instruction in GME over the past 15 years in the US. METHODS: We used a quantitative and qualitative survey of all program directors (PDs) across specialties. We compared our findings with a previous work from 2000-2001 that studied the same matter. Finally, we qualitatively analyzed PDs' responses regarding the reasons for implementing and not implementing RaT instruction...
2017: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/28489618/core-competencies-or-a-competent-core-a-scoping-review-and-realist-synthesis-of-invasive-bedside-procedural-skills-training-in-internal-medicine
#7
Ryan Brydges, Lynfa Stroud, Brian M Wong, Eric S Holmboe, Kevin Imrie, Rose Hatala
PURPOSE: Invasive bedside procedures are core competencies for internal medicine, yet no formal training guidelines exist. The authors conducted a scoping review and realist synthesis to characterize current training for lumbar puncture, arthrocentesis, paracentesis, thoracentesis, and central venous catheterization. They aimed to collate how educators justify using specific interventions, establish which interventions have the best evidence, and offer directions for future research and training...
May 9, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28484983/ischemic-preconditioning-in-the-intensive-care-unit
#8
REVIEW
Maranatha Ayodele, Sebastian Koch
Preconditioning is the premise that controlled preemptive exposure to sub-lethal doses of a stressor and can condition an organism or organ to later withstand a lethal dose. This process relies on marshaling endogenous survival resources that have evolved as part of an organism's evolutionary struggle to overcome at times harsh environmental conditions. This preconditioning response occurs through activation of myriad complex mechanisms that run the gamut from alterations in gene expression to the de novo synthesis and post-translational modification of proteins, and it may occur across exposure to a wide variety of stressors (i...
June 2017: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/28483242/prevention-of-post-operative-pediatric-tracheotomy-wounds-a-multidisciplinary-team-approach
#9
Timothy P McEvoy, Nolan B Seim, Abdullah Aljasser, Charles A Elmaraghy, Brenda Ruth, Leslie Justice, Sarah Begue, Kris R Jatana
OBJECTIVE: Tracheotomy-related pressure wounds have been reported as high as 29%. All advanced stage (stage 3 or 4) wounds are reported by hospitals, and CMS will no longer reimburse healthcare costs to manage them. We present the results of an intensive, multidisciplinary wound prevention strategy starting in the operating room at the time of tracheotomy placement. METHODS: Prospective analysis of a tracheostomy wound care protocol at an academic, tertiary-care pediatric hospital from September 2012 to February 2016...
June 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28481454/severe-acute-valproic-acid-intoxication-successfully-treated-with-liver-support-therapy
#10
Yongchun Ge, Bin Xu, Chuan Li, Qunpeng He, Tingting Zhu, Rong Fan, Dehua Gong
Valproic acid (VPA) is widely used for treatment of epilepsy. However, its overdose can cause intoxication and could be life-threatening. Due to lack of specific antidote and poorness of endogenous clearance, extracorporeal treatment for severe intoxication cases is indicated. Here, we report a case of severe intoxication of VPA which was successfully treated with liver support therapy. A previously healthy woman was admitted due to coma and hypotension after intentional ingestion of 20 g of sodium valproate...
May 8, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28480083/optic-nerve-sheath-diameter-as-a-bedside-assessment-for-elevated-intracranial-pressure
#11
Peter Williams
A previously fit and healthy 26-year-old lady with no significant medical history presented with a two-month history of headaches. The headaches were prolonged, generalised, and unusually severe for the patient. Examination revealed papilloedema. The patient's optic nerve sheath diameter was measured 3 mm posterior to the globe and found to be 7.5 mm. The patient subsequently had computed tomography scan of her brain that showed an optic nerve sheath diameter of 7.56 mm as measured 3 mm posterior to the globe...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28479425/thrombolytic-therapy-of-acute-massive-pulmonary-embolism-using-swan-ganz-pulmonary-artery-catheter
#12
Ilse Espina, Joseph Varon, Peter H Lin
Acute massive pulmonary embolism (PE) is associated with high fatality, and catheter-directed thrombolytic therapy has been shown to be an efficacious treatment for this condition. We herein report a patient who developed acute massive PE but could not undergo the conventional catheter-directed thrombolytic therapy. A Swan-Ganz pulmonary artery catheter was placed at bedside to initiate immediate thrombolytic infusion, which resulted in dramatic clinical improvement. This report underscores a potential role of thrombolytic therapy via a trans-jugular pulmonary artery catheter in patients with acute massive PE who could not undergo the conventional catheter-based thrombolytic intervention...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28474654/pulmonary-artery-catheter-directed-thrombolysis-for-intermediate-high-risk-acute-pulmonary-embolism
#13
Abhijeet Singh, Ayush Gupta, Jagdish Chander Suri
A case of 60-year-old male with acute pulmonary embolism without hypotension but signs of right ventricular dysfunction and elevated cardiac biomarkers is reported in this study. The patient comes under intermediate high-risk category and was successfully thrombolysed with alteplase infused through pulmonary artery catheter. Catheter-directed thrombolysis (CDT) can be considered as much safer and effective alternative to systemic thrombolysis in such patients with lower risk of bleeding. This novel bedside method of pulmonary artery CDT with the advantage of no radiation exposure and real time monitoring of pulmonary artery pressures as an end-point of thrombolysis can be utilized in the near future...
May 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/28466666/european-and-russian-physician-awareness-of-best-management-approaches-for-infections-due-to-antibiotic-resistant-gram-negative-bacteria
#14
Paurus Irani, Tehseen Salimi, Robert Epstein, Megan Leone-Perkins, Ronald Aubert, Mona Khalid, Emma Epstein, J Russell Teagarden
OBJECTIVES: The rapid spread of infections due to antibiotic-resistant, Gram-negative bacteria in Europe and surrounding regions requires a heightened level of awareness among physicians within their practice settings. METHODS: We surveyed 800 physicians who treat these infections across France, Germany, Spain, Italy, and Russia to assess their awareness of best management approaches. RESULTS: We found that more than two-thirds do not consider themselves highly aware of best management practices...
May 3, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28464782/from-ocean-to-bedside-the-therapeutic-potential-of-molluscan-hemocyanins
#15
Negar Talaei Zanjani, Monica Miranda Saksena, Fariba Dehghani, Anthony L Cunningham
Hemocyanins are large and versatile glycoproteins performing various immunological and biological functions in many marine invertebrates including arthropods and molluscs. This review discusses the various pharmacological applications of mollusc hemocyanin such as antiviral activity, immunostimulatory and anticancer properties that have been reported in the literature between the years 2000 and 2016. Emphasis is placed on a better mechanistic understanding of hemocyanin as a therapeutic agent. Elucidation of the mechanism of action is essential to improve the clinical efficacy and for a better understanding of some endogenous immunological functions of this complex glycoprotein...
May 2, 2017: Current Medicinal Chemistry
https://www.readbyqxmd.com/read/28461545/family-presence-during-trauma-resuscitation-family-members-attitudes-behaviors-and-experiences
#16
Karen O'Connell, Jennifer Fritzeen, Cathie E Guzzetta, Angela P Clark, Christina Lloyd, Shari H Scott, Michael D Aldridge, Barbara Kreling
BACKGROUND: The paradigm is shifting from separating family members from their children during resuscitation to one of patient- and family-centered care. However, widespread acceptance is still lacking. OBJECTIVE: To measure attitudes, behaviors, and experiences of family members of pediatric patients during the resuscitation phase of trauma care, including family members who were present and those who were not. METHODS: An observational mixed-methods study using structured interviews and focus groups was conducted at 3 level 1 pediatric trauma centers...
May 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28456907/bispectral-index-monitoring-in-cancer-patients-undergoing-palliative-sedation-a-preliminary-report
#17
Edith Monreal-Carrillo, Silvia Allende-Pérez, David Hui, Maria-Fernanda García-Salamanca, Eduardo Bruera, Emma Verástegui
INTRODUCTION: Continuous palliative sedation (PS) is currently titrated based on clinical observation; however, it is often unclear if patients are still aware of their suffering. The aim of this prospective study is to characterize the level of consciousness in patients undergoing PS using Bispectral Index (BIS) monitoring. PATIENTS AND METHODS: We enrolled consecutive patients with refractory symptoms requiring PS. We documented the level of sedation using Ramsay Sedation Scale (RSS) and BIS at 0, 2, 4, 6, 12, and 24 h during the first day of PS and examined their degree of association...
April 29, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28451468/a-feasibility-study-of-intermittent-electrical-stimulation-to-prevent-deep-tissue-injury-in-the-intensive-care-unit
#18
Angela Kane, Robyn Warwaruk-Rogers, Chester Ho, Ming Chan, Richard Stein, Vivian K Mushahwar, Sean P Dukelow
Objective: The primary goal of this study was to investigate the feasibility of utilizing intermittent electrical stimulation (IES) in an intensive care environment as a potential method for preventing pressure ulcers. Furthermore, we wished to evaluate the practicality of the innovation and end-user acceptability. Approach: Twenty immobile subjects, age ranging from 19 to 86 years old with a Braden Scale score ranging from 9 to 16 (very high to moderate risk of developing pressure ulcers), were enrolled. Intermittent 35 Hz electrical stimulation was administered through surface electrodes to the gluteal muscles causing them to contract for 10 s every 10 min...
April 1, 2017: Advances in Wound Care
https://www.readbyqxmd.com/read/28445175/traumatic-ventral-septal-defect-after-stab-wound-to-the-chest-missed-by-transthoracic-echocardiogram-a-case-report
#19
Abimbola O Faloye, Raphael Y Gershon
Traumatic ventral septal defect may be sustained after either blunt force or penetrating trauma to the chest. Severity ranges from asymptomatic to acute decompensated heart failure. Our patient suffered a stab wound to the chest and was initially taken to the operating room for repair of a lacerated right ventricle. Subsequent postoperative hemodynamic deterioration prompted a bedside transthoracic echocardiogram, which failed to identify causal factors. A transesophageal echocardiogram performed immediately after ventral septal defect was demonstrated...
April 25, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28443583/retrograde-cerebral-air-embolism-in-a-patient-with-intestinal-necrosis-a-case-report
#20
Onur Taydaş, Mehmet Ruhi Onur, Erhan Akpınar
BACKGROUND: Cerebral venous air embolism (CVAE) is a severe clinical condition related to unfavoured outcome in patients with neurological impairment. CVAE may occur secondary to arterial or venous interventions. A rare mechanism of CVAE is retrograde embolism that is characterized by gas flow in a direction opposite to that of the normal blood flow. CASE REPORT: A 69-year-old female was admitted to our hospital with shortness of breath and abdominal pain. Abdominal computed tomography (CT) revealed intramural gas in the bowel and free gas in the mesenteric veins and portal vein...
April 13, 2017: Balkan Medical Journal
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