79-year-old women has severe aortic stenosis and 2-vessel coronary artery disease s/p coronary artery bypass graft who developed acute dyspnea. She was found to have chronic occlusion of her vein graft and acute thrombosis of her subclavian artery, causing diffuse cardiac ischemia and myonecrosis.
I feel the most frustrating difficult intubations are those when you have the trachea cannulated and are unable to pass the endotracheal tube. This case is presents a difficult intubation of a patient who had a previous tracheostomy which had been decannulated and developed tracheal stenosis.
The Targeted temperature management Trial compared outcomes for therapeutic hypothermia at 33°C versus 36°C for cardiac arrest patients with persistent coma. It may very well be practice changing. Or maybe not. Before we can figure out what “truth” this research study may have uncovered, we will look at the development of therapeutic hypothermia and what the literature has already told us.
Glucagon is a peptide hormone secreted by the pancreas that raises blood glucose levels. Its has the opposite effect of insulin. The pancreas releases glucagon when blood glucose levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream.
Bursae are thin, slippery sacs located throughout the body that act as cushions between bones and soft tissues. They contain a small amount of lubricating fluid that allows the skin to move freely over the underlying bone. The olecranon bursa lies between the loose skin and the pointy bone at the back of the elbow called the olecranon. Normally, the olecranon bursa is flat. If it becomes injured, irritated or inflamed, fluid (serous, purulent, or hemorrhagic) will accumulate in the bursa causing it to swell.
One of the major risks of right heart catheterization in the ICU is pulmonary artery rupture. While exceedingly rare (0.06% – 0.2%), it has a high mortality of approximately 50% usually within 30 minutes. When I was first learning about pulmonary artery catheters, I envisioned this primarily as a problem with the distal tip of the catheter migrating into the small vessel and capillary bed, which then is rupture during balloon inflation. I felt secure that this serious complication was eliminated by ensuring proper tip positioning. Unfortunately, like everything in medicine the reality is more complicated.