Circulatory and Respiratory Physiology Commons^™

Extracorporeal Rescue In Massive Pulmonary Embolism: A Case Of Chronic Thromboembolic Pulmonary Hypertension Unveiled, Kenzo Ramos, Kari Gorder

Journal of Shock and Hemodynamics

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare yet curable cause of pulmonary hypertension from unresolved pulmonary emboli. We present the case of a 48-year-old man with progressive dyspnea and leg swelling, who was found to have bilateral pulmonary emboli with right heart strain. He developed cardiac arrest during thrombectomy, requiring emergent veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Further evaluation revealed acute emboli superimposed on CTEPH. After incomplete thrombectomy and persistent instability, he underwent successful pulmonary endarterectomy with ECMO decannulation, leading to recovery of right ventricular function and discharge in stable condition. This case illustrates that previously unrecognized CTEPH may …

Development Of A Longitudinal, Small-Group Pocus Curriculum For Internal Medicine Residents, Shah N. Mahmud Do, Ammar W. Bhatti Do, Ariq Rahman Md, Omar Al Qassab Md, Fraser Mackay Md

The Lahey Journal

Development of a Longitudinal, Small-Group POCUS Curriculum for Internal Medicine Residents

Introduction

Point-of-Care Ultrasound (POCUS) is integral for clinicians to enhance their diagnostic and procedural skills. Unlike Emergency Medicine or Anesthesia training programs, Internal Medicine programs often lack a structured and standardized curriculum. We thus developed a longitudinal and multi-pronged POCUS curriculum aimed at building trainee competency when utilizing ultrasound for diagnostic and procedural work-up.

Methods

The curriculum encompasses the following: basics of ultrasound, ultrasound-guided procedures, thoracic ultrasound/Bed Lung Ultrasound in Emergency (BLUE), and cardiac ultrasound/Focus-Assessed Transthoracic Echocardiography (FATE). These modules were integrated into the residents’ clinic blocks. We utilized …

Leveraging Clinical Standards To Improve The Translational Relevance Of Therapies For Experimental Spinal Cord Injury, Aaron L. Silverstein

Theses and Dissertations--Neuroscience

Efforts to improve treatment of spinal cord injury (SCI) often use animals to develop effective therapeutics, intending to improve the survival and the quality of life of persons with SCI. Over half of all SCIs in the United States occur at the cervical level and often cause locomotor deficits and life-threatening breathing dysfunction. Thus, my dissertation is focused on this important patient population.

After beginning with a description of translational research and surveying SCI from a clinical standpoint, I turned to describe experimental models of cervical SCI and more detailed neuroimmunological findings relevant to my work. Then, I conducted a …

Deciphering Dyspnea: Exercise-Related Flail Mitral Valve Masquerading As Pneumonia, Mehtab Galeh, Amjad Nader, Rania Esteitie

Journal of Shock and Hemodynamics

A 62-year-old male presented with a sudden onset of dyspnea following a racquetball session. Vital signs revealed a blood pressure of 136/63 mm Hg, heart rate of 116 beats/min, respiratory rate of 26 breaths/min, temperature of 98.7º F, and oxygen saturation of 85% on room air. The physical examination was notable for tachycardia, no audible murmur, and bilateral coarse breath sounds on lung auscultation. Pertinent laboratory data showed leukocytosis, elevated lactic acidosis, and elevated brain natriuretic peptide. Arterial blood gas analysis on room air revealed a pH of 7.39, partial pressure of carbon dioxide of 32 mm Hg, and arterial …

Assessing Mid To Long Term Amputation-Free Survival Rates In Chronic Limb-Threatening Ischemia; A Study Of Hybrid Vascular Techniques, Cristian Traian Paius, Vlad Denis Constantin, Alexandru Carap, Andrei Tarus, Grigore Tinica

Journal of Mind and Medical Sciences

Introduction. Chronic limb-threatening ischemia (CLTI) is a debilitating condition characterized by inadequate blood supply to the lower extremities, often leading to tissue damage, ulcers, and limb loss. Amputation-free survival (AFS) serves as a crucial measure in evaluating interventions and managing CLTI, emphasizing limb preservation, functional restoration, and prevention of recurrent ischemic events. Objectives. This study aimed to assess mid to long term AFS in CLTI patients treated with hybrid vascular techniques. Materials and Methods. Conducted over 24 months at the Emergency Hospital of Saint Pantelimon in Bucharest, Romania, the study enrolled 62 adult CLTI patients, tracking them postoperatively. Kaplan Meyer …

Optimizing Ventilator-Associated Pneumonia Prevention And Education: In Adult Icu Settings, Danielle Gonzalez

Nursing | Student Research Posters

Background: Ventilator associated pneumonia (VAP) in adult intensive care patient units (ICU) is one of the most common and deadly nosocomial infections today. Studies have identified a gap in intensive care nurse ventilator education and compliance with hospital protocols. Overall increasing the rates of VAP and morbidity. Hospitals worldwide have shown a decrease in VAP rates after inheriting "VAP-bundles''. This includes nurse specific interventions and assessments as a preventative measure. However, studies failed to demonstrate which bundle interventions directly correspond to the prevention of VAP. Purpose: Address all components of education, a nurse’s ability to properly identify and understand the …

Contribution Of Metabolic Cell Swelling On Microcirculatory Perfusion In Septic Shock, Charles E. Payne

Theses and Dissertations

Sepsis, a systemic immunological response that leads to organ-dysfunction, the development of septic shock, and death has mortality rate of 15-25%. A subset of sepsis, septic shock, has an in-hospital mortality rate of 30-50%. Sepsis and its treatment are the most expensive healthcare problem in the United States with the US Agency for Healthcare Research and Quality estimating annual costs over $20 billion. Hypoxia experienced in septic shock induces metabolic cell and tissue swelling leading to further microcirculatory dysfunction and poor tissue perfusion. Reversing metabolic cell swelling corrects these perfusion defects. Two models were used in rats to induce septic …

Upper Gastrointestinal Bleeding During The Covid-19 Pandemic; Particularities Of Diagnosis And Therapy, Adrian Silaghi, Bogdan Severus Gaspar, Dragos Epistatu, Daniela Gabriela Bălan, Ioana Păunică, Anca Silvia Dumitriu, Stana Paunica, Bogdan Socea, Vlad Denis Constantin

Journal of Mind and Medical Sciences

SARS-COV 2 recently caused a global pandemic, with the first case being reported in Romania in February 2020. Important restrictive measures were imposed, so that the addressability of patients to medical services decreased. Upper gastrointestinal bleeding had more severe forms of evolution at the time of presentation, which required additional methods of diagnosis and treatment. This is a retrospective study performed on 268 patients, which aims to evaluate the type and effectiveness of different treatment methods for upper gastrointestinal bleeding during the COVID 19 pandemic. Severity assessment was performed by measuring the Rockall score and additional methods of diagnosis. The …

Fear Of Covid-19, Anxiety, Depression And Suicide Among Elderly Patients With Chronic Physical Or Mental Diseases, Vasiliki Holeva, Vasiliki Aliki Nikopoulou, Eleni Parlapani, Konstantinos Karkaletsis, Styliani Kokkoni, Dimitrios Nouvakis, Patroklos Theocharis, Ioannis Diakogiannis

Journal of Mind and Medical Sciences

Older age renders individuals vulnerable during public emergency crises. Considering that older adults are a highly heterogeneous and continuously growing demographic subgroup, this study aimed to assess the mental health impact of COVID-19 on two groups of older patients: a group of chronic physical disease and a group of chronic mental disease. A total of 102 patients completed the Fear of COVID-19 Scale, the Generalized Anxiety Disorder scale, the Brief Patient Health Questionnaire (PHQ-9) and several questions regarding demographic characteristics. Suicidality was assessed by the 9th item of the PHQ-9. According to the results, older chronic disease patients showed higher …

Admission Pao2 And Mortality Among Pediatric Icu Patients And Critically Ill Subgroups, Cara Holton

Research Days

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Background and Objectives: Studies analyzing the association between hyperoxia and mortality in critically ill pediatric patients and those admitted after cardiac arrest are conflicting and limited by small sample sizes. The aim of this study is to evaluate the association between PaO2 on admission to the pediatric ICU and mortality in a heterogeneous, multicenter cohort and among subgroups of critically ill patients.

Methods/Design: A retrospective cohort study was conducted using data from Virtual Pediatric Systems (VPS) database. VPS is a clinical pediatric critical care database with over 135 participating hospitals in North America. All VPS …

Methamphetamine Associated Cardiomyopathy In Pregnancy: The Distinctions And The Implications, Ashan Hatharasinghe, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction

Methamphetamine associated cardiomyopathy (MAC) and peripartum cardiomyopathy (PPCM) are both rare obstetric conditions. Literature regarding methamphetamine associated cardiomyopathy in the obstetric population is limited, and it can be difficult to make the distinction between the two given the similarities in clinical presentation. However similar, there are significant distinctions in the pathophysiology of these two that can help clinicians with the management process.

Clinical Findings and Outcomes

This case involves a 35-year-old Hispanic G6P5005 at 37 weeks gestation presenting with acute respiratory failure secondary to acute decompensated heart failure with reduced ejection fraction and superimposed preeclampsia leading to urgent cesarean …

Venous Thromboembolism Risk Stratification Via Electronic Medical Record Classification, Shannon L. Carpenter, Laura Miller-Smith, Brittney Hunter, Ashley Duty, Justin Sheets, Yuri Tupa, Kate Gibbs

Posters

No abstract provided.

Variations In Practice Of Apnea Test For Brain Death: Review From A Multihospital Health Care System, Jeffrey Stein, Marvi V. Rijhwani, Ernesto Brauer

Journal of Patient-Centered Research and Reviews

Background: Ventilation encompasses both active and passive processes. Air is initially drawn into the lungs due to a negative intrathoracic pressure created using the respiratory muscles, most importantly the diaphragm. In contrast, expiration is the passive relaxation of the respiratory muscles. Oxygenation occurs when oxygen diffuses across the alveolar-capillary membrane. The ability to oxygenate without ventilation has been termed apneic diffusion oxygenation or apneic oxygenation. We believe it is crucial to keep alveoli open in order for adequate oxygenation to occur. This can be achieved with the aid of positive end-expiratory pressure (PEEP). We investigated this concept in patients who …

Venoarterial Extracorporeal Membrane Oxygenation For Cardiogenic Shock: A Retrospective Analysis Based On The Etiology Of Shock, Andrew Burchett, Thomas Tribble, Richard Charnigo, Susan Smyth, Maya Guglin

The VAD Journal

Abstract:

Background: We performed a retrospective analysis to evaluate the efficacy of VA-ECMO support in cardiogenic shock based on various etiologies.

Methods: We retrospectively analyzed 99 patients supported with VA-ECMO from January 1, 2012 to January 1, 2015. Outcomes included survival to discontinuation of VA-ECMO support and survival to hospital discharge. The etiologies of cardiogenic shock included cardiac arrest (CPR), acute myocardial infarction (AMI), decompensated congestive heart failure (CHF), pulmonary embolism (PE), right ventricular failure (RVF) not secondary to an acute pulmonary embolism, and post-cardiotomy syndrome (PCS). The PCS group was used as a reference group; odds ratios were estimated …

Ventilator Associated Pneumonia Prevention In The Traumatically Injured Patient: Beyond The Bundle!, Cindy Umbrell Msn,Rn,Cns,Ccrn, Kenneth Miller Med, Rrt-Nps

Patient Care Services / Nursing

No abstract provided.

Arterial Blood Pressure Monitoring In Overweight Critically Ill Patients: Invasive Or Noninvasive?, Ali Araghi, Joseph J. Bander, Jorge A. Guzman

Wayne State University Associated BioMed Central Scholarship

Abstract

Introduction

Blood pressure measurements frequently guide management in critical care. Direct readings, commonly from a major artery, are considered to be the gold standard. Because arterial cannulation is associated with risks, alternative noninvasive blood pressure (NIBP) measurements are routinely used. However, the accuracy of NIBP determinations in overweight patients in the outpatient setting is variable, and little is known about critically ill patients. This prospective, observational study was performed to compare direct intra-arterial blood pressure (IABP) with NIBP measurements obtained using auscultatory and oscillometric methods in overweight patients admitted to our medical intensive care unit.

Method

Adult critically ill …