Oxygen dissociation curve

If video is not visible click below

Here

http://youtu.be/HYbvwMSzqdY

Bedside caution on Thrombolytic therapy for central venous catheter occlusion

Thrombolytic agents successfully clear central venous catheter occlusions in most cases. (1).

Good practice is, once catheter function is restored, aspirate 4-5 mL of blood to remove thrombolytic  from catheter.




Reference / further reading:

1. Jacquelyn L. Baskin and col. - Thrombolytic therapy for central venous catheter occlusion - Haematologica. 2012 May; 97(5): 641–650.

 Skinfold vs Pneumothorax

"Absence of lung markings is not sufficient to make diagnosis of pneumothorax as lung may fold on itself"!

Click here* to have very informative slide presentation on recognising pneumothorax on CXR (from learningradiology.com)



*link: http://www.learningradiology.com/medstudents/recognizingseries/pneumothoraxflashpage.htm

An interesting way to find "optimum PEEP"

(Abstract)

This study was conducted to evaluate the effectiveness and safety of a practical protocol for titrating positive end-expiratory pressure (PEEP) involving recruitment maneuver (RM) and decremental PEEP.

Seventeen consecutive patients with acute lung injury who underwent PEEP titration were included in the analysis. After baseline ventilation, RM (continuous positive airway pressure, 35 cm H2O for 45 sec) was performed and PEEP was increased to 20 cmH2O or the highest PEEP guaranteeing the minimal tidal volume of 5 mL/kg. Then PEEP was decreased every 20 min in 2 cmH2O decrements.

The "optimal" PEEP was defined as the lowest PEEP attainable without causing a significant drop (>10%) in PaO2. The "optimal PEEP" was 14.5 +/- 3.8 cmH2O. PaO2 /FI O2 ratio was 154.8 +/- 63.3 mmHg at baseline and improved to 290.0 +/- 96.4 mmHg at highest PEEP and 302.7 +/- 94.2 mmHg at "optimal PEEP", both significantly higher than baseline (p<0.05).

Static compliance was significantly higher at "optimal" PEEP (27.2 +/- 10.4 mL/ cmH2O) compared to highest PEEP (22.3 +/- 7.7 mL/cmH2O) (p<0.05).

Three patients experienced transient hypotension and one patient experienced atrial premature contractions. No patient had gross barotrauma.

PEEP titration protocol involving RM and PEEP decrement was effective in improving oxygenation and was generally well-tolerated.



Reference:

Suh GY and col. - A practical protocol for titrating "optimal" PEEP in acute lung injury: recruitment maneuver and PEEP decrement..

J Korean Med Sci. 2003 Jun;18(3):349-54.

Q: What dose of Versed (midazolam) is optimum for antegrade amnesia?

Answer: About 0.05 – 0.1 mg/kg.

Reference:

Bulach R: Double-blind randomized controlled trial to determine extent of amnesia with midazolam given immediately before general anaesthesia. BJA 2005;94:300-5

Q: What is 80-10-10 distribution in brain?

Answer:

80% - Parenchyma

10% - Blood

10% - CSF

On IV acetaminophen

 "Compared to oral acetaminophen, IV acetaminophen achieves a rapid elevation in plasma concentration and higher peak levels. The IV form achieves plasma levels rarely achieved by similar oral doses of acetaminophen and produces 75% higher central nervous system (CNS) bioavailability compared to the oral form. The analgesic effect peaks within one hour and lasts for four to six hours." 

 Read full article here 

Darrell Harrington, MD 
Chief, Division of General Internal Medicine 
Harbor-UCLA Medical Center, Los Angeles 

 Source: Today's Hospitalist