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Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
Most of the time, the results of heart blood measurements will suggest that more drugs were present at the time of death than was actually the case, and the measured concentrations will be much higher than if they had been measured in the periphery. On the other hand, heart blood provides a wonderful medium for drug screening, simply for the purpose of detection, even if attempts at quantitation provide little useful information. Venous blood should be collected with a needleless syringe. An incision through the inferior vena cava, inside the pericardial sac, allows for the passage of a syringe for blood aspiration. The blood samples must be collected in a test tube containing a preservative (usually 1% sodium fluoride), labeled with the autopsy number and the full name of the decedent, and then kept in a refrigerated environment at −2°C to 4°C until processing. If, for some reason, arterial blood is desired, the samples can be taken from the descending thoracic aorta as it crosses the mediastinum. This can be an especially useful approach when there is evidence of extreme postmortem coagulation.
Carbon Dioxide Carriage in Blood
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Carbon dioxide exists in three forms in blood: dissolved in physical solution, as bicarbonate and as the carbamino form in combination with proteins, mainly haemoglobin. In arterial blood, bicarbonate accounts for 90% of the carbon dioxide, 5% is dissolved and 5% is present as carbamino compounds. In the capillaries of peripheral circulation, carbon dioxide is added to the blood from the tissues, so that the carbon dioxide content of venous blood is higher than that of arterial blood. Venous blood, with a lower oxygen content, has a higher capacity to carry carbon dioxide. Of the carbon dioxide transferred from the tissues and evolved in the lung, 30% is transferred in the venous blood as carbamino compounds, 10% is dissolved and 60% exists in the form of bicarbonate.
Trauma and Stabilisation
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
Venous blood: Urea, creatinine, creatine kinase. Acute kidney injury may develop from myoglobinuria, hypoxaemia, hypoperfusion, haemolysis.Electrolytes. Occasionally, electrolyte changes from fluid shifts.Full blood count and coagulation. Disseminated intravascular coagulation may occur.Toxicological assays for drugs and alcohol.
Hb Santa Juana (β 108(G10) Asn > Ser): a low oxygen affinity hemoglobin variant in a family of Bosnian background
Published in Hematology, 2023
N. P. Wildenberg, C. Rossi, A. E. Kulozik, J. B. Kunz
Because of the history of decreased oxygen saturation during anesthesia and the low-normal hemoglobin levels we hypothesized that Hb Santa Juana, similarly to Hb Schlierbach, Hb Yoshizuka and Hb Presbyterian, which are characterized by point mutations at the same position (supplemental table), may be associated with a decreased oxygen affinity. Because the methodology for directly determining the oxygen saturation curve was not available we validated this hypothesis with a well-established and readily available alternative method that calculates p50 (O2) using results from venous and capillary blood gas analyses [6]. This analysis revealed decreased oxygen affinity in all family members, with p50 (O2) ranging from 31.9 to 37.5 mmHg (calculated from venous blood samples) and 37.1 to 40.4 mmHg (capillary samples). We compared these results with p50 (O2) from eight patients not carrying a hemoglobin variant which resulted in significantly lower readings (24.9–28.1 mmHg, p < 0.01), consistent with the normal values reported in the literature (26 ± 1.3 mmHg, [6]).
Patient-specific hemodynamic analysis of IVCS-induced DVT
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Xudong Jiang, Xueping Gu, Tianze Xu, Xiaoqiang Li, Peng Wu, Lili Sun
It is well known that Virchow's triad includes three categories of factors that might contribute to thrombosis, i.e. hypercoagulability, hemodynamic changes (turbulence or stasis) and endothelial injury/dysfunction. IVCS not only causes EndMT and inflammation, but also brings hemodynamic changes (such as disturbance and stasis of blood flow) in the stenosis and nearby, which are related to thrombosis. Compared with arteries, venous blood flow is relatively slow. Studies have shown that in the venous system, blood flow disturbances due to reflux, outflow tract obstruction or stasis can cause venous hypertension, leading to collateral circulation, chronic venous diseases and DVT formation (Chiu and Chien 2011). Furthermore, the direction of venous blood flow is opposite to the arterial blood flow and more prone to thrombosis (Wolberg et al. 2012). In summary, the disorder and stasis of blood flow caused by various factors in the venous system are closely related to thrombosis.
Mechanical circulatory support in cardiogenic shock: a critical appraisal
Published in Expert Review of Cardiovascular Therapy, 2022
Giulia Masiero, Francesco Cardaioli, Giuseppe Tarantini
VA-ECMO is effectively a modified cardiopulmonary bypass circuit that provides continuous, non-pulsatile CO. It removes CO2 from and adds O2 to venous blood via an artificial membrane, bypassing the pulmonary circulation. The ECMO provides significant hemodynamic support (up to 8 l/min) increasing LV afterload and wall stress which in turn can increase myocardial oxygen consumption and therefore limit any cardio-protective benefit [43]. The implantation procedure needs a full collaboration between cardiologists, surgeons, anesthesiologists and perfusionists. Systemic anticoagulation with heparin is required to achieve an activating clotting time of 150 to 180 seconds [44]. Contraindications to ECMO include significant aortic valve regurgitation, severe peripheral arterial disease, bleeding diathesis, recent stroke or head trauma and uncontrolled sepsis [43]. At present, only small observational studies have examined VA-ECMO use in severe refractory AMI-CS patients showing high mortality rate even greater than 50% in some cases [45–47]. A recent propensity-score matched analysis among AMI-CS patients, including 5730 subjects receiving Impella and 560 treated with VA-ECMO, showed a lower rate of in-hospital mortality, respiratory failure, and vascular complications in patients treated with Impella [48]. At present, despite the lack of randomized data regarding the use of VA-ECMO in CS patients, it can serve as a bridge-to-recovery, bridge-to-bridge, and bridge-to-transplant for patients with refractory shock [8,10]. The ongoing ECLS-SHOCK and EURO-SHOCK Trials may add important data in this field [49,50].