Saturday January 3, 2009
Something which we have been doing, here is the data now
Intensivist have been using pig tail drainage catheter under ultrasound guidance for several years. Study by Liang in Intensive Care Medicine confirmed the findings.
On a retrospective review of 133 patients, pigtail drainage catheter yielded largest amount of fluid (5382 +/- 4844 ml) in massive transudative effusion with longest duration of drainage (9 +/- 7 days). It has the highest complication rate of 18%. The success rate was highest when used to treat traumatic hemothorax (100%) and postoperative pleural effusions (85%); drains inserted for empyema were more likely to fail (overall success rate, 42%). No significant insertion complications, such as hollow organ perforation, were caused by this procedure.
Editor’s Comment: This procedure is simple and safe to perform. In addition it helps us to prevent transfer critically ill patients to radiology department.
Laing SJ, Tu CY, Chen HJ, Chen W et al. Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU. Intensive Care Medicine. Published online Oct 11 2008.
Saturday, January 3, 2009
Friday, January 2, 2009
Friday January 2, 2009
Case: 52 year old male is admitted with frequent runs of ventricular tachycardia and was started on IV Lidocaine with 2mg/min drip. First lidocaine serum level is 8.5 micrograms/ml. To determine the time period to shut off Lidociane drip, do you know the half life of intravenous Lidocaine?
Answer: The elimination half-life of lidocaine is approximately 1.5–2 hours in most patients. But it may be prolonged in patients with liver insufficiency upto 6-8 hours. Also, in patients with congestive heart failure, it may be slightly prolonged upto 3 hours. Though Lidociane is excreted via urine but renal insufficiency doesn't effects its level much as 90% Lidocaine is metabolized in the liver by to the pharmacologically-active metabolites.
Lidocaine alters depolarization in neurons, by blocking sodium (Na+) channels in the cell membrane, leading to its anaesthetic effects. And toxic dosage may lead to nervousness, tingling, tinnitus, tremor, dizziness, blurred vision and seizures.
In above case, it would be appropriate to hold Lidocaine drip for 4-6 hours and drew the level again to determine the rate of infusion.
Case: 52 year old male is admitted with frequent runs of ventricular tachycardia and was started on IV Lidocaine with 2mg/min drip. First lidocaine serum level is 8.5 micrograms/ml. To determine the time period to shut off Lidociane drip, do you know the half life of intravenous Lidocaine?
Answer: The elimination half-life of lidocaine is approximately 1.5–2 hours in most patients. But it may be prolonged in patients with liver insufficiency upto 6-8 hours. Also, in patients with congestive heart failure, it may be slightly prolonged upto 3 hours. Though Lidociane is excreted via urine but renal insufficiency doesn't effects its level much as 90% Lidocaine is metabolized in the liver by to the pharmacologically-active metabolites.
Lidocaine alters depolarization in neurons, by blocking sodium (Na+) channels in the cell membrane, leading to its anaesthetic effects. And toxic dosage may lead to nervousness, tingling, tinnitus, tremor, dizziness, blurred vision and seizures.
In above case, it would be appropriate to hold Lidocaine drip for 4-6 hours and drew the level again to determine the rate of infusion.
Thursday, January 1, 2009
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