Based on the new ABG results, the patient is now in respiratory acidosis and hypoxic. Given the acute worsening, I would:
1. Intubate the patient for airway protection and to allow for mechanical ventilation
2. Start mechanical ventilation with initial settings of:
- Mode: A/C
- Tidal volume 6-8 ml/kg predicted body weight
- PEEP 10 cmH2O
- FiO2 100%
3. Consider sedation (e.g. propofol) and paralysis after intubation
4. Optimize oxygenation and ventilation by adjusting ventilator settings as needed
5. Treat the underlying cause of respiratory failure/dist
Pacemaker Mediated Tachycardia... or not?Junhao Koh
This patient has a history of heart failure and was admitted for worsening symptoms. She has a cardiac resynchronization therapy defibrillator (CRT-D) implanted but continues to have episodes of nonsustained ventricular tachycardia. Device interrogation revealed a mechanism of pacemaker-mediated tachycardia involving retrograde conduction of premature ventricular complexes triggering the device to pace the atria, initiating a reentrant loop. Changing the device settings eliminated this tachycardia.
Brugada Syndrome is a genetic cardiac condition characterized by abnormal ECG patterns and risk of sudden cardiac death. It is caused by mutations in the SCN5A gene which encodes cardiac sodium channels. Patients typically present with syncope or sudden death and have a distinctive pattern on ECG of ST segment elevation in leads V1-V3. Risk stratification focuses on history of symptoms like syncope as inducible arrhythmias on electrophysiological study have poor predictive value. Treatment involves medical management with quinidine or device therapy with an ICD for high-risk patients. Lifestyle modifications like avoiding fever or medications that affect sodium channels are also recommended.
1. The document discusses treatment guidelines for a 55-year-old male presenting with chest pain, including administering aspirin, heparin, beta blockers, and transferring the patient for primary angioplasty within 90 minutes.
2. It provides an overview of guidelines for various treatments of acute coronary syndromes, including thrombolytics, primary PCI, facilitated PCI, and rescue PCI.
3. The document reviews evidence and recommendations for therapies like beta blockers, analgesics, and anticoagulants in treating acute coronary syndromes.
Connected aircraft squadron electrocardiographic sign is a new strong index for monitoring and follows up the tachypneic patients with specific T- waves changes in special leads in several cardiorespiratory patients.
This document discusses several cardiac channelopathies including Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, and early repolarization syndromes. It provides details on the electrocardiographic patterns, genetic causes, clinical manifestations, diagnosis and management of these conditions. Specifically, it focuses on the electrocardiographic patterns that define Brugada syndrome, the genetic and ion channel basis for the condition, and its association with sudden cardiac death.
Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...YasserMohammedHassan1
Rationale: Electrocardiographic is a fundamental tool for a cardiologist, critical care physician, and emergency medicine specialist. The electrolyte imbalance is a very important entity in clinical medicine management. Camel-hump T-wave and the Tee-Pee sign, recently; Wavy triple and Wavy double signs of hypocalcemia (Yasser’s sign) are electrocardiographic findings linked to electrolyte deficiencies. Patient concerns: A middle-aged male car-painter patient presented to the emergency department with atypical severe twisting chest pain, hypocalcemia, hypokalemia, and hypernatremia.
Diagnosis: Hypocalcemia-induced Camel-hump T-wave, Tee Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign), and bradycardia in a car- painter. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of Camel-hump T-Wave, Tee-Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia. The twisting chest pain and its limited disappearance immediately after calcium gluconate injection indicate the pain can be named as “chest tetany”. Non-atropine bradycardia response is evidence that the management of the cause of bradycardia sometimes is essential e.g. hypocalcemia in the current case. Outcomes: There was a dramatic response of both clinical and electrocardiography including Camel-hump T-wave, Tee Pee sign, the wavy double sign of hypocalcemia, and bradycardia.
Electrocardiographic passing phenomenon (flying phenomenon or yasser’s phenom...YasserMohammedHassan1
The document summarizes a presentation on electrocardiographic passing phenomena given at a cardiology conference. It includes 10 case studies demonstrating different types of passing phenomena, such as accelerated junctional rhythm, bigeminy, and sinus arrhythmia. It discusses the historical discovery of these phenomena, how they are analyzed and classified, common target diseases they may indicate but not necessarily be related to, and how reassuring patients can be an effective therapy. Statistics on the study subjects are provided, such as average age and percentages of occupations and main complaints. Serial electrocardiograms are presented for each case study and management primarily involved reassurance without medical intervention.
Pacemaker Mediated Tachycardia... or not?Junhao Koh
This patient has a history of heart failure and was admitted for worsening symptoms. She has a cardiac resynchronization therapy defibrillator (CRT-D) implanted but continues to have episodes of nonsustained ventricular tachycardia. Device interrogation revealed a mechanism of pacemaker-mediated tachycardia involving retrograde conduction of premature ventricular complexes triggering the device to pace the atria, initiating a reentrant loop. Changing the device settings eliminated this tachycardia.
Brugada Syndrome is a genetic cardiac condition characterized by abnormal ECG patterns and risk of sudden cardiac death. It is caused by mutations in the SCN5A gene which encodes cardiac sodium channels. Patients typically present with syncope or sudden death and have a distinctive pattern on ECG of ST segment elevation in leads V1-V3. Risk stratification focuses on history of symptoms like syncope as inducible arrhythmias on electrophysiological study have poor predictive value. Treatment involves medical management with quinidine or device therapy with an ICD for high-risk patients. Lifestyle modifications like avoiding fever or medications that affect sodium channels are also recommended.
1. The document discusses treatment guidelines for a 55-year-old male presenting with chest pain, including administering aspirin, heparin, beta blockers, and transferring the patient for primary angioplasty within 90 minutes.
2. It provides an overview of guidelines for various treatments of acute coronary syndromes, including thrombolytics, primary PCI, facilitated PCI, and rescue PCI.
3. The document reviews evidence and recommendations for therapies like beta blockers, analgesics, and anticoagulants in treating acute coronary syndromes.
Connected aircraft squadron electrocardiographic sign is a new strong index for monitoring and follows up the tachypneic patients with specific T- waves changes in special leads in several cardiorespiratory patients.
This document discusses several cardiac channelopathies including Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, and early repolarization syndromes. It provides details on the electrocardiographic patterns, genetic causes, clinical manifestations, diagnosis and management of these conditions. Specifically, it focuses on the electrocardiographic patterns that define Brugada syndrome, the genetic and ion channel basis for the condition, and its association with sudden cardiac death.
Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...YasserMohammedHassan1
Rationale: Electrocardiographic is a fundamental tool for a cardiologist, critical care physician, and emergency medicine specialist. The electrolyte imbalance is a very important entity in clinical medicine management. Camel-hump T-wave and the Tee-Pee sign, recently; Wavy triple and Wavy double signs of hypocalcemia (Yasser’s sign) are electrocardiographic findings linked to electrolyte deficiencies. Patient concerns: A middle-aged male car-painter patient presented to the emergency department with atypical severe twisting chest pain, hypocalcemia, hypokalemia, and hypernatremia.
Diagnosis: Hypocalcemia-induced Camel-hump T-wave, Tee Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign), and bradycardia in a car- painter. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of Camel-hump T-Wave, Tee-Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia. The twisting chest pain and its limited disappearance immediately after calcium gluconate injection indicate the pain can be named as “chest tetany”. Non-atropine bradycardia response is evidence that the management of the cause of bradycardia sometimes is essential e.g. hypocalcemia in the current case. Outcomes: There was a dramatic response of both clinical and electrocardiography including Camel-hump T-wave, Tee Pee sign, the wavy double sign of hypocalcemia, and bradycardia.
Electrocardiographic passing phenomenon (flying phenomenon or yasser’s phenom...YasserMohammedHassan1
The document summarizes a presentation on electrocardiographic passing phenomena given at a cardiology conference. It includes 10 case studies demonstrating different types of passing phenomena, such as accelerated junctional rhythm, bigeminy, and sinus arrhythmia. It discusses the historical discovery of these phenomena, how they are analyzed and classified, common target diseases they may indicate but not necessarily be related to, and how reassuring patients can be an effective therapy. Statistics on the study subjects are provided, such as average age and percentages of occupations and main complaints. Serial electrocardiograms are presented for each case study and management primarily involved reassurance without medical intervention.
Managing Ventricular Arrhythmia In First In Man Studies A Nadaadelnada
The document discusses the increasing need to manage ventricular arrhythmia encountered during early clinical drug development as riskier compounds are advanced. It outlines factors contributing to this issue and strategies for intensive cardiac monitoring in first-in-man studies to ensure safety while accurately assessing potential drug-related arrhythmia events given baseline rates in healthy volunteers. Future directions are highlighted, including expert guidance documents and initiatives to better understand cardiac safety in early development.
Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (chang...YasserMohammedHassan1
Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (changeable phenomenon or Yasser’s phenomenon of hypocalcemia) is defined according to the author's opinion in the study as a novel electrocardiographic phenomenon characterized by serial dynamic changes in present in all cases of either Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Movable-weaning off an electrocardiographic phenomenon is a guide for both Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Don’t be angry if the staring electrocardiography or the last one was normal.
This document discusses different types of channelopathies, which are inherited arrhythmogenic diseases caused by mutations in ion channel genes. It summarizes the definitions, epidemiology, clinical manifestations, risk stratification approaches, and management recommendations for several major channelopathies:
- Long QT syndrome is associated with prolonged cardiac repolarization and can cause syncope or cardiac arrest. Risk stratification considers clinical factors and genetic testing, and management includes beta-blockers and ICDs.
- Brugada syndrome causes ST segment elevation and is a common cause of sudden cardiac death. Risk is assessed based on symptoms and ECG patterns, and ICDs are often recommended for high-risk patients.
- Cate
This patient has class III heart failure with an ejection fraction of 28% and was recently hospitalized for decompensated heart failure. She has been adherent to guideline directed medical therapy including diuretics, beta blockers, ACE inhibitors, and has a cardiac resynchronization device. Given her recent hospitalization and high BNP, adding an aldosterone inhibitor would be a reasonable next step to further optimize her medical management.
Wavy triple an ECG sign (Yasser’s sign) in hypocalcaemia -Cardiology and Eme...YasserMohammedHassan1
The Wavy triple an electrocardiographic sign (Yasser’s sign) is a new diagnostic sign seen in 97.3% (36 cases) of hypocalcemia. Dramatic improvement of both clinical manifestation and the new electrocardiographic sign simultaneously after calcium replacement had happened.
The Long QT Syndrome: Overview and Management The Long QT Syndrome: Overvie...MedicineAndFamily
Long QT Syndrome is a genetic disorder characterized by a prolonged QT interval on electrocardiogram that can cause dangerous arrhythmias and sudden cardiac death. Symptoms include unexplained fainting, seizures, or sudden death, especially with exercise or emotions. Treatment involves beta blockers, implantable cardioverter defibrillators, or left stellate ganglionectomy depending on risk level and genotype. Ongoing research seeks to better understand genotype-phenotype relationships and develop mutation-specific therapies.
The document provides information on electrocardiogram (ECG or EKG) basics including normal intervals, wave components, lead placements, axis determination, and common arrhythmias. It explains that the ECG provides information on heart rate, rhythm, and tissue health. Examples of various normal and abnormal rhythms are presented.
This document discusses the early management of suspected myocardial infarction (MI). It outlines key risk factors for cardiac events and recommendations for stabilizing, diagnosing, and treating patients presenting with chest pain. Diagnostic steps include electrocardiograms (EKGs), cardiac enzyme levels, and potentially angiography. Treatment involves aspirin, nitrates, anticoagulants, and potentially thrombolytics or angioplasty depending on the situation. Goals are to promptly diagnose and treat to reduce mortality from MI.
CARDIOTalks: La IC vuelve a escena
22/05/2015 17:45h - 19:30h
Hotel Sevilla Center. Sala Giralda I, Sevilla (XII Reunión Anual de la Sección de Insuficiencia Cardiaca y Trasplante de la SEC)
http://cardiotalks.secardiologia.es
Péptidos natriuréticos, nuestra protección endógena frente a la IC
Dr. Antonio Bayés-Genis, Badalona
Brugada Syndrome and LQTS - the evidenceJunhao Koh
Brugada Syndrome and Long QT Syndrome are cardiac conditions that can cause abnormal heart rhythms and sudden cardiac death. For Brugada Syndrome, the key aspects of diagnosis, risk stratification, and management discussed include identifying type 1 ECG patterns, assessing risk based on exercise stress tests and signal-averaged ECGs, and treating high-risk patients with medications like quinidine or catheter ablation. For Long QT Syndrome, diagnosis involves measuring the corrected QT interval on ECG, risk stratification considers specific genetic mutations and history of syncope, and management relies on beta blockers and ICDs for high-risk patients. Both conditions require careful medical management to reduce risks of life-threatening arrhythmias.
Nuclear cardiology imaging uses radiotracers and gamma cameras to image cardiac physiology and function. It is useful for diagnosing coronary artery disease, assessing risk, guiding treatment decisions, and evaluating outcomes. The presentation covered the basics of nuclear tracers, instrumentation, stress testing, image interpretation, and provided examples of clinical applications including assessing viability and guiding management of heart disease.
This document contains an ECG report from the Department of Cardiology at JIPMER in Pondicherry, India. It describes the ECG findings of a patient who presented with narrow complex tachycardia and includes the results of an electrophysiological study and ablation. The EPS found the patient had atrial tachycardia originating from the left atrium posteriorly, and they underwent successful ablation. The document provides details of the case from initial ECG and symptoms to diagnosis and treatment.
This document provides guidance on the early management of suspected myocardial infarction (MI). It outlines key risk factors, clinical presentations, diagnostic steps including EKG and imaging, and treatment recommendations including aspirin, nitrates, anticoagulation, reperfusion therapies, beta blockers, ACE inhibitors, and antiplatelet medications. Treatment should begin promptly based on history and risk rather than waiting for test results, with a goal of reducing mortality from MI.
Charge syndrome hallmarked with wpws and pda; 20 years post repairing-yasser ...YasserMohammedHassan1
CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity.
The long QT syndrome (LQTS) is a rare inherited heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsades de pointes (TDP, a form of irregular heartbeat that originates from the ventricles). These episodes may lead to palpitations, fainting and sudden death due to ventricular fibrillation. Episodes may be provoked by various stimuli, depending on the subtype of the condition.The condition is so named because of the appearances of the electrocardiogram (ECG/EKG), on which there is prolongation of the QT interval. In some individuals the QT prolongation occurs only after the administration of certain medications.
This document discusses heart failure with preserved systolic function, also known as heart failure with normal ejection fraction. Some key points:
- This condition represents 20-50% of all heart failure cases. However, relatively little is known about its morbidity and mortality.
- Median prevalence in studies was 36%, with a range from 13-74%. Rates of readmission were similar to heart failure with low ejection fraction but mortality was lower at 9% versus 18%.
- Causes include inaccurate diagnosis, episodic systolic dysfunction, diastolic dysfunction from various conditions like hypertension, cardiomyopathy, and aging.
- Diastolic dysfunction refers to abnormally elevated ventricular filling pressures despite normal or
1. Ventricular tachycardia (VT) is an important cause of sudden cardiac arrest and can manifest as premature ventricular contractions (PVCs) or sustained VT.
2. VT can be idiopathic, focal, or associated with structural heart disease such as ischemic or non-ischemic cardiomyopathy.
3. Treatment depends on the type and cause of VT but may include medications, implantable cardioverter defibrillators (ICDs), and catheter ablation which can be curative for some idiopathic VT cases.
Propranolol may help reduce stress and catabolism in burn patients by blocking catecholamines and glucocorticoids. While it shows promising outcomes in children, evidence is still limited in adults. The author recommends using propranolol in adults cautiously, starting early with an escalating dose as tolerated to target a heart rate 20% below maximum. Close monitoring is needed due to risks of unopposed alpha action and mesenteric ischemia. Further research is still required to fully understand propranolol's effects in different types of burn patients.
Intensive Care Medicine Subspecialty Training Committee Presentation 30 Jan 2016Hon Liang
The document discusses improving critical care training through a new "C" model: 1 trainee is paired with 1 mentor for 1 year to study 1 topic, producing 1 review article, 1 PowerPoint, and 10 multiple choice questions. This web-based program would establish new criteria for exit exams focusing on time logs, topic projects, and training materials. It aims to provide better, more robust training and credible exams through collaboration, curriculum development, and consistency across specialties and institutions.
Managing Ventricular Arrhythmia In First In Man Studies A Nadaadelnada
The document discusses the increasing need to manage ventricular arrhythmia encountered during early clinical drug development as riskier compounds are advanced. It outlines factors contributing to this issue and strategies for intensive cardiac monitoring in first-in-man studies to ensure safety while accurately assessing potential drug-related arrhythmia events given baseline rates in healthy volunteers. Future directions are highlighted, including expert guidance documents and initiatives to better understand cardiac safety in early development.
Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (chang...YasserMohammedHassan1
Movable-weaning off an electrocardiographic phenomenon in hypocalcemia (changeable phenomenon or Yasser’s phenomenon of hypocalcemia) is defined according to the author's opinion in the study as a novel electrocardiographic phenomenon characterized by serial dynamic changes in present in all cases of either Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Movable-weaning off an electrocardiographic phenomenon is a guide for both Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Don’t be angry if the staring electrocardiography or the last one was normal.
This document discusses different types of channelopathies, which are inherited arrhythmogenic diseases caused by mutations in ion channel genes. It summarizes the definitions, epidemiology, clinical manifestations, risk stratification approaches, and management recommendations for several major channelopathies:
- Long QT syndrome is associated with prolonged cardiac repolarization and can cause syncope or cardiac arrest. Risk stratification considers clinical factors and genetic testing, and management includes beta-blockers and ICDs.
- Brugada syndrome causes ST segment elevation and is a common cause of sudden cardiac death. Risk is assessed based on symptoms and ECG patterns, and ICDs are often recommended for high-risk patients.
- Cate
This patient has class III heart failure with an ejection fraction of 28% and was recently hospitalized for decompensated heart failure. She has been adherent to guideline directed medical therapy including diuretics, beta blockers, ACE inhibitors, and has a cardiac resynchronization device. Given her recent hospitalization and high BNP, adding an aldosterone inhibitor would be a reasonable next step to further optimize her medical management.
Wavy triple an ECG sign (Yasser’s sign) in hypocalcaemia -Cardiology and Eme...YasserMohammedHassan1
The Wavy triple an electrocardiographic sign (Yasser’s sign) is a new diagnostic sign seen in 97.3% (36 cases) of hypocalcemia. Dramatic improvement of both clinical manifestation and the new electrocardiographic sign simultaneously after calcium replacement had happened.
The Long QT Syndrome: Overview and Management The Long QT Syndrome: Overvie...MedicineAndFamily
Long QT Syndrome is a genetic disorder characterized by a prolonged QT interval on electrocardiogram that can cause dangerous arrhythmias and sudden cardiac death. Symptoms include unexplained fainting, seizures, or sudden death, especially with exercise or emotions. Treatment involves beta blockers, implantable cardioverter defibrillators, or left stellate ganglionectomy depending on risk level and genotype. Ongoing research seeks to better understand genotype-phenotype relationships and develop mutation-specific therapies.
The document provides information on electrocardiogram (ECG or EKG) basics including normal intervals, wave components, lead placements, axis determination, and common arrhythmias. It explains that the ECG provides information on heart rate, rhythm, and tissue health. Examples of various normal and abnormal rhythms are presented.
This document discusses the early management of suspected myocardial infarction (MI). It outlines key risk factors for cardiac events and recommendations for stabilizing, diagnosing, and treating patients presenting with chest pain. Diagnostic steps include electrocardiograms (EKGs), cardiac enzyme levels, and potentially angiography. Treatment involves aspirin, nitrates, anticoagulants, and potentially thrombolytics or angioplasty depending on the situation. Goals are to promptly diagnose and treat to reduce mortality from MI.
CARDIOTalks: La IC vuelve a escena
22/05/2015 17:45h - 19:30h
Hotel Sevilla Center. Sala Giralda I, Sevilla (XII Reunión Anual de la Sección de Insuficiencia Cardiaca y Trasplante de la SEC)
http://cardiotalks.secardiologia.es
Péptidos natriuréticos, nuestra protección endógena frente a la IC
Dr. Antonio Bayés-Genis, Badalona
Brugada Syndrome and LQTS - the evidenceJunhao Koh
Brugada Syndrome and Long QT Syndrome are cardiac conditions that can cause abnormal heart rhythms and sudden cardiac death. For Brugada Syndrome, the key aspects of diagnosis, risk stratification, and management discussed include identifying type 1 ECG patterns, assessing risk based on exercise stress tests and signal-averaged ECGs, and treating high-risk patients with medications like quinidine or catheter ablation. For Long QT Syndrome, diagnosis involves measuring the corrected QT interval on ECG, risk stratification considers specific genetic mutations and history of syncope, and management relies on beta blockers and ICDs for high-risk patients. Both conditions require careful medical management to reduce risks of life-threatening arrhythmias.
Nuclear cardiology imaging uses radiotracers and gamma cameras to image cardiac physiology and function. It is useful for diagnosing coronary artery disease, assessing risk, guiding treatment decisions, and evaluating outcomes. The presentation covered the basics of nuclear tracers, instrumentation, stress testing, image interpretation, and provided examples of clinical applications including assessing viability and guiding management of heart disease.
This document contains an ECG report from the Department of Cardiology at JIPMER in Pondicherry, India. It describes the ECG findings of a patient who presented with narrow complex tachycardia and includes the results of an electrophysiological study and ablation. The EPS found the patient had atrial tachycardia originating from the left atrium posteriorly, and they underwent successful ablation. The document provides details of the case from initial ECG and symptoms to diagnosis and treatment.
This document provides guidance on the early management of suspected myocardial infarction (MI). It outlines key risk factors, clinical presentations, diagnostic steps including EKG and imaging, and treatment recommendations including aspirin, nitrates, anticoagulation, reperfusion therapies, beta blockers, ACE inhibitors, and antiplatelet medications. Treatment should begin promptly based on history and risk rather than waiting for test results, with a goal of reducing mortality from MI.
Charge syndrome hallmarked with wpws and pda; 20 years post repairing-yasser ...YasserMohammedHassan1
CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity.
The long QT syndrome (LQTS) is a rare inherited heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsades de pointes (TDP, a form of irregular heartbeat that originates from the ventricles). These episodes may lead to palpitations, fainting and sudden death due to ventricular fibrillation. Episodes may be provoked by various stimuli, depending on the subtype of the condition.The condition is so named because of the appearances of the electrocardiogram (ECG/EKG), on which there is prolongation of the QT interval. In some individuals the QT prolongation occurs only after the administration of certain medications.
This document discusses heart failure with preserved systolic function, also known as heart failure with normal ejection fraction. Some key points:
- This condition represents 20-50% of all heart failure cases. However, relatively little is known about its morbidity and mortality.
- Median prevalence in studies was 36%, with a range from 13-74%. Rates of readmission were similar to heart failure with low ejection fraction but mortality was lower at 9% versus 18%.
- Causes include inaccurate diagnosis, episodic systolic dysfunction, diastolic dysfunction from various conditions like hypertension, cardiomyopathy, and aging.
- Diastolic dysfunction refers to abnormally elevated ventricular filling pressures despite normal or
1. Ventricular tachycardia (VT) is an important cause of sudden cardiac arrest and can manifest as premature ventricular contractions (PVCs) or sustained VT.
2. VT can be idiopathic, focal, or associated with structural heart disease such as ischemic or non-ischemic cardiomyopathy.
3. Treatment depends on the type and cause of VT but may include medications, implantable cardioverter defibrillators (ICDs), and catheter ablation which can be curative for some idiopathic VT cases.
Propranolol may help reduce stress and catabolism in burn patients by blocking catecholamines and glucocorticoids. While it shows promising outcomes in children, evidence is still limited in adults. The author recommends using propranolol in adults cautiously, starting early with an escalating dose as tolerated to target a heart rate 20% below maximum. Close monitoring is needed due to risks of unopposed alpha action and mesenteric ischemia. Further research is still required to fully understand propranolol's effects in different types of burn patients.
Intensive Care Medicine Subspecialty Training Committee Presentation 30 Jan 2016Hon Liang
The document discusses improving critical care training through a new "C" model: 1 trainee is paired with 1 mentor for 1 year to study 1 topic, producing 1 review article, 1 PowerPoint, and 10 multiple choice questions. This web-based program would establish new criteria for exit exams focusing on time logs, topic projects, and training materials. It aims to provide better, more robust training and credible exams through collaboration, curriculum development, and consistency across specialties and institutions.
This presentation discusses common mistakes in PowerPoint presentations and provides tips for effective presentations. It emphasizes telling a story, engaging the audience, and using humor. The document also includes summaries of burn treatment including initial fluid resuscitation, medications, nutrition, and complications in the ICU. Overall it promotes practicing presentations and focusing on the audience experience over excessive words or bullet points.
Blood and Trauma Update 2016 - Society of Intensive Care Medicine Symposium Hon Liang
This document discusses trauma resuscitation and the role of blood products. It reviews the history of trauma management from World War I to the modern era. Key developments mentioned include the birth of ATLS and damage control resuscitation. The document also summarizes recent guidelines regarding permissive hypotension, transfusion ratios of blood products, the use of tranexamic acid, and approaches to coagulopathy in trauma.
The document provides an overview of Singapore's healthcare system. It describes Singapore's dual public-private healthcare delivery model and financing system. Healthcare is financed through various means including Medisave, Medishield, general taxation, and individual contributions. The government aims to provide affordable and accessible healthcare while promoting individual responsibility and preventative care programs.
This document discusses various topics related to cardiology and emergency medicine. It provides:
1) Evidence that therapeutic hypothermia after cardiac arrest improves survival rates and neurological outcomes compared to normothermia. Cooling reduces metabolic demands and lowers intracranial pressure.
2) Guidelines for managing cardiac arrest in pregnancy, including positioning the patient to improve blood flow and considering C-section within 5 minutes of arrest if the uterus is at the umbilicus.
3) Evidence that supplemental oxygen does not benefit and may harm patients with acute myocardial infarction who do not have low oxygen saturation. Oxygen acts as a vasoconstrictor and decreases coronary blood flow. It should only be given to patients who
1) The document discusses several cases involving patients presenting with symptoms such as dizziness, lightheadedness, or syncope. For each case, the document provides recommendations on evaluating the patient, correlating symptoms with cardiac rhythms, and determining if permanent pacing is needed.
2) It also discusses recommendations for primary prevention of sudden cardiac death in post-MI patients based on left ventricular ejection fraction and inducibility of ventricular arrhythmias on electrophysiology studies.
3) The document seeks to apply the latest guidelines on evaluating and managing bradycardia, conduction disorders, and prevention of sudden cardiac death through appropriate use of diagnostic testing, medical therapy, pacemakers, implantable cardioverter-defibrill
- The document describes several case studies involving patients with heart failure:
- The first case involves a 62-year-old woman admitted for acute decompensated heart failure. After 5 days of IV diuresis resulting in weight loss of 8L, her creatinine increased. The best next step would be to stop IV diuresis and re-check labs the next day.
- The second case describes a 74-year-old man with heart failure who was readmitted for worsening symptoms. He underwent evaluation and was found to have constrictive pericarditis, which was treated with surgery.
- The document provides details on these cases and discusses topics like diagnosing and treating acute
This patient presents with a 3 month history of right leg pain on walking that resolves with rest. Examination finds the right leg cooler with sparse hair and thin skin. All pulses are absent below the femoral pulse. Doppler ultrasound finds softer signals in the right leg arteries and an ankle brachial pressure index of 0.6 on the right and 0.8 on the left. The patient has risk factors of smoking and diabetes. The clinical diagnosis is peripheral arterial disease and the patient is advised on lifestyle changes and medication while further investigation and monitoring is recommended.
Introduction to Electrophysiology - Ventricular Arrhtyhmias and Cardiac Devic...Jose Osorio
What is cardiac Electrophysiology?
This presentation will cover basics of EP. It is Part 2 of 4 lectures about EP.
Part 1 - basics of EP and Supraventricular Tachycardias (SVT)
Part 2 - Ventricular arrhythmias and Cardiac Devices
Part 3 - Afib
Part 4 - EKG
This document discusses oxygenation and its effects on the cardiovascular and hematologic systems. It covers topics such as ventilation, respiration, circulation, and case studies involving patient assessments. Key areas of focus include the anatomy and physiology of the heart and blood vessels, diagnostic tests, common cardiovascular conditions like heart disease, heart failure, hypertension, and peripheral vascular disease. Nursing interventions are provided for treating related symptoms and managing patient care.
1) Vital signs are important predictors of a patient's condition and can determine if they are sent to a ward, HDU, ICU, or die. Abnormal vital signs may indicate deterioration.
2) A 62-year-old man posts laparotomy is diaphoretic, pale, cool, and only speaking in short phrases, prompting assessment of his vital signs and condition.
3) While vital signs can help assess a patient's status, they should be interpreted in the context of the individual patient based on their history and normal values, as some medications can alter vital signs. Frequent monitoring is important for detecting deterioration.
800,000 Americans have a stroke each year, making it the fifth leading cause of death. Strokes occur when blood flow to the brain is interrupted, either by a blockage (ischemic stroke) or bleeding (hemorrhagic stroke). AJ, a 52-year-old man with risk factors of hypertension, diabetes, and hyperlipidemia, arrived at the emergency room after his speech became slurred and he lost function in his right side, symptoms of an ischemic stroke. A CT scan confirmed he had an acute ischemic cerebrovascular accident affecting the left side of his brain. He received tPA treatment within 3 hours and was admitted for further rehabilitation and management of risk factors to prevent future strokes.
This document discusses the approach to diagnosing and managing patients presenting with palpitations. It outlines common causes of palpitations including sinus rhythm, ectopic beats, supraventricular tachycardia, atrial fibrillation, atrial flutter, and ventricular tachycardia. For diagnosis, it recommends performing a 12-lead ECG and considering additional testing like Holter monitoring if needed to correlate rhythms with symptoms. Management depends on diagnosis but may include reassurance, lifestyle changes, or referral to cardiology depending on risk factors and abnormal findings.
The document provides information about strokes (cerebrovascular accidents), including signs and symptoms, treatments, and nursing care considerations. It discusses medications and procedures that can stop a stroke from progressing if administered within 3 hours, such as tissue plasminogen activator (TPA). It also outlines nursing diagnoses, goals, and interventions for issues like impaired physical mobility and chronic confusion that may result from a stroke.
1. A 35-year-old man presented with acute onset of breathlessness and was found to have pulmonary thromboembolism and deficiencies in protein C and protein S without evidence of deep vein thrombosis.
2. He was treated with supportive measures, heparin, acenocoumarol, and supplements but developed massive hemoptysis and succumbed to his illness despite intensive care.
3. The case report discusses evaluation, treatment, and long-term management of venous thromboembolism and highlights complications that can arise.
A 50-year-old woman presents with left arm and leg weakness for 5 hours. She has a history of atrial fibrillation that is rate controlled. CT of the head shows no evidence of hemorrhage. As there is no hemorrhage, what anticoagulant or antiplatelet would you prescribe? Warfarin to be started and covered by low molecular weight heparin is the best answer.
The document discusses the approach to traumatic shock. It details the pathophysiology of hemorrhagic shock, which leads to impaired oxygen delivery and hypoperfusion. The clinical features and diagnosis are variable depending on the cause, rate, and duration of blood loss. Treatment priorities include restoring intravascular volume, maintaining oxygen-carrying capacity, limiting ongoing blood loss, preventing coagulopathy and hypothermia. Massive transfusion protocols aim to replace lost blood with balanced ratios of packed red blood cells, plasma, and platelets to improve outcomes.
Anaesthetic management of Abdominal aortic aneurysmsAbhijit Nair
Anesthesia management for abdominal aortic aneurysm (AAA) repair requires careful hemodynamic control. The aortic cross-clamp can cause significant cardiac stress and changes in preload, afterload, and ejection fraction. Agents are needed to manage blood pressure rises during clamping and potential hypotension after removal. Postoperative care focuses on pain control to prevent increases in myocardial oxygen demand, and monitoring for potential renal insufficiency.
The document discusses an 84-year-old male who presented with chest heaviness. His admission ECG showed ST-elevation myocardial infarction (STEMI) involving the right coronary artery, sinus bradycardia, atrial ischemia, and third-degree atrioventricular block. He was given streptokinase thrombolytic therapy. Follow-up ECGs showed sinus tachycardia 30 minutes later and resolution of ST elevation with residual conduction abnormalities 6 hours later, consistent with successful thrombolysis. The document reviews the systematic approach and criteria for interpreting ECGs in the context of acute coronary syndromes.
Subarachnoid hemorrage –eso guidelines for managementAbdulgafoor MT
1. Intracranial aneurysms have an incidence of 9 per 100,000 people, with a mortality rate of 60% within 6 months if left untreated.
2. Clinical grading scales like Hunt-Hess, WFNS, and PAASH are used to assess patients presenting with subarachnoid hemorrhage, with PAASH showing slightly better correlation with outcome.
3. Risk factors for poor outcomes from aneurysmal subarachnoid hemorrhage include older age, hypertension, aneurysm size and location, rebleeding, delayed cerebral ischemia, and hydrocephalus.
The 62-year-old man presented with chest pain, difficulty breathing, palpitations, and fever for 4 weeks. Tests showed signs of a prior heart attack and severely reduced heart function. He was admitted to the intensive care unit for treatment of heart failure due to ischemic cardiomyopathy with an ejection fraction of 20%, borderline shock, and arrhythmia risks as an early complication of his heart attack.
This patient is a 25 year old female admitted to the ICU for respiratory failure and hypotension following a 6 day prodromal illness. She is intubated and receiving vasopressors. The differential diagnosis includes sepsis, severe sepsis, or septic shock from an unknown source. Principles of management include identifying the source, administering appropriate antibiotics, optimizing hemodynamics and organ function, and providing lung protective ventilation for her acute respiratory distress syndrome. Early enteral nutrition is important to support her systemic immune response and prevent further organ dysfunction from a cumulative energy deficit.
The QT interval is the time from the start of the Q wave to the end of the T wave.
It represents the time taken for ventricular depolarisation and repolarisation, effectively the period of ventricular systole from ventricular isovolumetric contraction to isovolumetric relaxation.
Case-1: A 23 years old gentleman presented with generalized weakness and fatigue , 2 hours after several bouts of vomiting and diarrhea. His serum potassium was 2.3 mEq/L and he had the following ECG.
This document discusses wide complex tachycardias and how to differentiate them based on electrocardiogram (ECG) findings. It provides details on what makes a complex narrow or wide, types of wide complex tachycardias including ventricular tachycardia and supraventricular tachycardia, and ECG criteria to help determine the source and mechanism such as the presence or absence of RS complexes and their intervals. Morphologic criteria on the ECG and algorithms like the ACC algorithm are presented to aid in differential diagnosis.
Similar to Med viva/revision for Anaes M.Med Part 2 (20)
Inferior vena cava ultrasound in Resuscitation - Why I am skepticalHon Liang
This document discusses the use of ultrasound to assess the inferior vena cava (IVC) as a measure of right atrial pressure during resuscitation. While studies have found correlations between IVC characteristics and directly measured right atrial pressure, the author is skeptical for several reasons. Patient-specific factors like position, age, breathing patterns and liver disease can affect IVC measurements. Technical difficulties in ultrasound measurement and inter-operator variability are also concerns. Additionally, extra-luminal pressures from sources like the lungs, pericardium and abdomen can influence IVC filling in complex ways. The author believes more evidence is needed to make sense of these contradictions before IVC ultrasound can reliably replace direct pressure monitoring during resusc
ETHER Senior Resident Stats Talk 29 Jan 2016Hon Liang
The document discusses issues related to statistics and research papers. It addresses why people dislike statistics and provides examples of how statistics can be misused or misinterpreted. It also summarizes different types of research papers and clinical trial designs. Key challenges with meta-analyses are outlined, including heterogeneity between studies, publication bias, and ensuring data quality. The document emphasizes applying results appropriately and not overstating conclusions. It concludes by noting that medutainment is prevalent and that paper critiques are more about logic than perfection.
The document discusses critical care management of burn patients. It covers immediate assessment and airway management in the first 24 hours including fluid resuscitation, lines, and early surgery if needed. Ongoing care in the ICU is then addressed, including medications, nutrition, wound care, and rehabilitation. Complications that can arise in the ICU are also listed. The goal is to provide fluid resuscitation, control pain and infection, optimize nutrition, and facilitate recovery - represented as providing the patient a "Tropical Holiday" in the ICU.
Mayo Clinic Critical Care Grand Rounds (26 Feb 2015)
Pro-Con debate: The use of ultrasound assessment of the Inferior Vena Cava to guide fluid resuscitation: fact or fiction?
Anaesthesia-Critical Care.
CCM Journal Club: Vasopressin-Epinephrine-Steroids for in hospital cardiac ar...Hon Liang
Mayo Critical Care Journal Club (15 Dec 2014). RCT: Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest. JAMA 2013.
Thermoregulation is important in humans because enzymatic reactions in the body are temperature sensitive and function optimally between 35-41°C. Under general anesthesia, the body's ability to regulate temperature is impaired as the interthreshold range widens and mechanisms like shivering are inhibited. This leads to increased heat loss and a drop in core temperature, which can cause complications if core temperature falls below 36°C and is considered hypothermia. The document discusses the mechanisms, effects, and strategies to prevent unintentional hypothermia during anesthesia.
Tan Hon Liang discusses several limitations and myths surrounding the Glasgow Coma Scale and use of central venous pressure. Regarding the Glasgow Coma Scale, it has many limitations as an assessment tool, including being an ordinal rather than continuous scale. Central venous pressure is a poor predictor of volume status, fluid responsiveness, and cardiac output. Studies show its correlation to hemodynamic status is very low, with a receiver operating characteristic curve area of only 0.56. Both tools are commonly used due to dogma but have been shown to have significant shortcomings through evidence.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
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You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
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Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
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An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
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A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
10. Why does QT needs to be
corrected?
This allows comparison of QT values at different heart rates and improves
detection of patients at increased risk of arrhythmias.
14. What is the problem with
prolonged QTc?
An abnormally prolonged QT is associated with an increased risk of ventricular
arrhythmias, especiallyTorsades de Pointes.
22. What is the limitation of
Bazett’s formula?
It over-corrects at heart rates > 100 bpm
under-corrects at heart rates < 60 bpm,
(but provides an adequate correction for heart rates ranging from 60 – 100 bpm).
26. Does hypokalemia cause
prolonged QTc?
Technically no.
U wave may cause apparent prolonedQTc.
But risk ofTdP not there.
Severe hypokalemia = asystole, remember?
42. How many types of
Brugada?
3 types:
Type 1: Brugada Sign + Clinical criteria
(DocumentedVT orVF. Family history of sudden cardiac death at <45 years old
.Coved-type ECGs in family members. Inducibility ofVT with programmed electrical
stimulation. Syncope. Nocturnal agonal respiration.)
Type 2:Type 2 has >2mm of saddleback shaped ST elevation
Type 3: morphology of either type 1 or type 2, but with <2mm of ST segment
elevation
53. What else should you look
out for?
RV infarct and heart block
Inferior infarct: must look for posterior infarct (V1-3)
Inferior infarct: must look for RV infarct
71. What is the difference
between BMS and DES?
Bare metal – more thrombogenic but epithelization more rapid.
Earlier thrombosis
Dual anti-platelet shorter.
DES – less thrombogenic but epithelization slower
Less thrombosis
Dual anti-platelet longer.
82. Data Intepretation
34 yo female intubated and ventilated following a
prolonged generalized tonic-clonic seizure. Initial non-
contrast CT brain shows bilateral
intracerebralhaemorrhages. ABG and GBC post
intubation:
90. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What is the likely diagnosis?
91. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What is the likely diagnosis?
Supratherapeuticwarfarinisation
92. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What are possible causes of
supratherapeuticwarfarinisation?
93. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What are possible causes of
supratherapeuticwarfarinisation?
Overdose
Drug interaction
Change in diet
94. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What are possible drug interactions causing high INR in
this patient?
95. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What are possible drug interactions causing high INR in
this patient?
Antibiotics
Omeprazole
Amiodarone
96. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What is the likeliest mechanism for antibiotics to cause
high INR in this patient?
97. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What is the likeliest mechanism for antibiotics to cause
high INR in this patient?
Vitamin K metabolism altered due to change in gut flora.
98. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What is the likeliest mechanism for omeprazole to cause
high INR in this patient?
99. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
What is the likeliest mechanism for omeprazole to cause
high INR in this patient?
Liver enzyme inhibition
100. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
Outline your management of this patient if not bleeding.
101. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
Outline your management of this patient if not bleeding.
Stop warfarin
Vitamin K in as low a dose as possible
Consider FFP or factor concentrate if high risk of bleeding
102. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
How much FFP should be given?
103. Data Intepretation
68-year-old male with chronicAF is noted to have the
following coagulation profile:
How much FFP should be given?
At least 10-15ml/kg.
104. Data Intepretation
ABG obtained from a patient admitted to the ICU after a
suicide attempt.
What anomaly do you notice in the blood gas report?
105. Data Intepretation
ABG obtained from a patient admitted to the ICU after a
suicide attempt.
What anomaly do you notice in the blood gas report?
Hypercapnia / resp acidosis.
Metabolic acidosis
106. Data Intepretation
ABG obtained from a patient admitted to the ICU after a
suicide attempt.
Anything about the P50?
107. Data Intepretation
ABG obtained from a patient admitted to the ICU after a
suicide attempt.
Anything about the P50?
A left shifted curve despite a high PCO2 and a low pH.
108. Data Intepretation
ABG obtained from a patient admitted to the ICU after a
suicide attempt.
List 2 other investigations you would perform to elucidate
the cause of the anomaly.
109. Data Intepretation
ABG obtained from a patient admitted to the ICU after a
suicide attempt.
List 2 other investigations you would perform to elucidate
the cause of the anomaly.
CoHb
Measure temperature
Measure 2,3 DPG
110. Data Intepretation
ABG obtained from a patient admitted to the ICU after a
suicide attempt.
How can you treat carbon monoxide poisoning?
111. Data Intepretation
ABG obtained from a patient admitted to the ICU after a
suicide attempt.
How can you treat carbon monoxide poisoning?
Supportive
100% oxygen
126. Case Scenerio
68 year-old man who had cardiac surgery 4 days
previously.
He is intubated and ventilated and developed an
increasing FiO2 requirement over the course of the day.
134. Case
19 year old male admitted after a severeTBI.
Due to refractory intracranial hypertension he has been
intubated, sedated and paralysed
You are called to the bedside because he has desaturated
to 85% on 100% oxygen.
145. Story
30 year old male.
ASA 2 smoker. History of childhood respiratory disorder
but well since.
Admitted for right ankle fracture following mountain bike
accident.
Underwent ORIF of right ankle fracture.
POD1: informs nurse of acute breathlessness and you are
contacted for an assessment.
146. Story
Parameters
BP 115 / 75 mmHg
HR 95 / min
SpO2 97% on room air
Temperature 37.5 C
Medication chart
PO Paracetamol 1g qdsprn
PO Synflex 550 mg bdprn
PO Oxycodone 5 mg q2h prn
IV Ondansetron 4 mg tdsprn
149. Describe your approach
My primary approach is to treat the underlying pathophysiology by first
elucidating the cause.
I will d0 so by reassessing the History, performing a directed Physical
Examination and ordering targeted Investigations.
161. Story continues
Patient worsens and consciousness drops.
You decide to intubate the patient.
Describe your intubation technique and choice of drugs.