Tachycardia origin prediction using point of care ultrasound (TOP-UP) - A novel technique.

Narrow complex tachycardia (NCT) is often due to supraventricular tachycardia (SVT). SVT with aberrancy, preexcitation, paced rhythm, rate-dependent bundle branch block, preexisting conduction defects or SVT due to drugs, and electrolyte abnormality can also be wide complex. Wide-complex tachycardia (WCT) is often ventricular tachycardia (VT), but fascicular VT (fVT) can present as NCT. Thus, WCT can be either VT or SVT. This has been a perplexing problem for the emergency physician for ages. Here, in this case series, we describe the novel use of point-of-care ultrasound to differentiate SVT from VT.

Defective barcode sign - A newer sonographic sign in hydropneumothorax.

Effusive pneumothorax can be hemopneumothorax, pyopneumothorax, or hydropneumothorax depending on the type of fluid compartment within the pleural cavity. Hydropneumothorax is the abnormal collection of air and serous fluid within the pleural cavity. Here, we report a case of a 34-year-old male who presented to the emergency department with cough and breathlessness. We did bedside point-of-care ultrasound-assisted clinical evaluation as the patient was vitally unstable, which showed "hydro point" and "defective barcode sign," which suggested hydropneumothorax. We present these clinical evaluation details, imaging/sonographic findings, and patient management in this case report.

The First Case Series Report of Typhonium trilobatum Tuber Poisoning in Humans.

Typhonium is a genus belonging to the Araceae family, native to southern Asia and Australia. In folk medicine, Typhonium is used for its analgesic, anti-inflammatory, antidiarrheal, and wound-healing properties. We report a toxidrome of airway compromise due to Typhonium trilobatum tuber ingestion. We present an interesting case series of four patients who consumed raw tuber of T. trilobatum with suicidal thoughts. They exhibited a constellation of symptoms such as swelling of lips and tongue, drooling of saliva, and severe throat pain. One patient had significant upper airway edema and severe respiratory distress requiring emergency endotracheal intubation. Laboratory investigations were grossly normal in all four individuals, expect for mild asymptomatic hypokalemia in one and eosinophilia in another patient. We successfully managed all our patients with repeated adrenaline nebulization, antihistamines, and steroids. Typhonium is believed to be a beneficial herb. Toxicity of Typhonium is not reported much in the literature till date. An emergency department (ED) physician should be aware of this tuber toxicity as it presents with airway compromise, which resolves over hours. The symptoms are due to the local effects of calcium oxalate crystals in the tuber. Airway management is the priority and repeated adrenaline nebulization together with supportive care is advised. HOW TO CITE THIS ARTICLE: Anandhi D, Prakash Raju KNJ, Vivekanandan MP, Kumaresan V. The First Case Series Report of Typhonium trilobatum Tuber Poisoning in Humans. Indian J Crit Care Med 2020;24(7):581-584.

Comparison of 10-mg and 5-mg warfarin initiation nomograms in a South Indian population - An open label trial.

INTRODUCTION: Early achievement of therapeutic INR leads to shorter hospital stay and lesser cost. Two warfarin initiation nomograms (10 mg nomogram and 5 mg nomogram) are widely used but it is not yet clear which one is better. They have been validated in the West but there are no studies from India. We undertook this study to compare the efficacy and safety of the 10 mg and 5 mg nomograms in the Indian population. METHODS: 169 patients were enrolled between august 2014 to July 2016. Patients with venous thromboembolism or atrial fibrillation secondary to valvular heart disease were included. Patients were allocated to 10 mg or 5 mg nomogram as per the policy of the treating unit. RESULTS: 52% of patients in the 10 mg nomogram achieved therapeutic INR by day 5 as compared to only 17% in the 5 mg nomogram (P = 0.022). The median time to achieve therapeutic INR was much shorter in the 10 mg nomogram (5 days vs 14 days, p = 0.018). Two patients in the 10 mg group (2.3%) and none in the 5 mg group had INR > 4 but they did not have any bleeding. CONCLUSION: The 10 mg nomogram achieved therapeutic INR significantly earlier with less INR measurements and appears safe. Indian patients require higher a dose of warfarin at initiation and maintenance as compared to other ethnic groups.