Anesthesiology and Intensive Care

  Left atrial hypertrophy   An increase in the thickness of the left atrial wall is known as left atrial hypertrophy . This occurs  frequently in left ventricular enlargement, although it can also occur alone. The P wave is often  widened because of the increased time that it takes the impulse to travel over the thickened atrial wall. The P wave is notched, like an M  shape . This is known as P-mitrale. In some  leads (typically V1) the P wave becomes negative. Right atrial hypertrophy   An increase in the thickness of the right atrium is known as right atrial hypertrophy. If the right  atrium is hypertrophied there will be an increase in the height of the P wave (2.5 mm or more).  This is seen most clearly in Lead II, and is due to the increase in the number of impulse directions  travelling directly towards Lead II. The P wave also looks peaked. This is known as   P-pulmonale . The width of the P...

WASHINGTON — PCI with a drug-eluting stent was inferior to CABG for the outcome of MACCE at 5 years, according to data presented at TCT 2016 and published in  The Lancet . “The study showed that PCI was not noninferior to CABG; in fact, CABG was superior to PCI,”  Evald H. Christiansen,  MD,  PhD ,  from Aarhus University Hospital in Skejby, Denmark, said in a presentation. The prospective, randomized, open-label, noninferiority NOBLE study was conducted at 36 hospitals in Europe between Dec. 9, 2008 and Jan. 21, 2015. Christiansen and colleagues randomly assigned 1,201 eligible patients with left main CAD to treatment with PCI (n = 598; mean age, 66 years; 20% women) or CABG (n = 603; mean age, 66 years; 24% women). Initially, operators could use any DES on patients assigned PCI, but in March 2010, they were advised to use a biolimus-eluting stent (Biomatrix Flex, Biosensors). Patients were included if they had stable angina pectoris, unst...

Common Signs and Symptoms: ECG Signs: Bigeminy: Regularised AF: Bidirectional VT: Atrial flutter with AV block: MANAGEMENT: Stop Digoxin Correct Hypokalemia Use caution if Heart Block is present Treat arrhythmias : Bradyarrhythmias digibind atropine adrenaline (but may aggravate cardiac irritability) pacing (rarely effective) Tachyarrhythmias digibind MgSO 4  as an adjunctive measure Lignocaine (unproven) often refractory to cardioversion Avoid potentially harmful interventions Calcium infusion (e.g. Calcium Chloride or Calcium Gluconate) "Stone heart" theoretical concern that intracellular calcium is already high in Digoxin Toxicity However original theory was from the 1950s and recent studies fail to find significant effect ( Levine (2011) J Emerg Med 40(1):41-6 +PMID:19201134 [PubMed] ) Catecholamines Electrical Cardioversion Safe if...

“Off-pump” or "beating heart" coronary bypass surgery, also known as OPCAB (for "Off-Pump Coronary Artery Bypass), differs from conventional Coronary Artery Bypass Grafting (CABG) in that the cardiopulmonary bypass pump (extracorporeal circulation) is not employed. Despite on contraversial results of different trials, we can admit main advantages and disadvantages of cardiac revascularization techniques. But studies are continuing, stuff and methods are progressing, so may be in future we will see another table... Information used   lifeinthefastlane.com                             www.escardio.org

   Hello!  I was asked by Tammy Hartsook to share information about job offer for CARDIAC ANESTHESIOLOGISTs. You can contact him, if you are interested. Read the details below: ________________________________________________________________________________ I have 2 positions near the coast of NC. We are looking for an MD that can do both general and Cardiac  cases. This is not a super busy Cardiac practice, yet must be Cardiac capable. The facility is doing about 1 cardiac case a week, on average about 70 cases per year.  Compensation is 565k per year with 6 weeks off. MD’s are primary call with CRNA back up. Call rotation is 1:3. We have an entire pool of PRN providers for schedule vacation coverage as well. This is about 60 miles from Wilmington and about 35 miles from Fayetteville.  This is a 1099 perm position, meaning that you are required to provider your own medical malpractice insurance and your own healthcare benefits. We hav...

P wave   - the spread of electrical activation (depolarisation) through the atrial myocardium. QRS complex   - the spread of electrical activation through the ventricular myocardium. T wave   - electrical recovery (repolarisation) of the ventricular myocardium.  U wave   may be due to slow replolarisation of the papillary muscles.  Some causes include: Bradycardia, hypokalaemia and digoxin. Measurements Heart rate :  Rule of 300   - Provided that the  rhythm is regular , heart rate can be estimated by dividing 300 by the number of large boxes in the R-R interval.  i.e. Heart Rate = 300/ no. of large boxes in the R-R interval PR interval : 0.12 - 0.20 s  QRS duration : 0.06 - 0.10 s  Corrected QT interval (QTc) : normal QTc = 0.40 s Bazett's formula:  QTc = QT / RR 1/2  (in seconds)   Determining of Heart Axis.  The fastest, non-specific method to determine the...

    Recommendations for Clear Liquids.   It is appropriate to fast from intake of clear liquids at least 2 h before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia (i.e., monitored anesthesia care). Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee. These liquids should not include alcohol. The volume of liquid ingested is less important than the type of liquid ingested.     Recommendations for Breast Milk.   It is appropriate to fast from intake of breast milk at least 4 h before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia  (i.e., monitored anesthesia care).     Recommendations for Infant Formula.   It is appropriate to fast from intake of infant formula at least 6 h before elective procedures requiring general anesthesia, regiona...