Answer:
Emphysematous pyelonephritisEmphysematous pyelonephritis is a necrotizing acute nephritis with extension of the infection through the renal capsule. This leads to the presence of gas within the kidney and in the perinephric space.
The mortality rate is 60% - 80% despite medical treatment and usually require surgical intervention with nephrectomy.
Q: Hypotension secondary to Milrinone therapy can be managed more efficiently with which pressor? A) Norepinehrine B) Dopamine C) Vasopressin D) Phenylephrine E) Epinephrine Answer: Vasopressin
Certainly any pressor can be use for hypotension but literature point towards vasopressin as better choice of pressor in milrinone induced hypotension. Low-dose vasopressin decreased the PVR/SVR ratio that was increased by milrinone. Considering the importance of maintaining systemic perfusion pressure as well as reducing right heart afterload, milrinone–vasopressin may provide better hemodynamics than milrinone–norephinephrine during the management of right heart failure.
Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients - Eur J Cardiothorac Surg 2006;29:952-956
Case: 47 year old male of Indian sub-continent origin admitted to ICU with status epilepticus. Patient has recently been started on TB prophylaxis medicine at his new work place. What is your probable diagnosis and what would be the treatment?
Answer: Isoniazid (INH) induced seizures. Isoniazid (INH) induced seizures is unique in the sense that it is usually refractory to standard anticonvulsant therapy. Even dose as low as as 1.5 g can be neurologically toxic. INH induced seizure requires administration of a specific antidote, pyridoxine (B-6), with dose of 5 gram in IV form. Dose can be repeated 2 to 3 times if needed.
Answer:
Atropine test is a simple pharmacological test based on the absence of cranial parasympathetic nervous influence on the heart in brain dead patients and may be a useful adjunct to testing brain stem function. A tachycardic response would demonstrate an intact cranial parasympathetic outflow. 2-3 mg of Atropine IV is then given. If there is less than 10 % or no increase in heart rate, this supports the diagnosis of brain death. Additional confirmatory tests are however required.
Answer: Bilateral Pneumothoraces Bilateral pneumothoraces can be very deceiving as there is no deviation of trachea, and percussion and breath sounds seems equal on both sides. Clinically these patients are usually haemodynamically compromised and on CXR you may see the characteristic 'disappearing heart' with bilateral tension pneumothoraces.
Answer:
Administer Magnesium before ibutalide useThe risk of developing torsade de pointes with ibutilide is about 4% but it can reduced with intravenous infusion of high-dose magnesium sulfate and having potassium level around 4.5 range.
Reference: Patsilinakos S, Christou A, Kafkas N, et al. Effect of high doses of magnesium on converting ibutilide to a safe and more effective agent. Am J Cardiol 2010; 106: 673–6
Answer:
Lorazepam and diazepam both have been used as a first line drugs in the management of Status Epilepticus. Though diazepam acts slightly faster than lorazepam its effective duration of action may be only 5-10 min - and may require repeated doses or quick followup with administration of phenytoin (or fosphenytoin). On the other hand once effective dose(s) of lorazepam is given, the effective duration of action of lorazepam is 8-10 hours, and so is more recommended for initial treatment of status epilepticus.Answer:
YesAmniotic fluid embolism (AFE) is a misnomer as clinical picture is more or less like acute collapse from pulmonary embolism but in fact it is an allergic type reaction. Amniotic fluid embolism (AFE) is a rare obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream and triggers an allergic reaction - which results in cardiorespiratory collapse. Another hallmark of the disease is severe coagulopathy. Diagnosis: Treatment:
Answer: Hamman's syndrome is a clinical condition and frequently requires ICU admission for observation. It is a spontaneous pneumomediastinum with subcutaneous emphysema. It occurs mostly in young females peripartum or postpartum. It is named after the physician (Louis Hamman 1877–1946), who described it.
Hamman's syndrome usually occurs in the second stage of labor but can be delayed to the postpartum phase. An association with prolonged labor has been proposed (increase intrathoracic pressure) with rupture of alveoli.
Treatment is supportive and course is usually benign.
Dudley DK, Patten DE. Intrapartum pneumomediastinum associated with subcutaneous emphysema. CMAJ 1988;139:641-2
Answer:
NoCardizem (Diltiazem) is frequently used in the treatment of anal fissures - either via oral route or can be applied topically!
It has a very good short term success rates and provide temporary relief till surgical intervention is done, if required. Local application of it relaxes the sphincter muscle, and allows the healing to proceed.
Answer:
There are 2 synergistic components to this pathophysiology.1. Bile Stasis: Absence of oral/enteral feeding results in a decrease or absence of cholecystokinin-induced gallbladder contraction.
2. Increase Bile Viscosity: Increased bile viscosity due to fever and dehydration causes acalculous cholycystitis
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