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Anesthesia Monitoring and Management
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
One hour into procedure. No eye movement, normal mucous membrane color and CRT.RR 5 breaths/minute.EtCO2 55 mmHg.SpO2 95%.Normal sinus rhythm, HR 32 beats/minutes.Blood pressure 120/55 (80) mmHg.This patient is currently hypoventilating, and this could be what has caused the saturation to be low.
Questions for part B
Published in Henry J. Woodford, Essential Geriatrics, 2022
A 73-year-old man presents following a sudden onset of a two-hour episode of right arm weakness and being unable to find the right words to say the day previously. His deficit has fully resolved and neurological examination is now normal. His blood pressure is 127/76 mmHg. An ECG shows sinus rhythm. He does not currently take any medication. Which of the following would be most appropriate to reduce his long-term risk of future stroke?A non-vitamin K antagonist oral anticoagulant (NOAC)Aspirin 75 mg dailyAspirin 75 mg plus clopidogrel 75 mg dailyClopidogrel 75 mg dailyWarfarin aiming for INR in range 2.0 to 3.0
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Before examining common arrhythmias, it is important that you are confident in recognising sinus rhythm. Whilst the study of arrhythmias can be interesting and challenging, the essential requirement is the ability to recognise deviation from the patient’s normal rhythm and evaluate the clinical effect of the arrhythmia (such as changes in blood pressure, breathlessness and/or onset of chest pain), so that early medical review can be requested in the event of rhythm change. For this reason, sinus rhythm and only the most common arrhythmias of sinus tachycardia, sinus bradycardia and atrial fibrillation, will be discussed in this section.
Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update
Published in Expert Review of Medical Devices, 2022
Julie Cooper, Christopher Joseph, Jason Zagrodzky, Christopher Woods, Mark Metzl, Robert W. Turer, Samuel A. McDonald, Erik Kulstad, James Daniels
Further research holds the potential to restore normal sinus rhythm more effectively and with greater safety than currently possible. Pulsed field energy to induce irreversible electroporation in cardiac tissue was first used in the 1980s but was superseded by radiofrequency ablation due to complications from early iterations of the technology (primarily barotrauma and microbubble formation). Newer approaches to utilizing pulsed field energy have recently been developed, with the anticipation that tissue selectivity might eliminate collateral damage during ablation of cardiac tissue. At present, there has been some progress in this area, with the caveat that demonstration of both safety and long-term efficacy has not been completed. A recent large survey of the first 1,758 cases treated with one of the first successfully commercialized systems for pulsed field ablation found significantly more complications than expected, prompting the authors to note that the high frequency of complications underscores the need for improvement.
Acute Enophthalmos After Lumbar Puncture in a Patient with Type 1 Neurofibromatosis Related Sphenoid Wing Dysplasia
Published in Neuro-Ophthalmology, 2022
Deanna Ingrassia Miano, Gregory Byrd, Rani Kattoula, Aye Thet, Ryan Adkins, Ryan Cosgrove, Samantha S. Johnson
A 19-year-old African American woman with a medical history significant for NF-1 presented to hospital after collapsing while leisurely walking outside. She denied any previous syncopal events, blurred vision, diplopia, dizziness, headache, incontinence, weakness, sensory loss, nor history of drug or alcohol use prior to this incident. She denied taking any medications, including anti-epileptics. She had been diagnosed with NF-1 5 years earlier after a single epileptic event, which led to the discovery of a right-sided sphenoid wing dysplasia on imaging. In addition, her family history was positive for NF-1 in her mother. The evaluation was notable only for mild right ankle pain secondary to the fall. An electrocardiogram demonstrated normal sinus rhythm. Aside from the patient’s previously known NF-1 related sphenoid wing dysplasia, a non-contrast computed tomography (CT) scan of the head was negative for acute abnormality (Figure 1A). She was subsequently admitted to the hospital for a further work-up. An electroencephalogram revealed no epileptiform activity. No acute changes were appreciated on magnetic resonance imaging (MRI) at this time. CT angiography of the brain revealed a 2 mm infundibular dilatation at the origin of the left ophthalmic artery. No vasculitic findings were observed.
Gigantic arteriovenous fistula between left coronary cusp and coronary sinus draining into the right atrium
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Syed Raza Shah, Imtiaz Ismail, Munis Raza, Sohail Ikram
A 65 year-old asymptomatic man came to the cardiology clinic after a low-dose CT scan, which was initially done as a preventative health screening tool for lung cancer screening, showed marked enlargement of his left circumflex coronary artery, measured at 18.9 mm, as an incidental finding (Figure 1). Patient was subsequently referred for a cardiac catheterization for further evaluation (Figures 2–4). There was no family history of congenital heart disease or other inherited abnormalities. The vital signs were normal. Physical examination was unremarkable. EKG showed normal sinus rhythm with no abnormalities. Chest X-rays showed only mild cardiomegaly. Coronary angiography revealed a huge vessel originating from the left coronary cusp that appeared to be draining into the right atrium. It was not clear from the angiogram if this vessel was originating from left coronary artery or directly from the left cusp. Because of its huge diameter, this vessel required a guiding catheter for optimal filling. There were no significant atherosclerotic lesions in the coronary arteries. No significant oxygen step up was noted in the right sided chambers and no pulmonary hypertension was seen. The case was presented to cardiothoracic surgeons. Since the patient was asymptomatic, they recommended medical management and continued close surveillance.