Severe myocardial ischemia after concentrated epinephrine use for the treatment of anaphylaxis: Kounis syndrome or epinephrine effect?Epinephrine is the cornerstone of treatment for anaphylaxis, which is a life-threatening condition that requires rapid management. However, epinephrine administration can have complications. We report a patient in whom accidental concentrated epinephrine use for management of anaphylaxis caused severe myocardial ischemia.
Management of cardiac arrest caused by coronary artery spasm: Epinephrine/adrenaline versus nitratesCardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious.
The impact of carvedilol on the defibrillation thresholdDefibrillation threshold (DFT) is the minimum energy required to successfully terminate ventricular fibrillation. Epinephrine has been shown to increase the DFT in the beta-blocker naïve, but using cardioselective beta-blockers leads to a reduction in the DFT on infusion of epinephrine and norepinephrine. We sought to determine the impact of carvedilol therapy on the DFT after infusion of epinephrine and norepinephrine.
Herpes simplex virus infection, massive pulmonary thromboembolism, and right atrial thrombi in a single patient: Case reportWe report a 32-year-old man with herpes simplex virus encephalitis who developed massive pulmonary thromboembolism with mobile right atrial thrombi during treatment for this condition. It was not safe to use thrombolytic therapy because of the high risk of cerebral bleeding associated with encephalitis. The patient was initially treated at another center, but his condition deteriorated during nadroparin therapy and he was referred to our hospital. Nadroparin was discontinued, and a continuous infusion of unfractionated heparin was administered through a central venous catheter.
Abciximab and fatal pulmonary hemorrhageAbciximab, a platelet glycoprotein IIb/IIIa receptor blocker, is a well-known agent in percutaneous coronary intervention because of its antiplatelet, antithrombotic effects, which allow for good outcome. Major bleeding is a well-recognized complication of abciximab therapy, and pulmonary hemorrhage, although infrequent, is a serious, under-recognized, and often fatal complication. We describe a case of fatal pulmonary hemorrhage in a young woman who presented with acute myocardial infarction and cardiogenic shock and was treated with abciximab in conjunction with percutaneous coronary intervention.
Functional recovery after neuromuscular blockade in mechanically ventilated critically ill patientsAn estimated 24% to 70% of individuals have prolonged paralysis or severe weakness after receiving neuromuscular blocking agents (NMBAs) when therapy is terminated.
Variables influencing intravenous catheter insertion difficulty and failure: An analysis of 339 intravenous catheter insertionsInserting an intravenous catheter (IV) is one of the most frequently performed invasive procedures by nurses. Little research has been conducted on ways to reduce the difficulty and failure, and enhance the ease and success, of IV insertion. We conducted this study to determine variables associated with IV insertion difficulty, failure, and success, and to learn special techniques nurses use to facilitate IV insertion.
Predictors of hospital readmission after discharge in patients with congestive heart failureThe purposes of this study were to (1) describe the characteristics of the population with congestive heart failure (CHF) who were admitted to a large, southeastern, acute-care hospital and (2) determine which patients are at risk for readmissions within 6 months.
The effect of dobutamine infusion on fractional diaphragm thickening and diaphragm blood flow during fatigueBackground: Diaphragm fatigue (DF) has been implicated in respiratory failure in diseases that increase inspiratory resistance loading (IRL) and may complicate weaning of patients from mechanical ventilation. Objective: The purpose of this study was to examine the effects of dobutamine administration (10 μg/kg/min) on DF and to identify the mechanisms by which dobutamine augments diaphragm shortening and diaphragm blood flow (DBF) during fatigue with a rat model. Methods: The study had an experimental design with 3 groups of Sprague-Dawley rats (n = 38) with 4 experimental periods: period 1, control; period 2, application of IRL; period 3, treatment; and period 4, recovery.