Case Report Is It Possible to Maintain Consciousness and Spontaneous Ventilation with Chest Compression in the Early Phase of Cardiac Arrest?

Chest compression is important in cardiopulmonary resuscitation. However, life support algorithms do not specify when chest compression should be initiated in patients with persistent spontaneous normal breathing in the early phase after cardiac arrest. Here we describe the case of a 69-year-old man who underwent femoral bypass surgery and was extubated at the end of the procedure. After extubation, the patient's breathing pattern and respiratory rate were normal. The patient subsequently developed ventricular fibrillation, evident on two monitors. Because defibrillation was ineffective, chest compression was initiated even though the patient had spontaneous normal breathing and defensive motor reflexes, which were continued throughout resuscitation. He regained consciousness and underwent tracheal extubation without neurological sequelae on postoperative day 1. This case highlights the necessity of chest compression in the early phase of cardiac arrest

Desenvolvimento de fibrilação ventricular por causa de etomidato para indução anestésica: um efeito colateral muito raro, relato de caso

ResumoJustificativa e objetivosA ocorrência de fibrilação ventricular em um paciente pode resultar em complicações inesperadas. Nosso objetivo é apresentar um caso de fibrilação ventricular que ocorreu após a indução anestésica com administração de etomidato.Relato de casoPaciente do sexo feminino, 56 anos, com pré‐diagnóstico de cálculos biliares, foi admitida na sala de cirurgia para colecistectomia laparoscópica. A anestesia foi induzida com a administração de etomidato com uma dose em bolus de 0,3mg/kg. A paciente apresentou uma grave e rápida adução dos braços logo após a indução. Taquicardia com QRS largo e frequência ventricular de 188bpm foram detectadas no monitor. O ritmo converteu‐se em fibrilação ventricular (FV) durante a preparação para a cardioversão. A paciente foi imediatamente submetida a desfibrilação. O ritmo sinusal foi obtido. Decidimos adiar a cirurgia por causa da condição de instabilidade da paciente.ConclusãoAlém dos efeitos secundários conhecidos de etomidato, taquicardia ventricular e fibrilação, embora muito raramente, também podem ser observadas. Até onde sabemos, esse é o primeiro caso na literatura de FV causado por etomidato.AbstractBackground and objectivesVentricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration.Case reportA fifty‐six‐year‐old female patient with a pre‐diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition.ConclusionIn addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature

Tramadol Iontophoresis Added to Treatment of Knee Osteoarthritis

The following is from http://www.earlham.edu/~peters/fos/2005_12_11_fosblogarchive.html#113465430061996426 Jim Giles, Internet encyclopaedias go head to head, Nature, December 14, 2005. (Thanks to Declan Butler.) Excerpt: Jimmy Wales' Wikipedia comes close to Britannica in terms of the accuracy of its science entries....[A]n expert-led investigation carried out by Nature — the first to use peer review to compare Wikipedia and Britannica's coverage of science — suggests that such high-profile ..

Assessment of the Anterior Talofibular Ligament Thickness in Patients with Chronic Stroke: An Ultrasonographic Study

Background: Patients with equinovarus deformity have an increased risk of fall and ankle ligament injury, because of inappropriate prepositioning of the ankle at the end of the swing phase, and inadequate leg and ankle stability during the stance phase. Accordingly, the aim of this study is to compare anterior talofibular ligament (ATFL) thickness of chronic stroke patients with that of healthy individuals using ultrasonography. Methods: This was a case-control study conducted in a university hospital between July 2015 and July 2016. We included 38 patients [study group; mean age, 59.0±11.1 years; mean body mass index (BMI), 25.4±4.3 kg/m2] and a control group of age-, sex-, and BMI-matched healthy individuals. Demographic and clinical characteristics of the patients (i.e., age, weight, height, Brunnstrom motor recovery stage, Functional Ambulation Scale, Ashworth Scale, and duration of hemiplegia) were recorded during their visits. Furthermore, ultrasound image of the ATFL was obtained from each ankle. The thickness of the ATFL was measured at the midpoint of the ligament between the attachments on the lateral malleolus and the talus using ultrasonography. Results: In the study group, the mean thickness of the ATFLs of the affected side (2.75±0.41 mm) was thicker than both the unaffected side (2.42±0.30 mm) and the healthy controls (2.35±0.19 mm; p=0.007, p<0.001, respectively). No differences were seen between the two sides of the control group. Conclusion: Chronic stroke patients have a thicker ATFL on both the affected and unaffected sides, compared with healthy individuals. This architectural feature of the ATFL may be a result of equinovarus deformity together with spastic muscles. For this reason, early treatment of deformed ligaments and spastic muscles is needed to prevent equinovarus deformity in patients with stroke

Önkol Fleksör Tendon Yaralanması Olan Gebe Hastaya Anestezik Yaklaşım

Periferik sinir blokları üst ekstremitelerin cerrahisinde kullanılan bir anestezi yöntemidir. Anestezi yönteminin seçimi ve yönetimi gebe hastalar için özelliklidir. Bu olguda, ön kolda fleksör tendon kesisi olan gebe hastada aksiler blok uygulamasını sunmayı hedefledik. On yedi yaşında 21 haftalık gebe hastaya blok öncesi sedasyon amacıyla premedikasyon uygulanmadı. Aksiller yaklaşımla nörostimulasyon tekniği kullanılarak brakial pleksus bloğu uygulandı. Kullanılan stimülasyon cihazı (Stimuplex® HNS 11-Braun, Germany) 1 mA akımda, 2 Hz frekans ve 0,1 ms hızda ayarlandı. Aksiller bölgede aksiller arter palpe edilerek 21G, 100 mm stimupleks iğne ile mediyan, radiyal, muskülakutanöz ve ulnar sinir motor yanıtları bulundu. Stimülasyon 0,3-0,5 mA akıma düşürülerek motor yanıtın azalmadan sürdüğü gözlenerek lokal anestezik ilaç uygulandı. Olguda, lokal anestezik olarak 20ml (% 0,5; 5 mg/ml) levobupivakain tercih edildi. Sonuç olarak önkol fleksör tendon kesisi olan gebe hastada levobupivakain kullanılarak yapılan aksiller brakial pleksus bloğunun etkili ve güvenilir anestezi yöntemi olduğu sonucuna varıldı.Anahtar Kelimeler: Brakial pleksus bloğu, gebelik, levobupivakai

The relationship between anti-cyclic citrullinated peptide and bone mineral density and radiographic damage in patients with rheumatoid arthritis

Objectives: We aimed to investigate the relationship between anti-cyclic citrullinated peptide (anti-CCP) levels and bone mineral density (BMD), bone turnover, and radiographic damage in patients with rheumatoid arthritis (RA)