Monday July 6, 2009
Q: Rewarming after therapeutic hypothermia should begun 24 hours after the
A) time of initiation of cooling or
B) from the time the target temperature (32-34 C) is achieved.
(Choose one)
Answer: Countdown for rewarming after therapeutic hypothermia should begun 24 hours after the time of initiation of cooling. The patient should be actively cooled by using an induced hypothermia protocol for 24 hours to a goal temperature of 32-34ºC. The goal is to achieve the target temperature as quickly as possible. In most cases, this can be achieved within 3-4 hours of initiating cooling.
See very good review article on Therapeutic Hypothermia (emedicine.com)
Monday, July 6, 2009
Sunday, July 5, 2009
Saturday, July 4, 2009
Friday, July 3, 2009
Friday July 3, 2009 (pediatric pearl)
Uniqueness of Neonatal/ Infantile Myocardium compared to adult myocardium
Neonatal myocardium has a large supply of mitochondria, nuclei and endoplasmic reticulum to support cell growth and protein synthesis but these are non-contractile tissues which render the myocardium stiff and non-compliant. This may impair filling of the left ventricle and limit the ability to increase the cardiac output by increasing stroke volume (Frank Starling mechanism). Stroke volume is therefore relatively fixed and the only way of increasing cardiac output is by increasing heart rate. The cardiac index (defined as the cardiac output related to the body surface area to allow a comparison between different sizes of patients) is increased by 30-60 percent in neonates and infants to help meet the increased oxygen consumption.
The sympathetic nervous system is not well developed predisposing the neonatal heart to bradycardia. Anatomical closure of the foramen ovale occurs between 3 months and one year of age.
Uniqueness of Neonatal/ Infantile Myocardium compared to adult myocardium
Neonatal myocardium has a large supply of mitochondria, nuclei and endoplasmic reticulum to support cell growth and protein synthesis but these are non-contractile tissues which render the myocardium stiff and non-compliant. This may impair filling of the left ventricle and limit the ability to increase the cardiac output by increasing stroke volume (Frank Starling mechanism). Stroke volume is therefore relatively fixed and the only way of increasing cardiac output is by increasing heart rate. The cardiac index (defined as the cardiac output related to the body surface area to allow a comparison between different sizes of patients) is increased by 30-60 percent in neonates and infants to help meet the increased oxygen consumption.
The sympathetic nervous system is not well developed predisposing the neonatal heart to bradycardia. Anatomical closure of the foramen ovale occurs between 3 months and one year of age.
Thursday, July 2, 2009
Wednesday, July 1, 2009
Wednesday July 1, 2009
Picture Diagnosis
Case: A 35-year-old man underwent pericardiectomy for pericarditis. Post procedure CXR and CT scan film is below, which shows a huge mass abutting the mediastinum in the left upper lung zone. Note: Pre-procedure CXR was normal and had no such mass!!
Answer: Gossypiboma
Gossypiboma is a technical term for retained surgical sponge. Patient underwent left upper lobectomy, and pathologic examination revealed gossypiboma (retained surgical sponge).
Picture Diagnosis
Case: A 35-year-old man underwent pericardiectomy for pericarditis. Post procedure CXR and CT scan film is below, which shows a huge mass abutting the mediastinum in the left upper lung zone. Note: Pre-procedure CXR was normal and had no such mass!!
Answer: Gossypiboma
Gossypiboma is a technical term for retained surgical sponge. Patient underwent left upper lobectomy, and pathologic examination revealed gossypiboma (retained surgical sponge).
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