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Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
This handheld device or monitor wave offers a non-invasive way to assist in the interpretation of the person’s gaseous exchange. The capnography device fits to an intubation tube to give these results. Capnography offers the practitioner immediate results at the bedside until further analysis is available. The device is used in an emergency resuscitation situation and during anaesthesia and sedation events. It can advise practitioners regarding the individual’s breath to breath carbon dioxide levels, the level of exhaled breath and their respiratory rate. The normal level ranges from 35 to 45 mm Hg. Arterial blood gases (ABGs) and VBGs sampling in an emergency situation can take time to obtain a specimen and analysis, so this device can assist in early recognition of gaseous exchange issues.
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 64 year old female patient presents with shortness of breath on exertion. She smokes five cigarettes per day and her past medical history includes rheumatoid arthritis, hypertension, hypercholesterolaemia and atrial fibrillation. Initial bloods are normal apart from the arterial blood gas, which reveals a PaO2 of 9.5 kPa (normal range 10.5–13.5 kPa) with a restrictive pattern on spirometry. High resolution CT chest demonstrates bilateral hyperdense consolidation which is predominantly peripheral, affecting the bases more than the apices with patchy ground glass opacification and reticulation.
Incredible journeys
Published in Brendan Curran, A Terrible Beauty is Born, 2020
Take a deep breath and hold it for as long as you can. How long did you manage? Thirty seconds to 1 minute, average; 1–2 minutes, good; 2–3 minutes, you must play a trumpet. More than 3 minutes and I hope an appreciative relative will get this book in your will! All animal cells need oxygen; some cells need it more than others do – muscle cells can do without it for limited periods but nerve cells need it continually. As a professional strangler will tell you, stop the supply of blood to the brain for 1–2 minutes and your next victim is in hand. Blood is necessary if oxygen is to get to the cells but, unlike a sugar such as glucose, oxygen does not dissolve very well in water, so specialised red blood cells do the job. They pick up oxygen in the lungs and get pumped by the heart via the arteries all around the body. Having delivered their critical cargo of oxygen to body cells, they return via the veins and heart to the lungs for more oxygen. The act of carrying oxygen actually alters the colour of the cells: arterial blood is scarlet and venous blood is dark red.
Neurosurgical intraoperative ultrasonography using contrast enhanced superb microvascular imaging -vessel density and appearance time of the contrast agent-
Published in British Journal of Neurosurgery, 2023
Mami Ishikawa, Kazuto Masamoto, Ryota Hachiya, Hiroshi Kagami, Makoto Inaba, Heiji Naritaka, Shojiro Katoh
The tumor comprised many vessels, judging from SMI of US monitoring without contrast agent Table 1, Figure 1(A), Video 2. Following injection of the contrast agent, flow in the tumor was visualized first, before flow appeared in the cerebellar arteries. In the operative field, red veins, representing arterial blood, were observed until two main feeders were cut. The tumor became prominent immediately after injection of contrast agent and the tumor margins were well recognized by drastic changes on SMI in grayscale mode, compared to those before injection of the contrast agent. Vessel density was about 10 times greater and appearance time was halved, compared to normal vessels (Table 1, Case 2). After removal of the high flow-tumor, US images showed no residual tumor, and flow in the brain was drastically increased following injection of the contrast agent (Video 2).
Challenges in COVID-19: is pulmonary thromboembolism related to overall severity?
Published in Infectious Diseases, 2020
Andrea Bellieni, Enrica Intini, Eleonora Taddei, Fabiana Baldi, Luigi Larosa, Rita Murri, Luca Richeldi, Roberto Bernabei, Roberto Cauda, Francesco Landi, Giuseppe Maria Corbo, Massimo Fantoni
Arterial blood gas revealed: PaO2 58 mmHg, pCO2 28 mmHg, pH 7.49, PaO2/FiO2 276 mmHg. Oxygen therapy was started with FiO2 28%. On day five from admission, the patient reported intercostal pain and dyspnoea. arterial blood gas showed: PaO2 87 mmHg, PaCO2 34 mmHg, pH 7.46, PaO2/FiO2 362.5 mmHg, oxygen saturation 96%. Coagulation tests and investigations for thrombophilia showed a normal platelet count, slightly elongated aPTT (38.9 s, rr 20–38), increased D-dimer (1649 ng/ml, rr <500) and Factor VIII activity (165.6%, rr 70–140) and a positive Lupus Anticoagulant. A contrast-enhanced chest CT scan documented pulmonary thromboembolism (Figure 1). Anticoagulation therapy was promptly started using low-molecular-weight heparin twice daily subctunaneous injections of 100 IU/kg (1 mg/kg).
Treatment of hypertriglyceridemia-induced acute pancreatitis with therapeutic plasma exchange in 2 pregnant patients
Published in Journal of Obstetrics and Gynaecology, 2019
A 37-year-old primiparous woman was admitted to the gastroenterology department of our hospital with complaints of epigastric pain and nausea during her 22nd week of gestation. She had an attack history of having HTG-AP, 3 years before this attack. In the medical history, there was an uncontrolled hypertriglyceridaemia with an irregular usage of fenofibrate for 10 years. The fibrate treatment was stopped due to her pregnancy. The patient’s weight was 63 kg, and her height was 162 cm. On physical examination, her arterial blood pressure was 105/60 mmHg, heart rate was 85/min, blood temperature was 37.0 °C. A physical examination revealed a rebound tenderness on epigastrium. The laboratory results are shown in Table 1. As a result of a sequence analysis, testing for APOA5 (apolipoprotein A5) ve LIPI (LIPASE I) genetic mutation associated with hypertriglyceridaemia were negative. The results of arterial blood gas analysis were pH: 7.40, PCO2: 33.8 mmHg, PO2: 41.5 mmHg, HCO3: 22.9 mmol/L, SO2: 77.2%. The Ranson’s score was 2 at admission and at the 48th hour. We stopped the oral intake and administered an analgesic and serum saline (4–6 L/day) therapy. Haemonetics MCS+ (Haemonetics Corp. Braintree, USA) was used in TPE procedures. Fresh frozen plasma was given for TPE at a volume of 40 mL per kg of body weight (BW), as well as a heparin infusion for an anticoagulation at a rate of 10 U/kg/hour. The 3200 and 2900 mL mean plasma volumes were exchanged/substituted during the extracorporeal procedures.