Carbon Monoxide Poisoning from Heavy Cigarette Smoking Presenting as Delusion in a Patient with a History of Chronic Schizophrenia (Methamphetamine Induced)

We describe a case of carbon monoxide poisoning in a 54-year-old male from heavy cigarette smoking presenting as delusions. The patient has a history of methamphetamine-induced schizophrenia now in remission for 2 years, and not on any psychotropics and is drug-free.

Effect of repeated episodes of ventricular fibrillation and defibrillation on arterial acid-base and electrolytes changes in a swine model / 中华急诊医学杂志

Objective:To investigate changes in arterial acid-base and electrolytes after repeated episodes of ventricular fibrillation (VF) and defibrillation in a swine model.Methods:Sixteen Peking white swine, weighting (32±2.5) kg, were placed with temporary pacemaker electrodes via the left femoral vein into the right ventricle after anesthesia. Then VF was electrically induced by using a programmed electrical stimulation instrument. An arterial cannula was inserted into the left femoral artery to measure mean arterial blood pressure and cardiac output using a PiCCO monitor, with blood samples collected. The pigs were randomly divided into two group: the manual defibrillation group (MD, n=8) and the automated external defibrillation group (AED, n=8). The first defibrillation was attempted with the manufacturer’s dose (150 J) for 15 s after the successful induction of VF in the MD group. If spontaneous circulation was not recovered, 2-min chest compression and subsequent defibrillation (200 J) were attempted. For the AED group, the defibrillation was delivered following voice prompts of the AED. After the return of spontaneous circulation, the pig was allowed to stabilize for 30 min, followed by the induction of the next episode of VF. The above process was repeated five times. Arterial blood gas, cardiac biomarkers, and hemodynamic variables were measured at 30 min after the return of spontaneous circulation. Results:All pigs were successfully induced VF five times and defibrillated successfully. There were no significant changes in heart rate and mean arterial blood pressure between the two groups after repeated episodes of VF and defibrillation. Compared with baseline measurements, cardiac output tended to decrease after repeated episodes of VF and defibrillation but was not statistically significant (all P>0.05). There were no significant differences in arterial pH, HCO 3-, sodium, and lactic acid in the two groups between each measurement time point and baseline values after repeated VF (all P>0.05), but potassium levels in the two groups decreased with time, and the difference was statistically significant compared with the baseline measurement (all P<0.05). There were no significant differences in myoglobin, creatine kinase isoenzyme-MB, and cardiac troponin I for the two groups compared with baseline values after repeated episodes of VF and defibrillation or various episodes of VF between the two groups (all P > 0.05). Conclusions:Repeated episodes of VF and defibrillation have no significant effect on pH balance, but significantly decrease blood potassium. Clinical approaches (MD vs. AED) do not affect defibrillation effect, with no significant differences in hemodynamic variables and myocardial injuries.

Primary assessment of patients admitted to the emergency ward using arterial blood gas

Background: Arterial blood gas study (ABG) is a point-of-care testing (POCT) diagnostic tool that can furnish metabolic and respiratory aberrations. This study was conducted systematically, to assess the metabolic and respiratory aberrations quickly and the scope for corrective treatment so that metabolic and respiratory abnormalities get corrected. Materials and Methods: A prospective cross-sectional study was done among 150 cases admitted to the Department of Emergency Medicine during a three-month period where the study on ABG was done. Data was collected in the prescribed format and a stepwise interpretation of the ABG was done. The four primary disorders taken into consideration are metabolic acidosis, metabolic alkalosis, respiratory alkalosis, and respiratory acidosis Results: Out of 150 cases 82 had respiratory alkalosis, 51 had metabolic acidosis, ten had respiratory acidosis, and seven had metabolic alkalosis as a primary disorder. Conclusion: ABG analysis is a POCT diagnostic tool for analyzing various metabolic and respiratory aberrations and can also guide us in the scope for correction of the disorder.

Effect of excessive umbilical cord torsion on fetal and neonatal outcomes / 中国新生儿科杂志

Objective:To study the effect of excessive torsion of the umbilical cord on fetal or neonatal outcomes.Methods:The observation group was selected from the puerperae who delivered in Beijing Obstetrics and Gynecology Hospital from July 2016 to June 2020 with excessive torsion of the umbilical cord. In the same period, the puerperae without excessive torsion of the umbilical cord were selected as the control group with a ratio of 1∶1. The general condition, mode of delivery, perinatal outcomes, and the effect of different umbilical coiling index (UCI) [twisted umbilical cord weeks/umbilical cord length (cm)] on fetal and neonatal outcomes were retrospectively analyzed between two groups.Results:Compared with the control group, the observation group (1 780 cases) had smaller neonatal gestational age [(37.9±3.2) weeks vs. (38.4±2.9) weeks], birth weight [(3 007±726) g vs. (3 354±616) g] and length [(48.5±4.3) cm vs. (49.6±4.1) cm], but higher incidence of fetal distress [34.9% (622/1 780) vs. 12.9% (230/1 780)], neonatal asphyxia [1.5% (26/1 780) vs. 0.7% (13/1 780)], and cord blood pH<7.20 [4.2% (75/1 780) vs. 2.8% (49/1 780)], the difference was statistically significant ( P<0.05). The UCI≥0.73 group had lower neonatal gestational age, birth weight and length, but higher incidence of cord blood pH<7.20 and neonatal asphyxia than the UCI<0.73 group, with statistically significant differences ( P<0.05). Conclusions:Excessive torsion of the umbilical cord increases the incidence of fetal hypoxia and neonatal asphyxia and has a significant effect on neonatal gestational age, birth weight and length. The higher the UCI, the greater the impact on fetus and neonate.

Lung function and stress echocardiography in pulmonary arterial hypertension: a cross-sectional study

ABSTRACT BACKGROUND: The mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mechanical, ventilatory and gasometric factors may also contribute to reduction of exercise capacity in these individuals. OBJECTIVE: To investigate whether there is an association between ventilatory pattern and stress Doppler echocardiography (SDE) variables in IPAH patients. DESIGN AND SETTING: Single-center prospective study conducted in a Brazilian university hospital. METHODS: We included 14 stable IPAH patients and 14 age and sex-matched controls. Volumetric capnography (VCap), spirometry, six-minute walk test and SDE were performed on both the patients and the control subjects. Arterial blood gases were collected only from the patients. The IPAH patients and control subjects were compared with regard to the abovementioned variables. RESULTS: The mean age of the patients was 38.4 years, and 78.6% were women. The patients showed hypocapnia, and in spirometry 42.9% presented forced vital capacity (FVC) below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower elimination of CO2 in each breath. There was a significant correlation between reduced FVC and the magnitude of increases in tricuspid regurgitation velocity (TRV). In IPAH patients, VCap showed similar tidal volumes and a higher RR, which at least partially explained the hypocapnia. CONCLUSIONS: The patients with IPAH showed hypocapnia, probably related to their higher respiratory rate with preserved tidal volumes; FVC was reduced and this reduction was positively correlated with cardiac output.

The predictive value of stair climbing test combined with arterial blood gas analysis on postoperative complications in lung cancer patients with limited pulmonary function / 中华胸心血管外科杂志

Objective:To evaluate the predictive value of stair climbing test combined with arterial blood gas analysis on postoperative complications in lung cancer patients with limited pulmonary function.Methods:A total of 1 231 hospitalized lung cancer patients with limited pulmonary function dating from August 2012 to August 2020 were retrospectively reviewed. Included in the cohort were 766 of patients who underwent stair climbing test(SCT) preoperatively and completed data collection. Patients were grouped according to their general condition, past medical history, surgical approach, pulmonary function test(PFT) and SCT results. Comparison of the postoperative cardiopulmonary complication rates were made between different groups, and independent risk factors were identified.Results:A total of 182 cardiopulmonary-related complications occurred in 144 cases, accounting for 18.8% of the entire cohort. Perioperative mortality rate was 0.9%(7/766). The rate of postoperative cardiopulmonary complications was significantly different between the groups stratified by gender, age, smoking index, PFT index(FEV1%, DLCO%), SCT results(height achieved, speed, changes in heart rate and oxygen saturation of the arteries before and after the test), ASA score, surgical approach(VATS/Open), resection range(Lobectomy/Sublobectomy), anesthetic duration, blood loss volume, etc. Logistic regression analysis showed that only height achieved( P<0.001), changes in heart rate( P<0.001), changes in oxygen saturation of the arteries( P=0.001), resection range( P=0.006) and anesthetic duration( P=0.025) were independent risk factors for cardiopulmonary-related complications in lung cancer patients with limited pulmonary function. Conclusion:The stair climbing test combined with arterial blood gas analysis could be used as a preoperative screening method for lung cancer patients with limited lung function and may have a predictive value for postoperative cardiopulmonary-related complications.

Changes of arterial blood gas indexes of free-field primary blast lung injury of pigs and its application value / 中华危重病急救医学

Objective:To observe the changes of arterial blood gas indexes in pigs with the free-field primary blast lung injury (PBLI) model, and to explore the value of arterial blood gas indexes in predicting moderate to severe PBLI.Methods:Nine adult healthy Landrace pigs were selected to construct the pig free-field PBLI model. Arterial blood samples were taken 15 minutes before the explosion (before injury) and 10, 30, 60, 120, and 180 minutes after the explosion (after injury). Arterial blood gas indexes and pulse oxygen saturation (SpO 2) were measured, compare the changes of blood gas analysis indexes and SpO 2 levels at different time points, and observe the changes of gross injury scores and pathological injury scores of lung tissue. Analyze the correlation between the blood gas indicators. Results:As time prolonged, at each time point, pH, arterial partial pressure of oxygen (PaO 2), and SpO 2 were lower than those before the injury, and blood lactic acid (Lac) and arterial partial pressure of carbon dioxide (PaCO 2) were higher than those before the injury. Compared with that before the injury, the pH value in the blood decreased significantly 10 minutes after the injury (7.39±0.06 vs. 7.46±0.02, P < 0.05), and the Lac increased significantly (mmol/L: 3.61±2.89 vs. 1.10±0.28, P < 0.05), and lasts until 180 minutes after injury (pH value: 7.37±0.07 vs. 7.46±0.02, Lac (mmol/L): 2.40±0.79 vs. 1.10±0.28, both P < 0.05); while PaO 2 and SpO 2 decreased significantly at 180 minutes after injury [PaO 2 (mmHg, 1 mmHg = 0.133 kPa): 59.40±10.94 vs. 74.81±9.39, P < 0.05; SpO 2: 0.75±0.11 vs. 0.89±0.08, P < 0.05], PaCO 2 increased significantly (mmHg: 56.17±5.38 vs. 48.42±4.93, P < 0.05). Correlation analysis showed that the gross injury score of lung blast injury animals was positively correlated with the pathological injury score ( r = 0.866, P = 0.005); PaO 2 and SpO 2 were positively correlated ( r = 0.703, P = 0.000); pH value and Lac were negative Correlation ( r = -0.400, P = 0.006); pH value is negatively correlated with PaCO 2 ( r = -0.844, P = 0.000). Conclusion:This study successfully established a large mammalian free-field PBLI model, arterial blood gas analysis is helpful for the early diagnosis of PBLI, whether SpO 2 can be used to evaluate the severity of lung injury remains to be further verified.

Feasibility of pulse oxygen saturation for the condition evaluation of acute respiratory distress syndrome patients in the Lijiang region / 中华危重病急救医学

Objective:To explore the feasibility of using pulse oxygen saturation (SpO 2) to evaluate the condition of patients with acute respiratory distress syndrome (ARDS) in the Lijiang region. Methods:Patients with ARDS who visited the department of emergency of People's Hospital of Lijiang from August to December 2020 were selected as study subjects. Patients were divided by severity into mild ARDS group [200 mmHg (1mmHg = 0.133 kPa)≤oxygenation index (PaO 2/FiO 2, P/F)≤300 mmHg] and moderate to severe ARDS group (P/F≤200 mmHg). The general condition, clinical diagnosis, arterial blood gas analysis results of the patients were recorded, and the differences of the above indexes between the two groups of ARDS were compared. Spearman correlation analysis was used to analyze the correlation between SpO 2 and arterial oxygen saturation (SaO 2). SpO 2 was carried into the Ellis equation and the Rice equation to calculate the derived P/F and analyze the correlation between the derived P/F and the P/F measured in arterial blood gas analysis; receiver operator characteristic curve (ROC curves) were plotted, the sensitivity and specificity of SpO 2/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) instead of P/F to assess oxygenation in patients with ARDS was calculated. To evaluate the feasibility of SpO 2 for the condition evaluation of patients with ARDS in the Lijiang region. Results:Compared with the mild ARDS group, the arterial partial pressure of oxygen (PaO 2), SaO 2 and hemoglobin (Hb) were significantly decreased in the moderate to severe ARDS group [PaO 2 (mmHg): 50.5 (39.3, 56.5) vs. 60.0 (55.0, 67.5), SaO 2: 0.86 (0.73, 0.91) vs. 0. 93 (0.90, 0.96), Hb (g/L): 142±27 vs. 156±24, respectively, all P < 0.05]. Correlation analysis revealed a significant positive correlation between SpO 2 and SaO 2 in ARDS patients residing at high altitude ( R = 0.650, P = 0.000). The P/F derived by the Rice formula was significantly and positively correlated with the P/F derived from arterial blood gas analysis ( R = 0.802, P = 0.000). The deduced P/F in mild and moderate to severe ARDS groups were all significantly correlated with the measured P/F ( R values were 0.562, 0.647, both P = 0.000). The P/F derived using the Ellis formula showed a significant positive correlation with the P/F derived from arterial blood gas analysis ( R = 0.822, P = 0.000). The deduced P/F of mild ARDS group and moderate to severe ARDS group were all positively correlated with the measured P/F ( R values were 0.556, 0.589, P values were 0.000, 0.010). There was a significant positive correlation between S/F and P/F in ARDS patients ( R = 0.828, P = 0.000), and the regression equation was S/F = 1.33 P/F+52.41. ROC curve analysis showed that S/F had some predictive value for patients with mild and moderate to severe ARDS, and area under ROC curve (AUC) and 95% confidence interval (95% CI) were 0.903 (0.829-0.977), 0.936 (0.870-1.000), both P = 0.000. When the cut-off value was 452 mmHg, S/F had a sensitivity of 100% and a specificity of 80.9% for predicting mild ARDS. When the cut-off value was 319 mmHg, S/F predicted moderate to severe ARDS with 95.1% sensitivity and 86.2% specificity. Conclusions:At high altitude, SpO 2 and SaO 2 have been correlated in patients with ARDS, and P/F derived using SpO 2 and measured P/F were significantly correlated in patients with ARDS, especially in those with moderate to severe ARDS. SpO 2 may be useful in the assessment of severity of illness in patients with ARDS at high altitude.

Gasometría arterial en residentes a gran altura, El Alto ­ Bolivia 2020 / Arterial blood gas analysis in residents at high altitude, El Alto, Bolivia 2020

INTRODUCCIÓN: la presión barométrica determina la presión parcial de los gases tanto en el medio ambiente como a nivel alveolar pulmonar, por lo que, para una determinada presión barométrica, la presión de oxígeno y dióxido de carbono es distinta. OBJETIVO: el objetivo del presente estudio es caracterizar los valores de gasometría arterial en residentes adultos sanos a muy alta altitud en la ciudad de El Alto. METODOLOGÍA: Estudio serie de casos, realizado durante la gestión 2019 en 22 (73%) mujeres y 8 varones (27%), con una media de edad de 36.07 años. El estudio contó con la aprobación del Comité de Ética Hospitalario. RESULTADOS: a 4150 metros sobre el nivel del mar, el pH tiende hacia la alcalosis (7.43) así como la PaO2 es menor (58.69mmHg), el valor de PaCO2 (26.14mmHg) es menor correspondiente a una ciudad con mayor altitud, el valor de bicarbonato sérico (20.14mmol/L) se encuentra disminuido en compensación a la disminución de la PaCO2 y el valor de la SatO2% (91.7%) es menor al reportado a nivel del mar. Hay que destacar que el índice PaO2/FiO2 no concuerda con el cálculo realizado según la fórmula propuesta dentro de la definición de los Criterios de Berlín. Se evidencia también que, en la muestra, si bien la correlación entre la PaO2 y la SatO2% resulta como alta, no resulta perfectamente lineal. CONCLUSIÓN: resulta imperativo precisar las características propias a la fisiología correspondientes a cada altitud, buscando aplicar parámetros propios como los de la gasometría arterial para el tratamiento de las enfermedades prevalentes en cada región, así como desarrollar investigaciones específicas a gran altura, ensayar posibilidades y documentarlas.

INTRODUCTION: barometric pressure determines the partial pressure of gases both in the environment and at the pulmonary alveolar level, so for a given barometric pressure, the pressure of oxygen and carbon dioxide is different. The objective of this paper is to characterize arterial blood gas values in healthy adult residents at very high altitude in the city of El Alto. METHODOLOGY: case series study, carried out during 2019; 22 volunteers (73%) women and 8 men (27%), mean age 36.07 years are included. The study was approved by the Hospital Bioethics Committee. RESULTS: at 4150 meter above sea level, pH tends towards alkalosis (7.43) as well as PaO2 is lower (58.69mmHg), the value of PaCO2 (26.14mmHg) is lower corresponding to a city with higher altitude, the value of serum bicarbonate (20.14mmol/L) is lower in compensation at the decrease in PaCO2 and the value of SatO2% (91.7%) is lower than that reported at sea level. The PaO2/FiO2 index does not match the calculation made according to the proposed formula within the definition of the Berlin Criteria. It is also evident that, although the correlation between PaO2 and SatO2% is high, it is not perfectly linear. CONCLUSION: it is imperative to precise the characteristics corresponding to the physiology corresponding to each altitude, looking forward to apply these parameters, such as those of arterial blood gas, in the treatment of prevalent diseases for each region, and so as develop specific studies at high altitude, also testing and reporting them.

Función ventricular derecha en residentes nativos a gran altura / Right ventricular function in native residents at high altitude

Los adaptados genéticamente a la altura son los tibetanos, sherpas y etíopes; los aymaras y quechuas están aclimatados (Bolivia, Perú y norte de Chile). En Bolivia el mal crónico de montaña afecta 10% de la población masculina. El objetivo fue determinar la función ventricular derecha en residentes sanos y con mal crónico de montaña mediante ecocardiografía transtoráxica. Se utilizaron participantes sanos y con mal crónico de montaña admitidos por el IBBA, desde el año 2012 al 2013. Las variables tomadas son: demográficas, espirometria forzada, gasometría arterial en reposo e hiperoxia, ECG y ECCTT. Los controles (n 40), la edad promedio (44,13±9,69 años), predominio masculino y sobrepeso (IMC 26,27±6,68kg /m2), procedentes de La Paz 3.600 msnm (54%), Potosí 4.000 msnm (22%), El Alto 4.100 msnm (15%) y Oruro 3.800 msnm (9%), el promedio de Hematocrito 51,34±2,91%, hemoglobina 17,15±0,89gr/ dl, Espirometria forzada y Gasometría arterial en reposo e hiperoxia normales, la ECCTT muestra hipertensión pulmonar leve (35,85±3,64mmHg), aumento de grosor del VD (0,51±0,08), TAPSE (2,94±3,85mmHg) y el índice de Tei (0,44±0,22) normales. Los casos (n 40), la edad promedio (48,43±8,08 años), predominio masculino y sobrepeso (IMC 29,54±3,41kg / m2), procedente de La Paz 3.600 msnm (56%), Potosí 4.000 msnm (24%), El Alto 4.100 msnm (13%) y Oruro 3.800 msnm (7%), Hematocrito 63,08±6,2%, Hemoglobina 21,01±2,01gr/dl con eritrotrocitosis, espirometría forzada normal, gasometría arterial en reposo con hipoxemia moderada (PaO2 51,73±4,68mmHg), hipocapnia (PaCO2 27,62±2,04mmHg) y gradiente Alveolo-arterial aumentado (7,61±3,15). Gasometría arterial en hiperoxia descarta shunt (PaO2 308,9±52,58mmHg), el ECG muestra 2 de 11 criterios de crecimiento VD, la ECCTT con hipertensión pulmonar moderada (PSAP 45,22±5,69mmHg), aumento de grosor del VD (0,73±0,22), TAPSE (2,08±0,18cm), normal e índice de Tei (0,51±0,10) ligeramente aumentado. Se concluyó que la función ventricular derecha se encuentra conservada, a pesar de tener hipertensión pulmonar leve (controles) y moderada (casos), con aumento del grosor del ventrículo derecho.

Those genetically adapted to the height are the Tibetans, Sherpas, and Ethiopians; the Aymara and Quechuas are acclimatized (Bolivia, Peru, and northern Chile). In Bolivia, chronic mountain sickness affects 10% of the male population. The objective was to determine the right ventricular function in healthy residents with chronic mountain sickness using transthoracic echocardiography. Use the healthy and chronically ill mountain participants admitted by the IBBA, from 2012 to 2013. The variables taken are demographic, forced spirometry, arterial blood gas at rest and hyperoxia, ECG, and ECCTT. Controls (n 40), average age (44.13 ± 9.69 years), male predominance and overweight (BMI 26.27 ± 6.68kg / m2), frequency from La Paz 3,600 masl (54%), Potosí 4,000 masl (22%), El Alto 4,100 masl (15%) and Oruro 3,800 masl (9%), the average Hematocrit 51.34 ± 2.91%, hemoglobin 17.15 ± 0.89gr / dl, Forced spirometry y Resting arterial blood gas and normal hyperoxia, ECCTT shows mild pulmonary hypertension (35.85 ± 3.64 mmHg), increased RV thickness (0.51 ± 0.08), TAPSE (2.94 ± 3.85 mmHg ) and the Tei index (0.44 ± 0.22) normal. The cases (n 40), the average age (48.43 ± 8.08 years), male predominance and overweight (BMI 29.54 ± 3.41kg / m2), derived from La Paz 3,600 masl (56%), Potosí 4,000 masl (24%), El Alto 4,100 masl (13%) and Oruro 3,800 masl (7%), Hematocrit 63.08 ± 6.2%, Hemoglobin 21.01 ± 2.01gr / dl with erythrocytosis, normal forced spirometry , resting arterial blood gas with moderate hypoxemia (PaO2 51.73 ± 4.68mmHg), hypocapnia (PaCO2 27.62 ± 2.04mmHg) and increased Alveolo-arterial gradient (7.61 ± 3.15). Arterial blood gas in hyperoxia rules out shunt (PaO2 308.9 ± 52.58mmHg), ECG shows 2 of 11 RV growth criteria, ECCTT with moderate pulmonary hypertension (PSAP 45.22 ± 5.69mmHg), increased RV thickness (0.73 ± 0.22), TAPSE (2.08 ± 0.18cm), normal and Tei index (0.51 ± 0.10) slightly increased. It was concluded that the right ventricular function is preserved, a weight of having mild pulmonary hypertension (controls) and moderate (cases), with increased thickness of the right ventricle.

Effect of flutter device on airway mucus clearance, physiological parameters, and arterial blood gas analysis in patients with coronary artery bypass grafting during Phase 1 cardiac rehabilitation – A randomized control trial

Background: cardiac surgery is associated with the occurrence of pulmonary complications, which may be defined as any pulmonary condition that occurring during the post-operative period which may produce dysfunction that is clinically significant and may adversely affects the clinical course. Objective: The objective of the study was to evaluate the effect of flutter device on airway mucus clearance, physiological parameters, and arterial blood gas analysis in patients with coronary artery bypass graft (CABG) in during Phase 1 cardiac rehabilitation. Materials and Methods: A total of 40 patients postoperative CABG surgery were randomly assigned to receive either experimental group along with flutter device and control group received conventional physiotherapy, outcome measure include arterial blood gas analysis, physiological parameters, and sputum amount. Result: This control trial of 5 days gave result that flutter device and conventional exercise have an effect on PCO2 and sputum index both experimental and control group while there was effect on PO2 in the investigational group and pulse rate in control group. Flutter device when analyzed from baseline to 5th post-operative day sputum score and PCO2 analysis. Other measures showed no significant differences. Conclusion: Flutter device should be incorporated as a routine practices along with other chest physiotherapy techniques during Phase 1 of cardiac rehabilitation, which can have positive results in the quality of life and improving overall functional status in subjects following CABG, thereby minimizing the hospital stay.

Arterial Blood Gas as a Prognostic Tool in Organophosphorus Poisoning Patients – A Prospective Observational Study

Introduction: Organophosphorus (OP) compounds constitute a heterogeneous category of chemicals specifically designed forthe control of pests, weeds, or plant diseases. Intentional ingestion of OP pesticides has been common and now the preferredform of poisoning due to its easy access in central and Southern parts of India. This predominantly occurs in rural communities.As a result of widespread use, OP poisoning is a major cause of morbidity and mortality worldwide.Aim: This study aims to access the arterial blood gas (ABG) analysis as a prognostic prediction tool in OP poisoning patients.Materials and Methods: This is a prospective study from February 2017 to March 2018, out of 114 patients who presented tothe emergency department, 14 patients were excluded from the study and the remaining 100 patients were included in the study.Results: Males were the most predominant group in OP ingestions in this study. In 29% of patients, the ABG interpretationwas normal and metabolic acidosis in the initial ABG had a mean intensive care unit (ICU) stay value of 12.92; respiratoryacidosis had a mean ICU stay value of 12.36; mixed acidosis had a mean ICU stay value of 9.33; respiratory alkalosis had amean ICU stay value of 5.37; metabolic alkalosis had a mean ICU stay value of 4.66. P-value was calculated and found to bestatistically significant. Moreover, it was also found that the patients who presented with extreme acidosis (≤7.1) had increasedmean ICU stay value (17.5).Conclusion: This study concludes that ABG analysis at the initial presentation could help in assessing the prognosis of OPpoisoning patients much earlier, which could help in intensifying the management.

A Novel Contemporary Perspective Teaching Method for Interpretation of Various Acid base Disorders Citing with Examples

Introduction: The understanding of the basic concepts inArterial blood gas analysis and interpretation is an essentialskill required for all the medical students. Many creativemethods of teaching are available for the same yet sometimesit remains a challenging task. Usually, the three mainparameters like measured pH, pCO2 and HCO3 values areutilized for interpretation of various acid base disturbances.The aim of the current research study was to apply a novelrecently published arterial blood gas interpretation method forteaching purposes.Material and methods: In this newly developed method, thenet changes in pH is related to both the changes in respiratoryand non-respiratory (metabolic) component affecting the pH.A total of 90 arterial blood gas sample data’s were utilizedand classified into various groups. The changes in pH due torespiratory and non-respiratory component is calculated andcorrelated with the net changes in actual pH.Results: The magnitude and the changes in direction eitherpositive denoting the alkaline effect or negative denoting theacidic effect is very well observed in all the 90 cases and theresults are tabulated. The relationship between changes in pHdue to respiratory component with pCO2 and the changes inpH due to non-respiratory component with bicarbonate andstandard bicarbonate values were graphically analysed.Conclusion: The study concludes that it is much easier toobserve the changes in magnitude and direction in variousacid base disturbances which will help in better understandingof cases presenting with different pH, pCO2 and HCO3 values.

Acid based disorders in intensive care unit: a hospital-based study

Background: Acid base disorders are common in the ICU patients and pose a great burden in the management of the underlying condition.Methods: Identifying the type of acid-base disorders in ICU patients using arterial blood gas analysis This was a retrospective case-controlled comparative study. 46 patients in intensive care unit of a reputed institution and comparing the type of acid-base disorder amongst infectious (10) and non-infectious (36) diseases.Results: Of the study population, 70% had mixed acid base disorders and 30% had simple type of acid base disorders. It was found that sepsis is associated with mixed type of acid-base disorders with most common being metabolic acidosis with respiratory alkalosis. Non-infectious diseases were mostly associated with metabolic alkalosis with respiratory acidosis. Analysis of individual acid base disorders revealed metabolic acidosis as the most common disturbance.Conclusions: These results projected the probability of acid bases disorders in various conditions and help in the efficient management. Mixed acid base disorders are the most common disturbances in the intensive care setup which is metabolic acidosis with respiratory alkalosis in infectious diseases and metabolic acidosis is the most common simple type of acid base disorder.

Comparative study on arterial and venous blood gas values in the initial evaluation of patients with diabetic ketoacidosis who are visiting the Emergency Department of Rajamutaiah Medical College and Hospital

Background: DKA is the most common serious and life-threatening acute complication of diabetes. The mortality rate is currently estimated at 2% to 10% for patients hospitalized with DKA. Mortality is predominantly due to underlying morbidities, such as sepsis or acute myocardial infarction, but deaths also occur as a result of hypokalemia induced arrhythmias and cerebral edema. Aim of the study: To compare arterial and venous blood gas values in the initial evaluation of patients with Diabetic Ketoacidosis (DKA). Materials and methods: The study was conducted in the division of emergency medicine at Rajah Muthiah Medical College and Hospital, Chidambaram in the year 2017 August to February 2018. Totally 61 patients were included in the study. Both sex in the age group of 14 to 70 years whose Capillary Blood Glucose equal to or greater than 250 mg/dl, Urine ketonuria (+) were included in the study. Results: 37% of patients had >12 urine ketone levels of the patients of patients were 2+ (15 mg/dl) which was 41.0%. 39.3% of patients were 1+ (5 mg/dl) and 19.7% of patients were 3+ (40 mg/dl). All G. Balaji, R. Devi. Comparative study on arterial and venous blood gas values in the initial evaluation of patients with diabetic ketoacidosis who are visiting the Emergency Department of Rajamutaiah Medical College and Hospital. IAIM, 2019; 6(5): 160-165. Page 161 patients were ketone positive. ABG pH valune in which 60.7% of patients were between the level of 7.01 – 7.4, 39.3% of them were from 6.7 – 7.0. ABG PCO2 value in which 44.3% of patients had values from 16-25, 21.3% of patients had values between 5-15 as well as 26-35 and 13.1% of patients had values from 36-45. In which about 65.7% of patients had HCO3 levels between 12.01-17, 15.2% of patients had HCO3 levels between 7.01-12 14.1 % of patients had levels between 17.01 – 18 and 5% of them between 2-7. VBG pH in DKA, in which, 57.4% were in between 7.01 – 7.41. 41% of patients had a pH from 6.7 – 7.0 and 1.6% were between 6.03 - 6.6. VBG HCO3 in which, 62.3% of patients had HCO3 levels from 12.01-17, 24.6% had from 7.01 – 12, 11.5% were in between 2-7 and 1.6% were showing levels in between 17.01-18. Conclusion: Venous blood gas measurements accurately and fairly demonstrate the degree of acidosis in the initial evaluation of patients with Diabetic Ketoacidosis in the Emergency Department in comparison with Arterial blood gas values.

Evaluation of pKa as a cause of discordance between calculated and measured bicarbonate in arterial and venous blood

Background: The measurement of bicarbonate level in blood is extremely common and often provides vitally important data used in the care of critically ill patients. The bicarbonate level in blood can be directly measured or derived from calculations using the Henderson-Hasselbalch equation; mostly adopted by the blood gas analyzers. Arterial blood gas (ABG) analysis is commonly performed for clinical evaluation, but the procedure has certain limitations in the form of reduced patient acceptability (because the procedure can be painful) and the potential to cause complications such as arterial injury, thrombosis with distal ischemia, hemorrhage, aneurysm formation, median nerve damage and, rarely, reflex sympathetic dystrophy. The aim of the study: If there is discordance between arterial and venous blood gas parameters including pH, pCO2, bicarbonate, Sodium, Potassium, chloride and discordance between measured and calculated bicarbonate in both arterial and venous blood samples. Materials and methods: Comparison study involving 250 patients for whom clinical Judgment was made that arterial blood sample is needed for assessment of acid-base status. Both arterial and venous blood samples were collected using heparinized autosampler syringes PICO 50 as close in time as possible and were analyzed in Arterial Blood Gas analyzer ABL 80 flex. Results: There was a statistically significant difference between arterial and venous pO2 (126+48.5 vs 62+30.5, p= 0.001) and SO2 (95% vs 68%, p=0.03). Conclusion: According to the study results traditionally measured venous bicarbonate can be a Shanmugapriya Chandrasekaran, Poonguzhali Gopinath. Evaluation of pKa as a cause of discordance between calculated and measured bicarbonate in arterial and venous blood. IAIM, 2019; 6(3): 127-131. Page 128 convenient substitute for calculated arterial bicarbonate in critically ill ICU patients. However, more accurate assessments will require ABG for additional parameters. Besides, the present study design did not involve the collection of data on patient demographics, the severity of illness, and a requirement for inotropic support or prognosis.

Effects of interposed abdominal pulling-pressing cardiopulmonary resuscitation on hemodynamics and oxygen metabolism in patients with cardiac arrest / 中华危重病急救医学

Objective@#To analyze the effect of interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) and standard cardiopulmonary resuscitation (S-CPR) on hemodynamics and oxygen metabolism in patients with cardiac arrest, and to evaluate the treatment effect of IAPP-CPR.@*Methods@#The patients with cardiac arrest, cardiac arrest time less than 30 minutes, and with S-CPR indications admitted to intensive care unit (ICU) of the First People's Hospital of Lianyungang from January 2017 to January 2019 were enrolled. The patients were divided into IAPP-CPR group and S-CPR group according to whether the patients had IAPP-CPR indication or not. The patients in the S-CPR group were operated according to the 2015 American Heart Association (AHA) CPR guidelines; and the patients in the IAPP-CPR group received the IAPP-CPR on the basis of the S-CRP. During the relaxation period, the patients were subjected to abdominal lifting and compressing with amplitude of 4-5 cm, frequency of 100-120 times/min, and the time ratio of lifting to compressing was 1∶1. Hemodynamic changes during resuscitation were recorded in the two groups. Hemodynamics, oxygen metabolism, arterial blood gas analysis and prognostic indicators were recorded at 30 minutes after successful resuscitation.@*Results@#During the study period, 77 patients were selected, 24 patients were excluded from giving up treatment and quitting, 53 patients were enrolled in the analysis finally, with 28 patients in the S-CPR group and 25 in the IAPP-CPR group. ① The heart rate (HR), mean arterial pressure (MAP) and coronary perfusion pressure (CPP) showed an upward trend during resuscitation, and a more significant increase was shown in the IAPP-CPR group. ② Hemodynamics after successful resuscitation: there were 16 patients with successful resuscitation in the IAPP-CPR group and 13 in the S-CPR group. The MAP, CPP, global ejection fraction (GEF) and stroke volume (SV) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR group were significantly higher than those in the S-CPR group [MAP mmHg (1 mmHg = 0.133 kPa): 52.88±3.11 vs. 39.39±4.62, CPP (mmHg): 36.56±6.89 vs. 29.61±6.92, GEF: 0.217±0.036 vs. 0.178±0.027, SV (mL): 38.43±5.25 vs. 32.92±8.28, all P < 0.05], but there was no significant difference in central venous pressure (CVP) or HR between the two groups. ③ Oxygen metabolism after successful resuscitation: the cardiac output (CO), arterial oxygen content (CaO2), oxygen transport (DO2) and oxygen consumption (VO2) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR group were significantly higher than those in the S-CPR group [CO (L/min): 2.23±0.38 vs. 1.99±0.29, CaO2 (mL/L): 158.0±11.8 vs. 141.4±8.2, DO2 (mL/L): 245.8±29.9 vs. 209.1±28.0, VO2 (mL/L): 138.2±24.9 vs. 112.8±18.1, all P < 0.05]. ④ Arterial blood gas after successful resuscitation: the values of the pH, arterial oxygen partial pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), oxygenation index (PaO2/FiO2) and central venous oxygen saturation (ScvO2) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR were significantly higher than those in the S-CPR group [pH value: 7.13±0.22 vs. 7.00±0.23, PaO2 (mmHg): 73.68±13.80 vs. 65.32±15.32, PaCO2 (mmHg): 36.24±11.77 vs. 29.12±7.82, PaO2/FiO2 (mmHg): 73.68±13.80 vs. 65.32±15.32, ScvO2: 0.628±0.074 vs. 0.589±0.066, all P < 0.05], and the blood lactic acid (Lac) level was significantly lower than that in the S-CPR group (mmoL/L: 9.80±4.28 vs. 12.18±3.63, P < 0.05). ⑤ The patients in the IAPP-CPR group had a shorter time for cardiac arrest to restoration of spontaneous circulation (ROSC) than that in the S-CPR group (minutes: 10.63±2.94 vs. 14.54±3.84, P < 0.01), and the rate of ROSC, CPR successful rate and 28-day survival rate were significantly higher than those in the S-CPR group [64.0% (16/25) vs. 46.4% (13/28), 60.0% (15/25) vs. 28.6% (8/28), 52.0% (13/25) vs. 21.4% (6/28), all P < 0.05]. There was no significant difference in incidence of rib fracture between the IAPP-CPR and S-CPR groups [92.0% (23/25) vs. 89.3% (25/28), P > 0.05], and no abdominal bleeding was found in both group.@*Conclusion@#IAPP-CPR can produce better hemodynamic effect during and after resuscitation than S-CPR, and oxygen metabolism and arterial blood gas analysis parameters at 30 minutes after resuscitation were better than S-CPR, with higher ROSC rate, CPR successful rate and 28-day survival rate, and no significant difference in complications between the two resuscitation methods.

Establishment of a non-venous bypass orthotopic liver transplantation model in Bama miniature pigs / 器官移植

Objective To establish a non-venous bypass orthotopic liver transplantation model in Bama miniature pigs with high repeatability and stability. Methods Twelve Bama miniature pigs were randomly divided into the donor group (n=6) and recipient group (n=6). Pigs underwent non-venous bypass orthotopic liver transplantation. The time of anhepatic phase during operation was shortened, blood pressure during anhepatic phase was stably maintained, and management of anesthesia and body fluid during operation were strengthened. The operation time, anhepatic phase and survival status of the recipients were observed and recorded. The intraoperative heart rate, mean arterial pressure (MAP) and changes in arterial blood gas analysis were monitored. The perioperative liver function was evaluated. Results Among 6 Bama miniature pigs, 1 died from transplantation failure intraoperatively. The operation time of the remaining 5 pigs was (247±27) min and the time of anhepatic phase was (46±4) min. Three animals survived for more than 2 weeks. Compared with the preanhepatic phase, the heart rate of the animals was significantly faster, MAP was considerably reduced to (46±6) mmHg, blood pH value, base excess (BE) and HCO3- level were all significantly decreased and serum level of K+ was significantly elevated during the anhepatic phase (all P < 0.05). In the neohepatic phase, MAP of Bama miniature pigs was significantly increased, heart rate was dramatically slower.Blood pH value, BE, HCO3- level were significantly increased and serum level of K+ was significantly declined (all P < 0.05). During abdominal closure, MAP, blood gas indexes and serum level of K+ were almost recovered to those in the preanhepatic phase. Compared with preoperative levels, the levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactate dehydrogenase(LDH)and alkaline phosphatase(ALP)were significantly increased after operation (all P < 0.05), the change in AST was the most obvious, and it gradually decreased at postoperative 2 d. The level of γ-gutamyl transferase(GGT) did not significantly elevated. The level of total bilirubin (TB) was evidently elevated at postoperative 5 d. Compared with the preoperative levels, the levels of total protein (TP) and albumin (ALB) were significantly decreased after operation (both P < 0.05), and began to gradually increase at postoperative 1 d. Conclusions The non-venous bypass orthotopic liver transplantation model of Bama miniature pig is convenient, with highly reproducible and survival rate, which can be utilized as a standardized liver transplantation model.

Prediction of early postoperative desaturation in extreme older patients after spinal anesthesia for femur fracture surgery: a retrospective analysis / 대한마취과학회지

BACKGROUND: Postoperative desaturation in older individuals is rarely addressed in the literature. The objective of this retrospective study was to investigate whether a preoperative spirometric test and arterial blood gas analysis (ABGA) might predict postoperative desaturation after spinal anesthesia in extreme older patients.METHODS: The medical records of 399 patients (age ≥ 80 yrs) who were administered spinal anesthesia for a femur neck fracture surgery were retrospectively reviewed. Early postoperative desaturation was defined as a reduction of oxygen saturation (SpO₂) below 90% within 3 days of surgery, despite O₂ supply via a nasal prong. Binary logistic regression analysis was used to identify predictors of early postoperative desaturation.RESULTS: The incidence of postoperative desaturation was 12.5%. Major morbidity rate was significantly higher in the desaturation group (n = 50) than that in the non-desaturation group (n = 349) (14% vs. 3.2%, P = 0.001) with more frequent postoperative stays in the intensive care unit (22% vs. 12%, P = 0.004). In a binary logistic regression analysis, preoperative ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO₂/FiO₂ ratio) (OR, 0.972; 95% CI 0.952–0.993; P = 0.010) and history of cardiovascular disease (OR, 2.127; 95% CI 1.004–4.507; P = 0.049) predicted postoperative desaturation.CONCLUSIONS: Preoperative PaO₂/FiO₂ ratio, but not preoperative spirometry, was predictive of the postoperative desaturation in older patients after being administered spinal anesthesia for femur fracture surgery. Based on our results, preoperative ABGA may be helpful in predicting early postoperative desaturation in these patients.