Friday, June 13, 2008
Thursday, March 13, 2008
Monday, March 3, 2008
I new interest in intra-operative monitoring during enarterectomy is re-visited. I will post a couple of interesting links.
Eric Blackwell, MD OBGYN.net Editorial Advisor
"I would like to share with you a few words about the use of a-mode ultrasound (echoencephalography) at Bowman Gray. My training began several years before the ready availability of computed tomography in the emergency center setting. An early application of ultrasound was for rapid screening of trauma and stroke patients for intracranial mass lesions. The underlying concept was that a-mode ultrasound could be used to identify structures normally located in the midline of the brain such as the third ventricle and falx cerebri."
The second reference is from the ARDMS newsletter.
" New techniques for detecting harmful blood clots and air bubbles in arteriesNew techniques for detecting emboli have played a major role in dramatically reducing stroke rates after carotid edarterectomy.New techniques for detecting emboli (harmful blood clots/air bubbles in arteries) developed at the University of Leicester have played a major role in dramatically reducing stroke rates after carotid endarterectomy. This is an operation designed to remove narrowings in the main arteries supplying the brain before they can cause a stroke."
Wednesday, February 6, 2008
Tuesday, January 29, 2008
Saturday, January 12, 2008
Friday, January 4, 2008
....was very busy. And "busy" in a good way. Lots of codes and respiratory distress. Not so much "weak and dizzy" and "TMD (todo me duele)". The kind of night that reminds you why you chose emergency medicine as a specialty, and not primary care.
Anyhoo, there was this one guy...
A 36 yo morbidly obese Samoan man with a past medical history of diabetes, hypertension, and has lots of 'bad habits', was brought in by paramedics complaining of chest pain which started 10 minutes prior to the 911 call. He was sitting on the sofa watching reruns on TV when he suddenly felt a tightening in his chest. He got up to get a cup of water, and the pain got worse. Then he felt weak and lightheaded so he sat down on the nearest chair. He then called for his wife, and she took one look at him and called 911.
In the field EMS established a very tiny finger IV (because 'his veins could not be accessed secondary to excessive adipose tissue.' i.e. he was too fat). They gave him an aspirin, and after he denied using Viagra, a nitroglycerin sublingual. Immediately thereafter his blood pressure dropped from 150s systolic to low 80s. He became very diaphoretic (lots of sweating), and short of breath.
Upon ED arrival the patient was alert and oriented, but very agitated sitting upright on the gurney, in moderate/severe respiratory distress. He weighed about 450 pounds, and was extremely diaphoretic, and c/o worsening SOB. EKG could not be obtained by the paramedics because the stickers wouldn't stick to the body for all the sweat. Also, the patient was so agitated and anxious that a good reading couldn't be obtained even when the EKG leads were held in place by assistants.
In the ED we attempted to obtain an EKG...for over 20 minutes. We cannot make a diagnosis of acute MI requiring thrombolytics if we cannot obtain an EKG. Afterall, there are other deadly causes of chestpain, some of which absolutely cannot be treated with thrombolytics (or else you kill the patient). It's one thing for someone to die. It's another thing to kill them. So we worked to obtain that EKG...over, and over, and over, and over again.
During this time we worked to establish a better IV with ultrasound guidance."