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Metabolic Laboratory Data
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
It is worth mentioning that there are times that the glucose level will be incorrect. Most commonly, this occurs when the sample was drawn from a PN line with an inadequate pullback and discard of the PN solution. This will cause the reading to be unexpectedly high. On the other hand, if the nurse draws from a line with saline flush. The glucose may be unexpectedly low. When either of these happens, I usually request the floor nurse to do a quick finger stick glucose and then repeat the lab.
Medications for endovascular therapy
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Heparin, also known as unfractionated heparin, is a naturally occurring glycosaminoglycan. It is metabolized by the liver and metabolites are excreted in the urine. Full anticoagulation with heparin may be contraindicated in patients with excessive bleeding risk or severe liver disease. Heparin is routinely used in the saline flush solution during all arteriographic and endovascular therapy cases. Systemic heparinization may or may not be used during strategic arteriography; there is no set standard. However, heparin should be administered during carotid arteriography, when an arteriographic catheter is passed across a critical lesion, or when the operator anticipates angiography in multiple vascular beds. Heparin or an alternative intravenous anticoagulant is always administered during therapeutic endovascular procedures. Intravenous boluses of heparin, ranging from 50 to 100 U/kg, are often used in conjunction with percutaneous interventions (see Chapter 17, Table 17.4). The half-life of heparin is 60–90 minutes and is prolonged in patients with renal or hepatic dysfunction. In lengthy procedures, heparin is typically redosed at 1-hour intervals. An activated clotting time (ACT; normal is 150–170 seconds) can be used to assess residual heparinization prior to sheath removal. Complex, small vessel endovascular cases, such as carotid or tibial cases, should be managed with an ACT of more than 250 seconds.
Coma and reduced level of consciousness
Published in Sherif Gonem, Ian Pavord, Diagnosis in Acute Medicine, 2017
Severe hypoglycaemia should be treated with IV glucose, for instance 25 ml of 50% glucose. This should be administered into a large vein and followed with a saline flush to reduce the risk of extravasation injury or phlebitis.
Dosing Errors Made by Paramedics During Pediatric Patient Simulations After Implementation of a State-Wide Pediatric Drug Dosing Reference
Published in Prehospital Emergency Care, 2020
John D. Hoyle, Glenn Ekblad, Tracy Hover, Alyssa Woodwyk, Richard Brandt, Bill Fales, Richard L. Lammers
Our simulations allowed us to observe a previously undescribed phenomenon for prehospital pediatric medication administration-entrainment of air into the administration syringe and administration of that air to the simulated patient. Although it is doubtful that the amount of air itself would be harmful, it still contributed to under dosing of medication, especially those given in small volume syringes (e.g., 1 mL). This phenomenon was observed when medications were drawn directly into an administration syringe and with transfer to a second syringe for dilution. The training EMS crews receive for dilution requires pushing out a set amount of saline from a pre-loaded 10-mL saline flush syringe, such that the volume matches the dilution volume in the PDR instructions, and then drawing up the entire volume of the supplied drug vial. Next a 3-way stopcock is affixed to the syringe with diluted drug and a smaller administration syringe (e.g., 1 mL or 3 mL) is attached to the stopcock. Diluted drug is then pushed into the administration syringe. An unintended consequence of this process is that the air in the stopcock, typically about 0.2–0.3 mL, is pushed into the administration syringe. In our simulations, this amount of air was rarely recognized or eliminated. A way to avoid this would be to prime the stopcock with diluted drug prior to attaching the administration syringe. Uniformly, this was not done.
Contrast enhanced ultrasound characterization of surgically resected renal masses in patients on dialysis
Published in Scandinavian Journal of Urology, 2019
Amanda E. Kahn, Andrew K. Ostrowski, Melanie P. Caserta, Isabella J. Galler, David D. Thiel
Two radiologists, with more than 10 years of experience in abdominal ultrasound, performed the CEUS examinations during the time of data collection for this study. Examinations were performed with a GE Logiq E9 ultrasound machine (GE Healthcare, Wauwatosa, WI) equipped with contrast specific software and the C1-6D broadband curvilinear transducer. The ultrasound contrast agent (UCA) utilized was Lumason (Sulfur hexafluoride lipid type-A microspheres, Bracco Diagnostics, Monroe Township, NJ). Patients were screened for contraindications to UCA, such as known allergy, prior to administration. UCA was injected following placement of a left antecubital 20 gauge intravenous (IV) line. A three way stopcock was used to allow for injection of the UCA followed immediately by a 5–10 mL saline flush. The microbubbles are sensitive to mechanical forces, and the contrast must be injected in the straight port to prevent bubble destruction during injection. The saline was injected in the perpendicular port [2]. Dosage of Lumason ranged from 1–2 mL per injection, with up to two possible repeat injections performed as needed. Dual mode screen display was utilized to allow for side-by-side images with a reference grayscale image on one half of the screen and the contrast enhanced image on the other half of the screen (Figure 1). All examinations were performed in contrast mode with a low mechanical index (<0.2). Continuous scanning was performed for up to 4 minutes and a cine loop of the first minute was saved for each patient. Still and cine images were also taken at various points during the examination after the initial minute of scanning.
Quantitative dynamic contrast-enhanced ultrasound to predict intrahepatic recurrence of hepatocellular carcinoma after radiofrequency ablation: a cohort study
Published in International Journal of Hyperthermia, 2020
Xue Han, Jing Dong, Zhao Liu, Bolin Wu, Yuhang Tian, Haoyan Tan, Wen Cheng
All patients underwent CEUS imaging one week before RFA. First, conventional ultrasound was performed to determine the lesion location, quantity, size, blood supply, and relationship to peripheral structures. Patients with lesions that could not be seen clearly were excluded from the study. Subsequently, CEUS was performed on the section of the lesion with the largest blood flow using a Siemens Acuson S3000 color Doppler ultrasound system (Siemens, Germany) with a transducer frequency of 2.0–5.0 Hz and a mechanical index of 0.06. The contrast agent was sulfur hexafluoride microbubbles (SonoVue, Bracco, Italy). It was prepared by dissolving 24.98 mg dry powder in 5 ml saline (0.9% NaCl) to a final concentration of 8 ml/mL. Microbubbles (2.4 ml) were injected through an antecubital vein in the left arm with a 20-gauge syringe. A microbubble bolus injection was followed by a 5 ml saline flush. The timer on the control panel was started at the beginning of the saline flush. The entire vascular phase of liver CEUS consists of the arterial phase, portal venous phase, and late phase, according to the CEUS Liver Imaging Reporting and Data System criteria [21]. The enhancement pattern of each tumor was observed, and a dynamic sequence of 2 min or more was recorded. SonoVue uptake and washout and echo intensity within the tumor were recorded for later analysis. In cases of multiple hepatic lesions, the largest lesion was analyzed using CEUS. The built-in auto contrast software was used to analyze the region of interest (ROI) quantitatively. The ROIs of the tumors were defined in the most enhanced area of the HCCs. The sizes of all the ROIs were 1 cm. Time–intensity curves were generated from the ROIs. Quantitative parameters were peak intensity (PI), time to peak (TTP), mean transit time (MTT), and area under curve (AUC). The operators of the ultrasound examination were experts in hepatology and ultrasonography, with more than 5 years of experience in ultrasound examination at the time of study initiation.