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First use of new ablation catheter in US offers improved atrial fibrillation treatment

Dr. Daniel Melby, an investigator at the Minneapolis Heart Institute Foundation, performed the first atrial fibrillation ablation in the US using Biosense Webster's new THERMOCOOL SMARTTOUCH SF contact force sensing catheter as part of an FDA regulated safety trial. 'Contact force sensing combined with the more efficient irrigation design of this catheter may allow for a more effective ablation pattern while potentially reducing risk of thrombus formation and improving outcomes,' said Dr. Melby.  
eurekalert.org
over 4 years ago
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Emergency Medicine Literature of Note: Early Goal-Directed Waste For Sepsis

Hey Ryan, As always great work and post. I did want to make sure something was clarified from your post.....Looking at the results, a significant portion of “usual” care patients still get arterial catheters (62.2%), CVCs (50.9%), and vasopressors (46.6%). What this tells me is that our “usual” care has components of the EGDT algorithm engrained in it. Sick patients need fluids, antibiotics, and supportive therapies (i.e. Early critical care and resuscitation), but they don’t need CVP and SCVO2 monitoring to dictate their care. So there are still components of EGDT that should continue to be used, it is the invasive monitoring that is not really needed. Hope all is well.Salim  
emlitofnote.com
over 4 years ago
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Suction Assisted Laryngoscopy Airway Decontamination

Suction Assisted Laryngoscopy Airway Decontamination UW Madison Mar 2015 from AirwayNautics on Vimeo. Movie captures the important lessons of a simulation session based upon using a rigid suction catheter (Yankauer and other variant) to decontaminate the airway of a modified Laerdal Difficult Airway Simulator mannequin. The technique described in this simulation is known as the…  
prehospitalmed.com
over 4 years ago
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Apneic oxygenation and high-flow nasal cannula don’t prevent desaturation during intubation?

0 0 Introduction 0 Recently there has been increased interest in the use of high-flow nasal cannula (HFNC) to provide preoxygenation and apneic oxygenation  
pulmcrit.org
over 4 years ago
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High-flow nasal cannula for apneic oxyventilation

0 Introduction 0 Last summer I wrote a postabout preoxygenation and apneic oxygenation using high-flow nasal cannula (HFNC).  At that point there was no ev  
pulmcrit.org
over 4 years ago
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ECMO - Avalon Cannula - Intensive Care Network

Intensivist Dr Roger Pye demonstrates the Avalon Cannula for ECMO. Presented at SMACCGold 2014.  
intensivecarenetwork.com
over 4 years ago
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Pacing Swan Ganz Catheter - Intensive Care Network

Roger Harris demonstrates Pacing Swan Ganz Catheters including a video animation and cadaveric pigs heart demonstration! Presented at SMACCGold 2014.  
intensivecarenetwork.com
over 4 years ago
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Medtronic Euphora Semicompliant Coronary Balloon Cleared in U.S. |

The FDA awarded Medtronic clearance for the company's Euphora Semicompliant Balloon Dilatation Catheter. The device received European regulatory approval l  
medgadget.com
over 4 years ago
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Antibiotic lock to prevent catheter infection in infants | Cochrane

Babies in the neonatal intensive care unit require medicines and fluids through their veins. To do this, a small tube (described as a central venous catheter, CVC) is inserted into the infant's vein through the umbilical cord or through the skin. This tube is placed just outside the heart. This tube is then used to give medicines and fluid without causing any discomfort. However, this tube does lead to an increased risk of infection, which can be life threatening. There are many measures taken to try to prevent this, but infection still occurs. This review looks at one way to prevent this infection by putting an antibiotic solution into the tube and leaving it to stay there for a certain length of time (called antibiotic lock) compared with a solution containing no antibiotic.  
cochrane.org
over 4 years ago
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Strategies used for the withdrawal of humidified high flow nasal cannulae (HHFNC) in preterm infants | Cochrane

Background: Humidified high flow nasal cannula (HHFNC) is a form of respiratory support used in the treatment of preterm infants. Potential risks of HHFNC include damage to the nose and leaking of air from the lungs. Infants on HHFNC require more nursing care and the use of extra equipment (when compared to not being on any support). However, potential complications of removing HHFNC from babies too early include increased episodes of forgetting to breathe, increased oxygen needs, increased effort of breathing, the need to restart HHFNC, and the need for a breathing tube with mechanical ventilation. Any of these complications can be seen as a "failure" and are potentially distressing to staff and family. The best way to withdraw HHFNC once it has been started is unknown. Options include simply stopping, weaning the flow, increasing the time off HHFNC each day, or combinations of both.  
cochrane.org
over 4 years ago
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Medtronic Fortex PTA High Pressure Balloon to Maintain Access During Dialysis |

Medtronic is launching in the U.S. its Fortex percutaneous transluminal angioplasty (PTA) balloon catheter. The over-the-wire device features a high-pressu  
medgadget.com
over 4 years ago
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Effectiveness of dressings and other devices that are used to keep a peripheral venous catheter in place | Cochrane

Most people admitted to an acute/emergency hospital ward require the insertion of a peripheral venous catheter/cannula (PVC), often known as a 'drip' or 'IV'. A PVC is a flexible, hollow, plastic tube that is inserted in a peripheral vein, most commonly in the hand, or lower arm. Up to half of all PVCs stop working before treatment has finished and a new one has to be inserted. This is uncomfortable for the patient and costly for the healthcare system. One of the reasons PVCs fail, is that the products used to hold them in place are not fully effective, and allow the PVC to move around. This movement causes redness, inflammation and even blood infections. The PVC can become blocked, or leak into the surrounding tissues, or even fall out as a consequence of the movement. The function of PVC dressings and/or securement devices is to keep the PVC in the vein, and to cover the insertion site so that it is kept dry and clean and protected from infection.  
cochrane.org
over 4 years ago
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Small tube - big problem - BBC News

Catheters are a common, but little considered aspect of many patients' care. But in this week's Scrubbing Up Mandy Fader, professor of continence technology at the University of Southampton, says there needs to be a rethink about how they are used.  
bbc.co.uk
over 4 years ago
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Industry 'must do more' to improve urinary catheters - BBC News

A leading researcher says industry must "wake up and invest more" in urinary catheters  
bbc.co.uk
over 4 years ago
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WHAT THE HELL I AM DOING? I AM ENGORGING A VEIN IS WHAT I AM DOING!

I’m not sure where this fits in, in this age of ultrasounding everything, but there is an interesting short report in EMJ. It describes a simple technique to achieve IV access in patients where the periphery is shut down.  A typical scenario could be a patient in shock were all you can get in is a pathetic 22-24G cannula on the hand, when what you really want to do is a rapid infusion through a 14-16G in the cubital vein.  
scancrit.com
over 4 years ago
Sinaiem dark
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respiratory-failure

As we all know, NiPPV is a well established practice and therapy of choice in patients with COPD and CHF exacerbations.  It is typically used in patients with hypercarbic respiratory failure.  But for those patients who come to the ED with pure hypoxemic respiratory failure (in say, someone with pneumonia) is there a better way to oxygenate them when standard nasal cannula isn’t doing the trick and you want to avoid intubation?  According to 2 recent studies high flow nasal cannula may provide the answer.  In comparing NiPPV to standard oxygen delivery therapy to high flow nasal cannula the intubation rates did not differ significantly, but appear to be lower in the high flow NC group.  Additionally, the 90 day mortality rate was significantly lower and ventilator free days were increased in the the high flow NC group compared to the other two.  The other benefit is that there was less patient discomfort in the high flow NC group.  
sinaiem.org
over 4 years ago
Static.www.bmj
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Delivering thrombectomy for acute stroke using cardiology services

Evidence is mounting for the supplementary benefit over thrombolysis of endovascular therapy in selected patients with acute stroke. Mechanical percutaneous removal of intracerebral clot using an aspiration catheter ensures that the artery is recanalised. Like thrombolysis, the benefits are greater with early treatment, and we need to think about how to achieve this. Evidence on the benefits of rapid primary percutaneous coronary intervention in patients presenting with ST segment elevation myocardial infarction (STEMI) led to a network being set up in the United Kingdom to provide 24 hour care.1 Teams staffing these networks, skilled in opening arteries quickly, could also provide endovascular therapy to selected patients with acute stroke.  
feeds.bmj.com
over 4 years ago
Sinaiem dark
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a-different-approach-to-central-line-placementu

Today’s pearl comes to you directly from Dr. Reuben Strayer (emupdates.com) and I think is particularly applicable to resident learners.  The traditional teaching for CVC placement has involved needle puncture and stabilization of said needle followed by detaching the syringe and threading a wire.  Many, typically less experienced providers (i.e. residents), have a tendency to move the needle (even while attempting to keep it stable) while removing the ultrasound or while unscrewing the syringe.  This process often dislodges the needle making it impossible to threat the wire.  A technique that has been around for some time, but is underutilized, is the wire through catheter technique, which allows you to thread a catheter over the needle so that it remains stable inside the vein, rather than having to perform the more difficult task of stabilizing the needle.  The two techniques are demonstrated in the video attached to the link that follows.  Also, do not forget your confirmatory techniques, which are discussed in the video as well.  Without further ado, the soothing voice of Dr. Strayer.  
sinaiem.org
over 4 years ago
Podcast art for itunes 600 600 2011 version
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does-central-line-position-matter-can.html

To avoid misplacement of the central line we used the very simple technic discribed by Bedel et al http://www.ncbi.nlm.nih.gov/pubmed/24052186Subclavian view show intracardiac positionning of the guidewire before insertion of the catheter. We believe this to be a better approch for your [b] point.  
pulmcrit.org
over 4 years ago
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Lab-on-a-Disc Device Detects Urinary Tract Infections in About an Hour |

UTIs are a common occurrence in hospitalized patients with catheters, but they're typically detected too late and can lead to sepsis. Currently, a diagnost  
medgadget.com
over 4 years ago