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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: May 2017 (Page 1 of 2)

Impact of gravitational interaction between the Moon and the Earth on the occurrence of episodes of cardiogenic pulmonary edema in the field


While circadian variation of occurrence of cardiovascular emergencies has been described, it has not been assessed whether fluctuations of gravitational interaction between the Earth and the Moon may induce other types of its variation in time have the similar impact. Therefore, we decided to evaluate whether there is an association between the occurrence of prehospital cardiogenic pulmonary edema (CPE) episodes treated by Emergency Medical Services (EMS) and fluctuations in the intensity of gravitational interaction between the Earth and the Moon.

Methods. We extracted all dispatches to CPE episodes from the EMS database of the Central Bohemian Region, Czech Republic, between 2.11.2008 and 1.7.2014. For each episode, the intensity of gravitational interaction between the Moon and the Earth was calculated. The study period was divided into 11 sections of equal duration according to the different intensity of gravitational interaction, and occurrence of CPE was compared among the groups.

Results. We observed up to 4,744 episodes of CPE during the study period. Occurrence of CPE episodes was highest in the periods with the weakest intensity of gravitational interaction (≤1.80e1026 N), while in the periods of the most intense gravitational interaction (≥2.26e1026 N), the lowest proportion of CPE cases was observed (23.44 vs. 3.79 %, p <0.001).

Conclusions. We identified a significant association between the intensity of gravitational interaction between the Earth and the Moon and occurrence of CPE, treated by our EMS. The weakest intensity was associated with its increased occurrence and vice versa. Further research is required for potential use of this phenomenon in a chronotherapeutic approach to secondary prevention of CPE.

Key words: cardiogenic pulmonary edema, gravitational interaction

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Reactive cholecystitis as the leading sign of subacute perforation of the right ventricle with the electrode of an implantable cardioverter defibrillator


Subacute lead perforation of the right ventricle caused acute, reactive, acalculous cholecystis, which initially distracted the attention of physicians from the development of hematopericard. Implantation of a cardioverter defibrillator in a young patient after sudden cardiac arrest, but before treatment of significant stenosis of the proximal left anterior descending artery, resulted in a life-threatening condition only 36 days after arrest. After removing the implantable cardioverter defibrillator, there was no sign of pathological cardiac rhythm disorders.

Key words: subacute lead perforation of the right ventricle, reactive acalculos cholecystitis

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Middle latency auditory evoked potential index for prediction of post-resuscitation survival in elderly populations with out-of-hospital cardiac arrest


Background. Out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate in the elderly. Although most reports have investigated among elderly patients with OHCA until 1990s, non-invasive monitorings cannot presently predicted cerebral resuscitation during cardiopulmonary resuscitation (CPR). Findings of a previous study suggest that monitoring of middle latency auditory evoked potentials (MLAEP) during CPR could provide an indicator of effective post-resuscitation survival.

Objectives. We speculated that the MLAEP index (MLAEPi), measured in an emergency room, can predict post-resuscitation survival among elderly patients with OHCA.

Methods. This prospective study included 31 elderly patients aged ≥65 years with OHCA who received basic life support (BLS) and did not achieve restoration of spontaneous circulation (ROSC) until arrival at the emergency center between December 2010 and December 2011. All patients were administered advanced cardiac life support (ACLS) in the emergency room. Initial MLAEPi was measured using an MLAEP monitor (aepEX plus®, Audiomex, UK) during the first cycle of ACLS. Prediction of the post-resuscitation survival was investigated.

Results. Eight patients who achieved ROSC were admitted to our hospital and 23 did not achieve ROSC in the emergency room. Initial MLAEPi was significantly higher in patients with than without ROSC (median, 33 vs. 26, p = 0.02). Three survivors, among patients with ROSC, were discharged from our hospital (survivors) and 5 died during hospitalization (non-survivors). Initial MLAEPi was significantly higher in survivors than in non-survivors (median, 35 vs. 28, p = 0.03) or patients without ROSC (median, 35 vs. 26, p < 0.01).

Conclusions. MLAEPi satisfactorily denotes cerebral function and predicts post-resuscitation survival in elderly populations.

Key words: cardiopulmonary resuscitation, basic life support, advanced cardiac life support, age, monitoring, critical care

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The utility of point-of-care biomarkers as a prognostic tool for patients with acute coronary syndromes


Introduction. Patients with symptoms suggestive of acute coronary syndrome (ACS) have various medical backgrounds and different stages of underlying coronary disease. Hence, patients entering the emergency room (ER) with ACS suggestive symptoms, present a challenge to emergency physicians. We hypothesized that a point-of-care test (POCT) for multiple cardiac biomarkers can be used as a prognostic tool for predicting severity and hospital mortality in acute myocardial infarction (AMI) patients.

Methods . We conducted a retrospective analysis of all patients who presented to the ER of a university urban hospital with chest pain, chest discomfort and shortness of breath of potential cardiovascular origin during a 3-year period. Biomarkers from the POCT and coronary angiography (CAG) results were used for diagnosis. Severity was evaluated based on involvement and status of major coronary arteries, ejection fraction and in-hospital mortality.

Results. Out of 1336 patients, 329 patients were diagnosed with AMI. Risk of major coronary artery occlusion was increased with an increased number of positive POCT findings. The percentage of patients with severe left ventricular dysfunction was higher in the group with 2 or 3 positive POCTs than 0 or 1. As the number of positive POCTs increased from 1 to 3, our results showed an increment in the percentage of in-hospital mortality

Conclusions. This study identified the possibility of a POCT as a prognostic tool. The POCT is easy to use by the bedside and can be checked relatively quickly? in a short period of time. If the POCT result is used to predict the prognosis in ACS patients, emergency physicians may approach patients with more caution.

Key words: chest pain, shortness of breath, acute myocardial infarction, in-hospital mortality

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Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients


Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension.

Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor.

Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables inside each group compared to the baseline value. With cardiac index (CI) as a dependent variable, a significant correlation between CI and stroke volume index (SVI) was found (β=0.849, p<0.001) and also between CI and heart rate (HR) (β=0.573, p<0.001). In group H the incidence of hypotension was 35%, whereas in group L it was 10%. The same difference was seen in the use of phenylephrine between the groups, however the difference was not significant.

Conclusion. In our study it was found that in young, healthy patients there are no significant differences in haemodynamic parameters and in incidence of hypotension between a high and low spinal block. Young, healthy patients compensate a decrease in systemic vascular resistance caused by the spinal anaesthesia with a compensatory increase in CI resulting from an increase in SVI and HR. However, a trend towards less hypotension, less bradycardia and less frequent phenylephrine use in a low spinal block was noted.

Key words: spinal anaesthesia, hyperbaric bupivacaine, haemodynamic parameters, cardiac output, hypotension

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