Friday December 4, 2009
Pulmonary Artery Catheter in Amniotic fluid embolism !!

20 years ago it was suggested by Mason that probable diagnosis of Amniotic fluid embolism can be made by analyzing pulmonary artery blood with the logic that amniotic fluid does not ordinarily enter the maternal circulation, and the identification of large numbers of fetal squamous in the postpartum pulmonary microvasculature is of clinical significance. (He applied similar argument for other similar diseases such as fat embolism). Diagnosis becomes more probable if other fetal debris such as mucin or hair is present.

Technique described: Obtain blood from the distal lumen of a pulmonary artery catheter (in wedged position). After discarding the first 10 ml of blood, draw an additional 10 ml, heparinize and analyze utilizing Papanicolaou's method.Above technique is only suggestive of amniotic fluid embolism and not a gold standard.


Power Point Presentation: AMNIOTIC FLUID EMBOLISM



References: Click to get abstract/article

1. Pulmonary microvascular cytology. A new diagnostic application of the pulmonary artery catheter - Chest, V. 88, 908-14

2. Amniotic fluid embolism - Masson RG - Clin Chest Med.1992 Dec;13(4):657-65.

Thursday December 3, 2009


Q: What is Scombroidosis?


Answer: Scombroidosis refers to histamine poisoning from the ingestion of fish improperly stored at an elevated temperature. Histamine and cis-urocanic acid are produced by various bacteria that multiply in the spoiled fish.

Patients usually present with a frightening flush but no urticaria, palpitations, syncope, nausea, vomiting, or diarrhea.

Wdneesday December 2, 2009
Bedside trick


Q: How to make IABP more visible radiographically (on CXR) after insertion?


Answer: Shoot CXR on standby mode.

As in stand by mode there is no movement of baloon, chances to have better capture of IABP tip is high.

Tuesday December 1, 2009


Q: Name at least 3 Antibiotics which should be use with caution in patients with active seizure?


Answer:

1. Fluoroquinolones
2. Primaxin (Imipenem and Cilastatin)
3. Zyvox