Moyamoya Disease Suzuki Staging System

 

REFERENCE:

White, T. et al.  Moyamoya: An Update for the Practicing Neurologist.  Practical Neurology.  November / December, 2017.

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Antibiotic Dosing in Renal Replacement Therapy

Source: Critical Care Review

Stats Reference Table

Type 1 Error: rejecting null when null is TRUE.

Type 2 Error: rejecting null when null is FALSE.

Lower p value results in less type 1 error, more type 2 error.

MRI evolution of Cerebral Abscess

img_1682.jpg

 

Reference:

Criner, G., Barnette, R. and D’Alonzo, G. (2010). Critical Care Study Guide. Dordrecht: Springer.

 

 

Pulmonary Artery Catheter Waveforms and Normal Values

As the PAC is inserted, the following waveforms can be observed.

1. When the catheters enters the RA, a CVP tracing is seen – characterized by a and v waves.img_1652

 

 

 

 

 

 

 

 

 

2. As the catheter enters the RV, a sharp increase in systolic pressure is noted.img_1653

3. As the catheter is advanced to the pulmonary artery, an increment in diastolic pressure is seen as well as the presence of a dichromatic notch. img_1654

4. When the catheter is advanced further into the pulmonary artery, and wedged – a sine wave that oscillates with respiration is seen. img_1655

THE RA WAVEFORM:

The RA waveform is characterized by presence of 2 waves: a wave (contraction of the RA) and the v wave (passive filling of the RA).

The x descent represents RA relaxation, which is interrupted by the c wave which represents closure of the tricuspid valve.

The y descent follows the v wave, which signals the opening of the tricuspid valve and exit of blood from the RA to the RV.

img_1656

OVERDAMPING:

The wave below illustrates flushing of the catheter – which results in high pressures in the transducer (1). Flushing stops, and results in fall in pressures and an overshoot (2), and a return to normal waveform.

img_1661

The wave below – overshooting is absent, and the waveform is flattened, which is found in an overdamped waveform. Overdamping can be caused by a kinked catheter, air bubbles, fibrin clot.

img_1662

 

 

 

 

 

CATHETER WHIP.

The graph below illustrate catheter whip – where ventrcicular contractions are transmitted to the PAC.

img_1663

OVERWEDGING:

The arrow indicates when the balloon is inflated. There is a sustained increment in pressure reading.

img_1664

 

 

 

 

ACUTE MITRAL INSUFFICIENCY

Prominent v waves represent blood that enters the LA during ventricular systole due to an incompetent mitral valve.

img_1665

 

 

 

 

TRICUSPID REGURGITATION

Broad c-v waves can be seen.

img_1666

 

 

 

 

 

RV INFARCTION

Marked acute dilatation of the RV occurs. Acute dilatation is limited by the pericardium. Deep x and y descents, resembling the letter W is seen.

img_1667

 

 

 

 

 

MEASURED HEMODYNAMICS VARIABLES:

img_1648

DERIVED HEMODYNAMICS VARIABLES

img_1649

OXYGEN TRANSPORT VARIABLES

img_1650

Reference:

Criner, G., Barnette, R. and D’Alonzo, G. (2010). Critical Care Study Guide. Dordrecht: Springer.

Formulae: Acid-base disorders

img_1647

 

 

Reference:

Criner, G., Barnette, R. and D’Alonzo, G. (2010). Critical Care Study Guide. Dordrecht: Springer.

Pediatric GCS (Glasgow Coma Scale)

img_1646

 

 

 

References

Garvin, R. and Mangat, H. (2017). Emergency Neurological Life Support: Severe Traumatic Brain Injury. Neurocritical Care, 27(S1), pp.159-169.