DOCSLIB.ORG

Evaluation and Management of Bradydysrhythmias

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Evaluation and Management of Bradydysrhythmias VISIT US AT BOOTH # 116 AT THE ACEP SCIENTIFIC ASSEMBLY IN SEATTLE, OCTOBER 14-16, 2013 September 2013 Evaluation And Management Volume 15, Number 9 Of Bradydysrhythmias In The Author Nathan Deal, MD Assistant Professor, Section of Emergency Medicine, Baylor Emergency Department College of Medicine, Houston, TX Peer Reviewers Abstract Joshua M. Kosowsky, MD Vice Chair for Clinical Affairs, Department of Emergency Medicine, Brigham and Women’s Hospital; Assistant Professor, Bradydysrhythmias represent a collection of cardiac conduction Harvard Medical School, Boston, MA abnormalities that span the spectrum of emergency presentations, Charles V. Pollack, Jr., MA, MD, FACEP Professor and Chair, Department of Emergency Medicine, from relatively benign conditions to conditions that represent Pennsylvania Hospital, Perelman School of Medicine, University serious, life-threatening emergencies. This review presents the of Pennsylvania, Philadelphia, PA electrocardiographic findings seen in common bradydysrhythmias CME Objectives and emphasizes prompt recognition of these patterns. Underlying Upon completion of this article, you should be able to: etiologies that may accompany these conduction abnormalities are 1. Recognize the electrocardiographic features of common discussed, including bradydysrhythmias that are reflex mediated bradydysrhythmias. (including trauma induced) and those with metabolic, environ- 2. Consider a variety of pathologies that give rise to mental, infectious, and toxicologic causes. Evidence regarding the bradydysrhythmias. 3. Identify the emergent therapies for the unstable patient management of bradydysrhythmias in the emergency department with bradycardia. is limited; however, there are data to guide the approach to the un- 4. Be familiar with common antidotes for acute toxicities that stable bradycardic patient. When decreased end-organ perfusion is result in bradydysrhythmias. present, the use of atropine, beta agonists, and transcutaneous or Prior to beginning this activity, see the back page for faculty transvenous pacing may be required. disclosures and CME accreditation information. Editor-In-Chief Nicholas Genes, MD, PhD Keith A. Marill, MD Scott Silvers, MD, FACEP Research Editor Andy Jagoda, MD, FACEP Assistant Professor, Department of Assistant Professor, Harvard Medical Chair, Department of Emergency Michael Guthrie, MD Professor and Chair, Department of Emergency Medicine, Icahn School School; Emergency Department Medicine, Mayo Clinic, Jacksonville, FL Emergency Medicine Residency, of Medicine at Mount Sinai, New Attending Physician, Massachusetts Emergency Medicine, Icahn School Corey M. Slovis, MD, FACP, FACEP Icahn School of Medicine at Mount York, NY General Hospital, Boston, MA of Medicine at Mount Sinai, Medical Professor and Chair, Department Sinai, New York, NY Director, Mount Sinai Hospital, New Michael A. Gibbs, MD, FACEP Charles V. Pollack, Jr., MA, MD, of Emergency Medicine, Vanderbilt York, NY Professor and Chair, Department FACEP University Medical Center; Medical International Editors of Emergency Medicine, Carolinas Professor and Chair, Department of Director, Nashville Fire Department and Peter Cameron, MD Associate Editor-In-Chief Medical Center, University of North Emergency Medicine, Pennsylvania International Airport, Nashville, TN Academic Director, The Alfred Kaushal Shah, MD, FACEP Carolina School of Medicine, Chapel Hospital, Perelman School of Emergency and Trauma Centre, Associate Professor, Department of Hill, NC Medicine, University of Pennsylvania, Stephen H. Thomas, MD, MPH Monash University, Melbourne, Emergency Medicine, Icahn School Philadelphia, PA George Kaiser Family Foundation Steven A. Godwin, MD, FACEP Australia of Medicine at Mount Sinai, New Professor & Chair, Department of Professor and Chair, Department Michael S. Radeos, MD, MPH York, NY Emergency Medicine, University of Giorgio Carbone, MD of Emergency Medicine, Assistant Assistant Professor of Emergency Oklahoma School of Community Chief, Department of Emergency Editorial Board Dean, Simulation Education, Medicine, Weill Medical College Medicine, Tulsa, OK Medicine Ospedale Gradenigo, University of Florida COM- of Cornell University, New York; Torino, Italy William J. Brady, MD Jacksonville, Jacksonville, FL Research Director, Department of Ron M. Walls, MD Professor of Emergency Medicine Emergency Medicine, New York Professor and Chair, Department of Amin Antoine Kazzi, MD, FAAEM and Medicine, Chair, Medical Gregory L. Henry, MD, FACEP Hospital Queens, Flushing, New York Emergency Medicine, Brigham and Associate Professor and Vice Chair, Emergency Response Committee, Clinical Professor, Department of Women’s Hospital, Harvard Medical Department of Emergency Medicine, Medical Director, Emergency Emergency Medicine, University Robert L. Rogers, MD, FACEP, School, Boston, MA University of California, Irvine; Management, University of Virginia of Michigan Medical School; CEO, FAAEM, FACP Scott D. Weingart, MD, FCCM American University, Beirut, Lebanon Medical Center, Charlottesville, VA Medical Practice Risk Assessment, Assistant Professor of Emergency Inc., Ann Arbor, MI Medicine, The University of Associate Professor of Emergency Hugo Peralta, MD Peter DeBlieux, MD Maryland School of Medicine, Medicine, Director, Division of Chair of Emergency Services, John M. Howell, MD, FACEP Professor of Clinical Medicine, Baltimore, MD ED Critical Care, Icahn School of Hospital Italiano, Buenos Aires, Interim Public Hospital Director Clinical Professor of Emergency Medicine at Mount Sinai, New Argentina of Emergency Medicine Services, Medicine, George Washington Alfred Sacchetti, MD, FACEP York, NY Dhanadol Rojanasarntikul, MD Emergency Medicine Director of University, Washington, DC; Director Assistant Clinical Professor, Attending Physician, Emergency Faculty and Resident Development, of Academic Affairs, Best Practices, Department of Emergency Medicine, Senior Research Editors Medicine, King Chulalongkorn Louisiana State University Health Inc, Inova Fairfax Hospital, Falls Thomas Jefferson University, Memorial Hospital, Thai Red Cross, Science Center, New Orleans, LA Church, VA Philadelphia, PA James Damilini, PharmD, BCPS Clinical Pharmacist, Emergency Thailand; Faculty of Medicine, Robert Schiller, MD Francis M. Fesmire, MD, FACEP Shkelzen Hoxhaj, MD, MPH, MBA Room, St. Joseph’s Hospital and Chulalongkorn University, Thailand Professor and Director of Clinical Chief of Emergency Medicine, Baylor Chair, Department of Family Medical Center, Phoenix, AZ Suzanne Peeters, MD Research, Department of Emergency College of Medicine, Houston, TX Medicine, Beth Israel Medical Center; Senior Faculty, Family Joseph D. Toscano, MD Emergency Medicine Residency Medicine, UT College of Medicine, Eric Legome, MD Medicine and Community Health, Chairman, Department of Emergency Director, Haga Hospital, The Hague, Chattanooga; Director of Chest Pain Chief of Emergency Medicine, Icahn School of Medicine at Mount Medicine, San Ramon Regional The Netherlands Center, Erlanger Medical Center, King’s County Hospital; Professor of Sinai, New York, NY Medical Center, San Ramon, CA Chattanooga, TN Clinical Emergency Medicine, SUNY Downstate College of Medicine, Brooklyn, NY Case Presentations upon arrival or that they will become unstable during the course of their evaluation and treatment. It is about 20 minutes into your shift when EMS ar- While these scenarios may not occur on a regular rives with a pleasant 80-year-old woman who has had basis, emergency clinicians must be prepared to a syncopal event. She describes standing in her home provide emergent interventions, as needed, to sta- earlier today and becoming lightheaded and falling to the bilize these patients. Familiarity with resuscitation ground. She is now resting comfortably, and her vital techniques and medications as well as procedures signs are: blood pressure, 140/72 mm Hg; pulse rate, 74 (including transvenous pacer placement) is central beats/min; respiratory rate, 14 breaths/min; and oxygen to management. This issue of Emergency Medicine saturation, 99% on room air. You have just begun to take Practice provides a systematic review of the litera- her history when you are interrupted and called to your ture on bradydysrhythmias and presents recommen- next patient... dations based on the best available evidence. You approach the bedside of a 27-year-old woman who is pale, diaphoretic, and writhing in pain. The only Critical Appraisal Of The Literature history you are able to obtain is that she has had mild lower abdominal pain for a few days that acutely wors- A review of the literature on bradydysrhythmias ened today. Initial vital signs are: blood pressure, 70/40 proved to be challenging due to the vast number mm Hg; pulse rate, 58 beats/min; respiratory rate, 20 of articles mentioning relevant terms. The review breaths/min; and oxygen saturation, 99% on room air. was initially performed through PubMed and Ovid ® Your brief exam is significant for diffuse abdominal ten- MEDLINE , using the keywords bradydysrhythmias, derness and guarding. You then hear a flurry of activity sinus bradycardia, sick sinus syndrome, tachy-brady from the hallway... syndrome, sinoatrial block, sinus arrest, first-degree heart Your next patient is being rushed down the hall on a block, second-degree heart block, Mobitz type I, Mobitz stretcher. Brought in by a family member for intermittent type II, Wenckebach, third-degree heart block, complete lightheadedness and shortness of breath,
Load more

Recommended publications
  • Cardiovascular Responses to Hypoxemia in Sinoaortic-Denervated Fetal Sheep
    003 1-399819 1 /3004-038 1$03.0010 PEDIATRIC RESEARCH Vol. 30. No. 4, I991 Copyright ID1991 International Pediatric Research Foundation. Inc. I1riiirc~c/it1 U.S. ,.I Cardiovascular Responses to Hypoxemia in Sinoaortic-Denervated Fetal Sheep JOSEPH ITSKOVITZ (ELDOR), EDMOND F. LAGAMMA. JAMES BRISTOW, AND ABRAHAM M. RUDOLPH Ccirdiovascz~karResearch Instillrle. Unlver:c.i/yqf Califi~rniu,Sari Francisco. Sun Francisco. Cu11fi)rilia94/43 ABSTRACT. Fetal cardiovascular response to acute hy- hypoxemia in postnatal life (1 3). The vascular effects of periph- poxemia is characterized by bradycardia, hypertension, and eral chemoreceptor stimulation, with ventilation held constant, redistribution of cardiac output. The role of aortic and include coronary vasodilation and vasoconstriction in the carotid chemoreceptors in mediating these responses was splanchnic organs and the skeletal muscles. Stimulation of the examined in eight sinoaortic-denervated and nine sham- carotid body chemoreceptors results in reflex bradycardia and operated fetal lambs. Blood gases, pH, heart rate, arterial negative inotropic responses. The bradycardia and peripheral pressure, and blood flow distribution were determined be- vasoconstriction during carotid chemoreceptor stimulation can fore and during hypoxemia. In intact fetuses, heart rate be reversed by effects arising from concurrent hypernea (13). fell from 184 -+ 12 to 165 + 23 beatslmin (p< 0.01) but The arterial chemoreceptors (aortic and carotid bodies) are increased from 184 + 22 to 200 + 16 beatslmin (p< 0.05) active in the fetal lamb and are responsive to hypoxemia (14- in the sinoaortic-denervated fetuses. Intact fetuses showed 21). Stimulation of the fetal arterial chemoreceptors result in an early hypertensive response to hypoxemia, whereas the bradycardia, which is abolished by SAD (19, 20, 22).
    [Show full text]
  • Investigation of the Cardiovascular Action of Sympathetic Amines Using Two Kinds of Strain Gauge Instrument
    Nagoya ]. med. Sci. 29: 155-165, 1966. INVESTIGATION OF THE CARDIOVASCULAR ACTION OF SYMPATHETIC AMINES USING TWO KINDS OF STRAIN GAUGE INSTRUMENT ATSUSHI SEKIYA, MITSUYOSHI NAKASHIMA, AND ZENGO KANDA Department of Pharmcology, Nagoya University School of Medicine (Director: Prof. Zen go Kanda) SUMMARY Ventricular responses of a few catecholamines in rabbits were studied with the use of various parameters: blood pressure, systemic output or stroke volume, heart rate, ventricular contractile force and change of segment length of ventricular muscle. In recording ventricular contraction, two kinds of apparatus, strain gauge compass and arch, which we devised, were used. Simultaneous recordings of these various factors permit characterization and direct comparison of the nature and sequence of left ventricular responses by infusion of catecholamines. Epinephrine or norepinephrine, in smaller dose produced almost the same changes in ventricular contractile force and segment length of ventricular muscle. However, in the course of a short time after the administration of the large dose of these drugs, the change of coutractile force by means of strain gauge arch was significant, but the change of muscle segment length measused by means of strain gauge compass was more complicated and gave us much information of cardiac function. Namely, there were a decrease of stroke deflection with a decrease of stroke volume and a downward displacement of systolic and diastolic excursion curve which meant heart dilatation. By the administration of methoxamine, the changes of muscle segment length were more marked than the changes of contractile force. By the administration of isoproterenol, the changes of contractile force were more marked than the changes of muscle segment length changes.
    [Show full text]
  • Resetting of the Baroreflex Control of Sympathetic Vasomotor Activity
    REVIEW published: 15 August 2017 doi: 10.3389/fnins.2017.00461 Resetting of the Baroreflex Control of Sympathetic Vasomotor Activity during Natural Behaviors: Description and Conceptual Model of Central Mechanisms Roger A. L. Dampney* Physiology, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia The baroreceptor reflex controls arterial pressure primarily via reflex changes in vascular resistance, rather than cardiac output. The vascular resistance in turn is dependent upon the activity of sympathetic vasomotor nerves innervating arterioles in different vascular beds. In this review, the major theme is that the baroreflex control of sympathetic vasomotor activity is not constant, but varies according to the behavioral state of the animal. In contrast to the view that was generally accepted up until the 1980s, I argue that the baroreflex control of sympathetic vasomotor activity is not inhibited or overridden during behaviors such as mental stress or exercise, but instead is reset under those Edited by: Chloe E. Taylor, conditions so that it continues to be highly effective in regulating sympathetic activity and Western Sydney University, Australia arterial blood pressure at levels that are appropriate for the particular ongoing behavior. A Reviewed by: major challenge is to identify the central mechanisms and neural pathways that subserve Satoshi Iwase, Aichi Medical University, Japan such resetting in different states. A model is proposed that is capable of simulating the Craig D. Steinback, different ways in which baroreflex resetting is occurred. Future studies are required to University of Alberta, Canada determine whether this proposed model is an accurate representation of the central *Correspondence: mechanisms responsible for baroreflex resetting.
    [Show full text]
  • SIMULATED HUMAN DIVING and HEART RATE: MAKING the MOST of the DIVING RESPONSE AS a LABORATORY EXERCISE Sara M
    SIMULATED HUMAN DIVING AND HEART RATE: MAKING THE MOST OF THE DIVING RESPONSE AS A LABORATORY EXERCISE Sara M. Hiebert and Elliot Burch Advan Physiol Educ 27:130-145, 2003. doi:10.1152/advan.00045.2002 You might find this additional information useful... This article cites 15 articles, 3 of which you can access free at: http://ajpadvan.physiology.org/cgi/content/full/27/3/130#BIBL Medline items on this article's topics can be found at http://highwire.stanford.edu/lists/artbytopic.dtl on the following topics: Pharmacology .. Heart Diseases (Drug Development) Physiology .. Exertion Medicine .. Fitness (Physical Activity) Medicine .. Exercise Medicine .. Bradycardia Downloaded from Physiology .. Humans Updated information and services including high-resolution figures, can be found at: http://ajpadvan.physiology.org/cgi/content/full/27/3/130 Additional material and information about Advances in Physiology Education can be found at: http://www.the-aps.org/publications/advan ajpadvan.physiology.org This information is current as of January 10, 2007 . on January 10, 2007 Advances in Physiology Education is dedicated to the improvement of teaching and learning physiology, both in specialized courses and in the broader context of general biology education. It is published four times a year in March, June, September and December by the American Physiological Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright © 2005 by the American Physiological Society. ISSN: 1043-4046, ESSN: 1522-1229. Visit our website at http://www.the-aps.org/. T E A C H I N G I N T H E L A B O R A T O R Y SIMULATED HUMAN DIVING AND HEART RATE: MAKING THE MOST OF THE DIVING RESPONSE AS A LABORATORY EXERCISE Sara M.
    [Show full text]
  • Pharmacology of Autonomic Nervous System
    Yerevan State Medical University after Mkhitar Heratsi M.G. Balasanyan, L.G. Dheryan, A.V. Baykov, A.G. Tananyan, N.A. Voskanyan Pharmacology Guideline For the third year students Pharmacology of autonomic nervous system Yerevan-2017-2018 Pharmacology of autonomic nervous system Nervous system is divided into 2 parts: Central nervous system (CNS) and peripheral nervous system (PNS). CNS in its` term consists of brain and spinal cord. PNS consists of all afferent (sensory) neurons, which provide impulse conduction from peripheral organs and all efferent (motor) neurons, which provide impulse conduction from center to periphery. Efferent part of nervous system includes 2 main parts: autonomic nervous system and somatic nervous system. Vegetative or autonomic nervous system acts out of human’s will and isn`t directly regulated by the human`s conscious. VNS maintains body homeostasis and regulates function of inner organs (digestion, blood supply of organs, regulation of blood pressure etc.). Synapses of SNS are localized in CNS, but peripheral synapses of VNS are localized out of CNS in ganglions. Preganglionic nerves of VNS are myelinated, postganglionic nerves are not myelinated. VNS innervates smooth muscles, myocardium and exocrine glands. Besides VNS is included also peripheral ganglions. The mediators of VNS are NA and ACH. Somatic nervous system (SNS) is regulated by conscious and regulates motor activity, breathing, position. SNS innervates skeletal muscles, synapses are located in CNS, nerve fibers are myelinated. SNS doesn`t have
    [Show full text]
  • A Systematic Review of the Evidence Supporting a Role for Vasopressor Support in Acute SCI
    Spinal Cord (2010) 48, 356–362 & 2010 International Spinal Cord Society All rights reserved 1362-4393/10 $32.00 www.nature.com/sc REVIEW A systematic review of the evidence supporting a role for vasopressor support in acute SCI A Ploumis1,2, N Yadlapalli2, MG Fehlings3, BK Kwon4 and AR Vaccaro2 1Division of Orthopaedics and Rehabilitation, Department of Surgery, University of Ioannina, Ioannina, Greece; 2Department of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA; 3Division of Neurosurgery and Spinal Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada and 4Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada Study design: A systematic review of clinical and preclinical literature. Objective: To critically evaluate the evidence supporting a role for vasopressor support in the management of acute spinal cord injury and to provide updated recommendations regarding the appropriate clinical application of this therapeutic modality. Background: Only few clinical studies exist examining the role of arterial pressure and vasopressors in the context of spinal cord trauma. Methods: Medical literature was searched from the earlier available date to July 2009 and 32 articles (animal and human literature) answering the following four questions were studied: what patient groups benefit from vasopressor support, which is the optimal hypertensive drug regimen, which is the optimal duration of the treatment and which is the optimal arterial blood pressure. Outcome measures used were the incidence of patients needing vasopressors, the increase of arterial blood pressure and neurologic improvement. Results: Patients with complete cervical cord injuries required vasopressors more frequently than either incomplete injuries or thoracic/lumbar cord injuries (Po0.001).
    [Show full text]
  • Dexmedetomidine: the Anesthetic As an Antiarrythmic Minati Choudhury* Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
    maco har log P y: r O la u p c e n s a A Choudhury, Cardiol Pharmacol 2015, 4:3 v c o c i e d r s a s Open Access C Cardiovascular Pharmacology: DOI: 10.4172/2329-6607.1000153 ISSN: 2329-6607 Review Article OpenOpen Access Access Dexmedetomidine: The Anesthetic as an Antiarrythmic Minati Choudhury* Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India Abstract Cardiac arrhythmias are significant cause of morbidity and mortality during perioperative period as well as in critically ill patients in intensive care units (ICU).These rhythm disturbances that may be well tolerated in normal heart can cause significant hemodynamic instability in patients with a congenital or acquired heart problem. Management of these arrhythmias possess a challenge because currently available antiarrhythmic have several disadvantages. Dexmedetomidine (DEX) is a highly selective alpha-2 adrenergic receptor agonist with sympatholytic, sedative, amnesic and analgesic properties. Growing evidences has been suggested the potential therapeutic application of DEX in the management of cardiac rhythm disturbances. This work has an intention to review and update the application of DEX for management of various cardiac arrhythmias. A comprehensive review of pharmacology, mechanism of antiarrhythmic action and side effects of this drug is presented. Keywords: Dexmedetomidine; Cardiac arrhythmias; Perioperative decongestant produced severe cardiovascular depression. Gradually, it period; Intensive care unit gained acceptance for the management of blood pressure as well as an adjunct to other agents in anesthesia practice. DEX is the stereoisomer Introduction of medetomidine subsequently gained massive importance as a sedative agent during perioperative period.
    [Show full text]
  • Quantitative Analysis of the Oculocardiac Reflex by Traction on Human Extraocular Muscle
    Quantitative Analysis of the Oculocardiac Reflex by Traction on Human Extraocular Muscle Tsutomu Ohashi, Manabu Kase, and Masahiko Yokoi The oculocardiac reflex was quantitatively studied in 15 patients with strabismus. The reflex was observed in all patients when the medial rectus and inferior oblique muscles were stretched; the medial rectus muscle had a lower threshold than the inferior oblique. Bradycardia was evoked in 7 of the 15 patients when the lateral rectus was tractioned with tensions of 50 g and 600 g. The oculocardiac reflex was a graded phenomenon as a function of tension applied to the extraocular muscles. As tension was increased, bradycardia occurred rapidly and became deep. Systemic administration of atropine prevented completely the bradycardia from occurring. The results suggest that the response of the extraocular muscles to stretch are critically mediated through a polysynaptic path to the heart, resulting in suppression of the heart rate. Invest Ophthalmol Vis Sci 27:1160-1164, 1986 The oculocardiac reflex is a physiological response Materials and Methods of the heart to physical stimulation of the eye or the The oculocardiac reflex was examined in 15 patients ocular adnexa, characterized by bradycardia or ar- with strabismus under general anesthesia. Their ages rhythmia, which sometimes leads to cardiac arrest.1 ranged from 11 months-10 yr. Seven of the 15 patients The major pathway mediating the oculocardiac reflex were exotropes, and eight were esotropes with or with- seems to consist of an afferent link through the out overaction of the inferior oblique muscle. None of ophthalmic portion of the trigeminal nerve to the vagus the patients had cardiac or neurological disorders.
    [Show full text]
  • Systolic Murmurs
    Published online: 2019-12-03 THIEME Clinical Rounds 165 Systolic Murmurs Maddury Jyotsna1 1Department of Cardiology, Nizam's Institute of Medical Sciences, Address for correspondence M. Jyotsna, MD, DM, FACC, FESC, Punjagutta, Hyderabad, Telangana, India FICC, Department of Cardiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082, India (e-mail: [email protected]). Ind J Car Dis Wom 2019;4:165–174 Murmur is the vibration of heart components or great ves- The areas to be auscultated other than above mentioned sels.1 Systolic murmurs are those murmurs that can be heard classical five areas are as follows: between S1 and S2. 1. The right parasternal region, 2. The right and left the base of the neck, Basics of Murmur 3. The right and left carotid arteries, 4. The left axilla, The turbulent flow generates murmurs, but the acoustic 5. The interscapular area. force generated by the turbulence is not sufficient to produce an audible sound on the chest wall.2 Brun proposed the con- cept of vortex shedding for the mechanism of generation of Characteristics of the Systolic Murmur the murmurs. Vortices are produced from the diseased valves or great vessels. These vertices can be produced by increased 1. Intensity (loudness)—Intensity of the systolic murmur flow with normal valves or great vessels. These vortices can is graded into six grades. Grade 1 refers to a murmur so produce sustained vibrations to generate audible murmur on faint that it can be heard only with special effort. A grade 2 the chest wall. murmur is faint but is immediately audible.
    [Show full text]
  • The Top 5 Anesthetic Complications Hypothermia
    The Top 5 Anesthetic Complications Donna M. Sisak, CVT, LVT, VTS (Anesthesia/Analgesia) Seattle Veterinary Specialists Kirkland, WA [email protected] COMPLICATION (medical definition): An unanticipated problem that arises following, and is a result of, a procedure, treatment, or illness. A complication is so named because it complicates the situation. MedicineNet.com As we prepare for an anesthetic event we respect the knowledge and skill required by the anesthetist to monitor and manage a patient to a successful outcome. The anesthetist should have a general understanding of: the anesthetic agents, methods for delivering (and assessing) the anesthetic agent, and the appropriate action required in the event of an anesthetic-related complication/emergency. Despite thorough patient monitoring/supportive care by an astute anesthetist complications can still occur. The duration of the event can influence outcome; the longer the patient is anesthetized the greater the chance for a complication. Anesthesia time should be carefully planned out by the clinician (surgeon) and anesthetist to prevent a prolonged anesthetic experience for the patient. Five complications that commonly occur: Hypothermia Abnormal heart rate (arrhythmias) Hypoventilation Hypotension Difficult recovery Hypothermia During an anesthetic event the patient’s thermoregulatory center is affected by anesthetic (opioids) agents potentiating hypothermia. Acepromazine, propofol, alfaxalone, and inhalants decrease temperature due to vasodilation – eventually slowing the metabolism. Additional causes of hypothermia include: endotracheal intubation, clipped fur, open body cavities (chest, abdomen), IV fluids, increased high fresh oxygen flow, and surgical prep solution. The consequences of hypothermia include: decreased metabolism (decreased anesthetic requirements), decrease immune response, delayed wound healing, and coagulopathies. As hypothermia progresses patients become bradycardic and unresponsive to anticholinergic (atropine, glycoprryolate) therapy.
    [Show full text]
  • Central Parasympathetic Activation Assessed by Cardiac Vagal Motoneuron Recordings in Rat Emil Toader
    Central parasympathetic activation assessed by cardiac vagal motoneuron recordings in rat Emil Toader To cite this version: Emil Toader. Central parasympathetic activation assessed by cardiac vagal motoneuron recordings in rat. Tissues and Organs [q-bio.TO]. Université Claude Bernard - Lyon I, 2008. English. tel-00291046 HAL Id: tel-00291046 https://tel.archives-ouvertes.fr/tel-00291046 Submitted on 26 Jun 2008 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. N° d’ordre : 41-2008 Année 2008 THESE Présentée devant L’UNIVERSITÉ CLAUDE BERNARD – LYON1 pour l’obtention du DIPLOME DE DOCTORAT (arrêté du 7 août 2006) présentée et soutenue publiquement le 28 mars 2008 par Emil-Codrut TOADER ACTIVATION PARASYMPATHIQUE CENTRALE MISE EN EVIDENCE PAR ENREGISTREMENT DES MOTONEURONES CARDIAQUES VAGAUX CHEZ LE RAT CENTRAL PARASYMPATHETIC ACTIVATION ASSESSED BY CARDIAC VAGAL MOTONEURON RECORDINGS IN RAT Directeur de thèse : Luc QUINTIN JURY M. J.M. PEQUIGNOT Président M. R.M. McALLEN Examinateur M. E. MOYSE Rapporteur et Examinateur M. L. QUINTIN Responsable de thèse MME. C. SEVOZ-COUCHE Rapporteur et Examinateur Laboratoire de Physiologie, (CNRS UMR 5123) Directeur: B. ALLARD 2 UNIVERSITE CLAUDE BERNARD - LYON I Président de l’Université M.
    [Show full text]
  • Breathing and the Control of Heart Rate Erica Potter
    BREATHING AND THE CONTROL OF HEART RATE by ERICA POTTER School of Physiology and Pharmacology University of New South Wales . : '.,; ' Ph.D . January 1981 ACKNOWLEDGEMENTS I am very grateful to Professor W.E Glover for enabling me to undertake this project in the School of Physiology and Pharmacology, to the National Heart Foundation of Australia for its support of this project, to Miss Diane Madden for her untiring technical help, to Dr. Simon Gandevia for a stimulating period of collaboration, to Mrs. Judy Bokor who typed this thesis and especially to my supervisor, Associate Professor Ian Mccloskey for his encouragement, pa~ience and guidance throughout. STATEMENT REGARDING WORK DONE IN COLLABORATION Some of the results reported in chapter 3 have been published in a paper (Davis, Mccloskey and Potter, 1977) whicl included also some results from work done by Dr. Anne Davis. Dr. Davis and I did not perform our experiments together, and none of her results are included in this thesis. Experiments involving recordings of heart rate in animals and man are described in chapters 4, 5 and 6; some of these were performed in equal collaboration with Dr. Simon Gandevia and were published with him (Gandevia, McCloskey and Potter, 1978 a, b). The collaborative work done with Dr. Gandevia was not included in his Ph.D thesis. The experiments on nerve recordings in the same chapters and elsewhere throughout this thesis were performed by me. Associate Professor Ian Mccloskey supervised my work and collaborated in many experiments. PUBLICATIONS ARISING FROM WORK DESCRIBED IN THIS THESIS 1. Davis, A.L., Mccloskey, D.I, and Potter, E.K (1977).
    [Show full text]