- Recognition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) and use of high-dose nitroglycerin infusion. [Journal Article]
- AJAm J Emerg Med 2018 May 10
- Sympathetic Crashing Acute Pulmonary Edema (SCAPE), or flash pulmonary edema, is the extreme end of the acute pulmonary edema spectrum. A sympathetic surge occurs as a result of decreased systemic pe...
Sympathetic Crashing Acute Pulmonary Edema (SCAPE), or flash pulmonary edema, is the extreme end of the acute pulmonary edema spectrum. A sympathetic surge occurs as a result of decreased systemic perfusion resulting in further increases in afterload, causing the patient to decompensate. Patients can decompensate quickly, therefore patients require rapid interventions. The use of high-dose nitroglycerin (HDN) has been a topic of interest as it is believed to achieve preload and afterload reduction. However, its use continues to be controversial due to concerns of drug induced hypotension, syncope or paresthesia. Although there are Free Open Access Medical Education (FOAM) based podcasts as well as few studies to suggest the use of HDN, the evidence is limited by statistical flaws, incomplete dosing parameters and inconsistent methods of administration. In order to address these limitations, a protocol at our ED was created to ensure the safe and effective use of HDN. Here, we present a case of HDN use for the management of SCAPE based on this protocol.
- Difficulties in interpretation when assessing prolonged and subacute exposure to the toxic effects of chlorine. [Journal Article]
- JFJ Forensic Leg Med 2018 May 08; 58:82-86
- The purpose of this study was a toxicological interpretation of exposure to chlorine with unusual course. Medical, clinical and court records, as well as reviews of the literature, served as the basi...
The purpose of this study was a toxicological interpretation of exposure to chlorine with unusual course. Medical, clinical and court records, as well as reviews of the literature, served as the basis for this interpretation. The first case of poisoning concerns a 52-year-old man who for a short time (probably several hours), during the industrial cleaning of facilities with sodium hypochlorite, was exposed to chlorine in a presumed high concentration. The man was obese and suffered from hypertension and moderate atherosclerosis, and therefore could be more susceptible to the toxic effects of chlorine. After exposure no pulmonary edema or symptoms typical for acute respiratory distress syndrome were present. The second case concerns the chronic poisoning of a 56-year-old man who worked for eight years, 8 h a day, 5 days a week, in a room which was next to a chlorination room. In this chamber technical sodium hypochlorite was stored and dosed. In both cases, determining a cause and effect relationship between exposure to toxic and allergic agents in the form of active chlorine, and the onset of symptoms may be difficult. The findings described above in the first and second case are particularly important in cases of compensation claims and may have a completely different etiology than previously described in medical literature.
- The clinical practice of high-flow nasal cannula oxygen therapy in adults: A Japanese cross-sectional multicenter survey. [Journal Article]
- RIRespir Investig 2018; 56(3):249-257
- CONCLUSIONS: We documented patient demographics, clinical indications, and settings of HFNC use in the real world. We also demonstrated positive effects of HFNC on respiratory parameters. Further studies are urgently needed regarding the efficacy and safety of HFNC in populations outside of previous clinical trials.
- The Timing and Frequency of Pulmonary Veins Unexcitability Relative to Completion of a Wide Area Circumferential Ablation Line for Pulmonary Vein Isolation. [Journal Article]
- JCJACC Clin Electrophysiol 2016; 2(1):14-23
- CONCLUSIONS: The majority of PV pairs develops entrance and exit block before complete anatomic encircling by RFA lesions. Early entrance block is frequently associated with loss of PV sleeve excitability, consistent with a spreading wave of injury or edema rather than a permanent conduction barrier. This may help to explain the significant rate of PV conduction recovery associated with the acute endpoints of entrance and exit block.
- Vasopressin analog terlipressin attenuates kidney injury in hemorrhagic shock. [Journal Article]
- TSTrauma Surg Acute Care Open 2016; 1(1):e000039
- In hemorrhagic shock (HS), volume replacement with crystalloid solution can restore the hemodynamic status and decrease mortality. However, it can also lead to tissue edema and pulmonary congestion, ...
In hemorrhagic shock (HS), volume replacement with crystalloid solution can restore the hemodynamic status and decrease mortality. However, it can also lead to tissue edema and pulmonary congestion, as well as increasing vascular permeability. Here, we analyzed the effects that resuscitation with lactated Ringer's solution (LRS) or administration of the vasopressin analog terlipressin has on renal function in a porcine model of HS.
- [Comparison of lung protection for hydrochloric acid or oleic acid induced rat acute respiratory distress syndrome models pretreated with penehyclidine]. [Journal Article]
- ZWZhonghua Wei Zhong Bing Ji Jiu Yi Xue 2018; 30(5):434-438
- CONCLUSIONS: Inflammatory cell infiltration and alveolar collapse mainly happened in HCl induced ARDSp, while pulmonary interstitial edema and hemorrhage was mostly seen in ARDSexp rats induced by OA intravenous injection. There was no significant difference in oxygenation and inflammatory response between the two models of rats. Pre-intraperitoneal injection of penehyclidine equally improved oxygenation state, inhibited lung inflammation response, and reduced lung injury in the two kinds of ARDS, but there was no difference in protective role between two models pretreated with penehyclidine.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Papillary muscle rupture is a rare and potentially fatal complication often following a myocardial infarction or secondary to infective endocarditis. Acute rupture frequently results in severe mitral...
Papillary muscle rupture is a rare and potentially fatal complication often following a myocardial infarction or secondary to infective endocarditis. Acute rupture frequently results in severe mitral valve regurgitation and subsequent acute life-threatening cardiogenic shock and pulmonary edema. There are 5 papillary muscles in the heart originating from the ventricular walls. These muscles attach to the tricuspid and mitral valve leaflets via the chordae tendineae and functionally prevent regurgitation of ventricular blood via tensile strength by preventing prolapse or inversion of the valves during systole. Three of these papillary muscle and chordae tendineae complexes are attached to the tricuspid valve (anterior, posterior, septal), and 2 are attached to the mitral valve (anterolateral and posteromedial). Papillary muscle dysfunction leads to regurgitation of blood through the valves causing backflow of blood that can lead to the left or right-sided heart failure. Literature first identifies papillary muscle rupture as early as 1948. Visualization via 2-dimensional echocardiography was first reported in 1981. Transesophageal echocardiography was first used in 1985 in identifying the condition.
- Text mining and network analysis to find functional associations of genes in high altitude diseases. [Journal Article]
- CBComput Biol Chem 2018 May 02; 75:101-110
- CONCLUSIONS: The network constructed from this study proposes a large number of genes that work in-toto in high altitude conditions. Overall, the result provides a good reference for further study of the genetic relationships in high altitude diseases.
- Left atrium and pulmonary artery compression due to aortic aneurysm causing heart failure symptoms. [Journal Article]
- RPRev Port Cardiol 2018 May 09
- Patients with thoracic aortic aneurysm (TAA) are mostly asymptomatic and TAA is rarely related to heart failure (HF). We report the case of an 80-year-old female patient, with type A TAA without diss...
Patients with thoracic aortic aneurysm (TAA) are mostly asymptomatic and TAA is rarely related to heart failure (HF). We report the case of an 80-year-old female patient, with type A TAA without dissection, with right pulmonary artery and left atrium compression, who presented with HF, preserved ejection fraction and acute pulmonary edema.
New Search Next
- Ubiquitin-proteasome signaling in lung injury. [Review]
- TRTransl Res 2018 Apr 23
- Cell homeostasis requires precise coordination of cellular proteins function. Ubiquitination is a post-translational modification that modulates protein half-life and function and is tightly regulate...
Cell homeostasis requires precise coordination of cellular proteins function. Ubiquitination is a post-translational modification that modulates protein half-life and function and is tightly regulated by ubiquitin E3 ligases and deubiquitinating enzymes. Lung injury can progress to acute respiratory distress syndrome that is characterized by an inflammatory response and disruption of the alveolocapillary barrier resulting in alveolar edema accumulation and hypoxemia. Ubiquitination plays an important role in the pathobiology of acute lung injury as it regulates the proteins modulating the alveolocapillary barrier and the inflammatory response. Better understanding of the signaling pathways regulated by ubiquitination may lead to novel therapeutic approaches by targeting specific elements of the ubiquitination pathways.