Monday, January 31, 2011
Answer: Transfusion of cryoprecipitate.
Prepare for administration of 6 to 8 units of cryoprecipitate containing factor VIII. It is not a bad idea to also adminster 6 to 8 units of platelets.
Sunday, January 30, 2011
A; Delta-p is diastolic blood pressure minus intracompartmental pressure. It is a measure of perfusion pressure. Delta-p measurements of less than 30 mm Hg is used for fasciotomy. Other clinical situations should be taken into consideration.
Saturday, January 29, 2011
A; It is a simple poor man's test to diagnose renal cause for hypertension. It has high sensitivity but a low specificity.
In this test, the baseline level of renin in the blood is determined by drawing blood. Then an oral dose of captopril is given and, after an hour, the plasma renin level is determined again. Because captopril blocks the activity of one of the proteins that renin works on, the blood pressure should fall. This decrease in blood pressure is detected by both kidneys, but especially by the one that has a blocked blood supply. This kidney responds by secreting a large amount of renin. Thus an exaggerated renin response after the dose of captopril is suggestive of a renovascular hypertension. hypertension.
The captopril test for identifying renovascular disease in hypertensive patients. - Am J Med. 1986 Apr;80(4):633-44.
Friday, January 28, 2011
Q: What is the 'rule of thumb' of Esmolol dose in heart rate (HR) control of Atrial fibrillation?
A; Following intravenous infusion of esmolol for 30 minutes with dose of:
- 50 mcg/kg per minute HR drop by 8%
- 100 mcg/kg per minute HR drop by 11%
- 150 mcg/kg per minute HR drop by 14%
- 200 and above mcg/kg per minute HR drop by 15%
Related Previous Pearl: Esmolol is metabolised in...?
Source: AHFS Drug Information. (CR) Copyright, 1959-2010, Selected Revisions January 2010. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814
Thursday, January 27, 2011
Q: What is the equivalency of three major anti-lipids Crestor (Rosuvastatin) Lipitor (atorvastatin) and Zocor (Simvastatin)?
Answer: Crestor 5 mg = Lipitor 10 mg = Zocor 20 mg
Wednesday, January 26, 2011
B) Amphotericin B,
E) All of the above
Answer: All of the above
Antibiotics such as ciprofloxacin, amphotericin B and rifampcin can also potentially cause red man syndrome beside vancomycin. Like vancomycin, they are capable of causing direct degranulation of mast cells and basophils. Red man syndrome is amplified if these antibiotics are combined with vancomycin or with each other. Red man syndrome is also magnified in patients receiving vancomycin and opioid analgesics, muscle relaxants, or contrast dye because these drugs can also stimulate histamine release.
Tuesday, January 25, 2011
Answer: Furosemide is sell under brand name Lasix. The name Lasix is derived from the phrase "lasts six (hours)" — referring to its duration of action of 4 to 6 hours!
Monday, January 24, 2011
Answer: In patients particularly with renal failure/uremia hydralazine may produce a marked decrease in blood pressure, resulting in central reactions such as anxiety, delirium, disorientation, depression, and coma.
Also Hydralazine is a cerebral vasodilator and is known to increase intracranial pressure which, together with its effect upon systemic blood pressure, reduces the cerebral perfusion pressure.
Sunday, January 23, 2011
Answer: Acapella® is a vibratory Positive Expiratory Pressure (PEP) Therapy System which also combines the benefits of airway vibrations to mobilize pulmonary secretions.
PEP devices work by having a one way valve that creates resistance when the patient breathes out against it. With PEP therapy, the pressure difference that occurs when a patient breathes out allows the lungs to fill with additional air, which in turn will push the mucus out as the lungs try to return to an equilibrant volume.
Patient inhales deeply with a 3 to 4 second breath hold, alternating with normal breathing. Inspiratory to expiratory ratio is kept around 1:3 to 1:4. After 5-10 exhalations of alternating regular/deep breaths, patient is asked to cough.
Blue Acapella - has low expired lung volumes with less than 15 lpm for 3 seconds.
Green Acapella - has high expired lung volumes with more than 15 lpm for 3 seconds.
Saturday, January 22, 2011
Answer: Ethylene glycol poisoning
Ethylene glycol’s major toxicity is a result of it’s metabolites: glycoaldehyde, oxalic acid, glycolic acid, and glyoxylate. Oxalic acid combines with calcium to form calcium oxalate crystals.
Friday, January 21, 2011
Rajpal S, Ali R, Bhatnagar A, Bhandari SK, Mittal G. Clinical and bioavailability studies of sublingually administered atropine sulfate. Am J Emerg Med. Feb 2010;28(2):143-50.
Thursday, January 20, 2011
Answer: Administration of aerosolized colistin may cause bronchospasm, especially in patients with previous related history. Orders to give bronchodilators prior to administration of colistin may prevent the problem.
Wednesday, January 19, 2011
Answer: Yes! Ferritin level
Five major causes described for RLS
1. Iron Deficiency: Even without significant anemia, serum ferritin levels below 50 ng per mL can exacerbate RLS symptoms. Serum ferritin levels is now considered essential in the workup of RLS.
2. Neurologic: in association with spinal cord and peripheral nerve lesions.
3. Pregnancy: RLS may affects women during pregnancy. Symptoms usually subside within a few weeks postpartum.
4. Uremia: RLS occurs in up to 50 percent of patients with end-stage renal failure and subside after renal transplantation.
5. Drug-Induced like: tricyclic antidepressants, SSRIs, lithium, Caffeine and dopamine antagonists.
Tuesday, January 18, 2011
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.
Monday, January 17, 2011
Sunday, January 16, 2011
"The U.S. Food and Drug Administration (FDA) is alerting healthcare professionals and patients about cases of rare, but severe liver injury, including two cases of acute liver failure leading to liver transplant in patients treated with the heart medication dronedarone (Multaq)"
See full alert here
Saturday, January 15, 2011
Friday, January 14, 2011
Answer: Takotsubo cardiomyopathy, also known as broken-heart-syndrome, or simply stress cardiomyopathy, is a type of non-ischemic cardiomyopathy.
The hallmark of the disease is bulging out of the apex of the heart with preserved function of the base that earned the syndrome its name "tako tsubo", or octopus trap in Japan, where it was first described.The cause appears to involve high circulating levels of catecholamines. If individual survives their initial presentation, patient usually improves within 2 months. For unknown reason - Takotsubo cardiomyopathy is more commonly seen in post-menopausal women.
Thursday, January 13, 2011
Q: What is uremic frost?
Answer: Uremic frost is a dermatological manifestation of severe azotemia. When the blood urea nitrogen level is high, the concentration of urea in sweat increases greatly. Evaporation of sweat causes urea to crystallize and deposit on the skin.
Wednesday, January 12, 2011
Answer: Dipsogenic DI is due to a defect or damage to the thirst mechanism, which is located in the hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output.
Clinical significance: Desmopressin (or other drugs) should not be used to treat dipsogenic diabetes insipidus because they may decrease urine output but not thirst and fluid intake. This fluid "overload" can lead to water intoxication, leading to hyponatremia and so brain damage.
There is no effective treatment but some recommends small doses of DDAVP at bedtime to relieve nocturia.
Tuesday, January 11, 2011
Answer: Pituitary hormones of clinical significance include
- adrenocorticotropic hormone (ACTH),
- follicle-stimulating hormone (FSH),
- luteinizing hormone (LH),
- growth hormone (GH),
- thyroid-stimulating hormone (TSH), and
- antidiuretic hormone (ADH)
4 essential treatments to keep in mind:
- Desmopressin acetate (DDAVP) if Diabetes insipidus develops.
- Hydrocortisone: Should be initiated even before workup is initiated.
- Reproductive hormones (Estrogen or Testosterone)
Growth hormone is not routinely replaced in adults.
Monday, January 10, 2011
Q: Describe 5 functions of angiotensin II ?
Answer: One of the functions of the kidney is to monitor blood pressure.
Kidney secretes renin.
Renin acts on angiotensinogen, splitting off a fragment called angiotensin I.
angiotensin I is cleaved by a angiotensin converting enzyme (ACE) — producing angiotensin II.
- constricts the walls of arterioles closing down capillary beds
- stimulates the proximal tubules in the kidney to reabsorb sodium ions
- stimulates the adrenal cortex to release aldosterone. (Aldosterone causes the kidneys to reclaim still more sodium and water).
- increases the strength of the heartbeat;
- stimulates the pituitary to release the vasopressin.
Sunday, January 9, 2011
Conditions/drugs which may cause decrease fibrinogen levels:
- Anabolic steroids,
- Phenobarbital and
- Valproic acid
Conditions/drugs which may cause increase fibrinogen levels:
- Cigarette smoking, and
Saturday, January 8, 2011
Answer: Recombinant Factor VIIa
Low-molecular-weight heparins are inhibitors of factor Xa, but have small therapeutic window and has the risk of bleeding. Fondaparinux has a long elimination half-life.
rFVIIa overcome the inhibition of thrombin generation and normalize the fondaparinux-induced prolongation of aPTT and PT. Sensitive thrombin-generation assays demonstrated the efficacy of rFVIIa in restoring impaired thrombin formation after fondaparinux administration. rFVIIa reverses not only the anticoagulant effect of fondaparinux but also the profibrinolytic effects of this agent, probably through activation of thrombin-activatable fibrinolysis inhibitor (TAFI).
Ability of Recombinant Factor VIIa to Reverse the Anticoagulant Effect of the Pentasaccharide Fondaparinux in Healthy Volunteers - Circulation. 2002;106: 2550
Friday, January 7, 2011
It is now pretty much establish that bedside ultrasound (can be easily learn and perform by intensivist) is more sensitive in detecting pneumothorax.
(see video in this regard in our videos section)
Wilkerson RG, Stone MB (January 2010). "Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma". Acad. Emerg. Med. 17 (1): 11–17
Thursday, January 6, 2011
Wednesday, January 5, 2011
Hint: Triad of HTN, Hypokalemia and metabolic alkalosis
Answer: Primary hyperaldosteronism
Aldosterone hypersecretion acts on the cortical collecting duct to stimulate potassium secretion into the tubular fluid, enhancing renal potassium wasting.The metabolic alkalosis is due to increased renal hydrogen ion loss mediated by hypokalemia and aldosterone.
Tuesday, January 4, 2011
Dopexamine is basically a β2-adrenergic receptor agonist. It is considered an inotropic agent. It can be use in heart failure for afterload reduction with positive inotropicity. Beside beta2-adrenergic stimulation it also stimulates peripheral dopamine (DA1 and DA2) receptors. Also it inhibits neuronal reuptake of noradrenaline (uptake-1).
Net effect is increase cardiac output through positive inotropism and reduce afterload through increased flow to renal and mesenteric beds. It improves gastric mucosal oxygenation.
Dose is infusion at 0.5 microgram per kg per minute increasing up to 6 micrograms per kg per minute. Central line infusion is recommended. As always with similar drugs patients receiving dopexamine should be monitored with EKG, hemodynamics, urine output etc. It may cause hypotension.
Dopexamine is not approved for use currently in the US or Canada.
Monday, January 3, 2011
Answer: It has much shorter half life.
Dronedarone is less lipophilic and so has an elimination half-life of only 24 hours in contrast to amiodarone which has half life extended over several weeks.
Sunday, January 2, 2011
Answer: Yes - usually its safe
Documented allergies to contrast media or shellfish should not imply that a patient is allergic to iodine. Reactions to contrast media are due to the high osmolar or ionic content of the dye. The primary allergen in shellfish is tropomyosin. No known association exists between amiodarone and reactions to contrast media or shellfish. Unless until true allergy exist specifically for iodine, Amiodarone is usually a very safe medicine from this perspective.