Emergency Resuscitation Extracorporeal Membrane Oxygenation (ER ECMO) in 60 Saves Life.

Aluminum phosphide (ALP) is one of the most commonly used pesticides worldwide with high mortality rates primarily due to the production of phosphene gas which causes severe mitochondrial damage leading to refractory myocardial depression, refractory hypotension, severe metabolic acidosis, and acute respiratory distress syndrome.[1] There is no antidote for ALP poisoning and treatment remains mainly supportive. The available literature shows a favorable outcome with extracorporeal membrane oxygenation (ECMO) in severely intoxicated patients presenting early with cardiovascular collapse. In this study, we describe an adult male who presented to us with ALP poisoning following deliberate self-harm, was put on ECMO in the emergency room and had a good prognosis.

Assessment of Olfactory Dysfunction Using ODOFIN Sniffin' Sticks: A Prospective Comparative Study.

Olfactory loss can impair the ability to detect harmful warning smells like smoke or gas leaks, significantly affect the quality of life and increase the morbidity. This study was done using Sniffin stick test kit with an objective to compare the effect of Steroid Nasal Spray with Normal Saline Nasal Spray in improving the olfactory dysfunction seen in cases of chronic nasal obstruction. This Prospective comparative study was conducted on patients presenting to the ENT OPD with olfactory dysfunction due to various nasal pathologies. The olfaction was assessed qualitatively using ODOFIN Sniffin' sticks before and 2 weeks after the use of either a steroid [Group A] or Saline Nasal Spray [Group B] and the results documented and analysed. Total 162 eligible patients were selected. Majority of the study participants were males and the major symptom was Hyposmia. In group A, the initial Sniffin stick test showed Anosmia in 26 and Hyposmia in 55 patients and after 2 weeks, only 2 and 26 patients had Anosmia and Hyposmia respectively. Wherein group B, there was no significant improvement in the olfaction even after 2 weeks of treatment. The improvement in the olfaction was significant between the groups. (p = < 0.001). Our study using ODOFIN Sniffin' sticks for assessing olfactory dysfunction in various nasal pathologies showed that Steroid Nasal Spray is an effective and safe treatment option in managing olfactory dysfunction.

A survey of a population of anaesthesiologists from South India regarding practices for rapid sequence intubation in patients with head injury.

BACKGROUND AND AIMS: Evidence and utility of the individual steps of the rapid sequence induction and tracheal intubation protocols have been debated, especially in the setting of traumatic brain injury. The purpose of this survey was to determine preferences in the current approach to rapid sequence intubation (RSI) in head injury patients among a population of anaesthesiologists from South India. METHODS: A questionnaire was E-mailed to all the members of the Indian Society of Anaesthesiologists' South Zone Chapter to ascertain their preferences, experience and comfort level with regard to their use of rapid sequence intubation techniques in adult patients with head injury. Participants were requested to indicate their practices for RSI technique for a head-injured patient upon arrival at the Emergency Medical Services department of their hospital. RESULTS: The total response rate was 56.9% (530/932). Of the total respondents, 35% of the clinicians used cricoid pressure routinely, most respondents (68%) stated that they pre-oxygenate the patients for about 3 min prior to RSI, thiopentone (61%) and propofol (34%) were commonly used prior to intubation. Rocuronium was the muscle relaxant of choice for RSI among the majority (44%), compared to succinylcholine (39%). Statistical analyses were performed after the initial entry onto a spreadsheet. Data were summarised descriptively using frequency distribution. CONCLUSION: In a rapid sequence intubation situation, the practice differed significantly among anaesthesiologists. Owing to disagreements and paucity of evidence-based data regarding the standards of RSI, it is apparent that RSI practice still has considerable variability in clinical practice.

Large left ventricular pseudoaneurysm and spontaneous recanalized coronaries.

35 year old with ruptured lateral wall of Left ventricle (LV) resulting in large pseudo aneurysm contained within the pericardium [Figure 1]. There was free flow of blood between the LV and pseudoaneurysm .He underwent endoventricular patch plasty of the defect after opening the wall of aneurysm [Figure 2].

Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy.

BACKGROUND: Paravertebral and inter pleural blocks (IPB) reduce post-operative pain and decrease the effect of post-operative pain on lung functions after breast surgery. This study was designed to determine their effect on lung functions and post-operative pain in patients undergoing modified radical mastectomy. MATERIALS AND METHODS: A total of 120 American Society of Anesthesiologists physical status 1 and 2 patients scheduled to undergo breast surgery were randomly allocated to receive IPB (Group IPB, n = 60) or paravertebral block (PVB) (Group PVB, n = 60) with 20 ml of 0.5% bupivacaine pre-operatively. A standard protocol was used to provide general anesthesia. Lung function tests, visual analog scale (VAS) for pain at rest and movement, analgesic consumption were recorded everyday post-operatively until discharge. RESULTS: Lung functions decreased on 1(st) post-operative day and returned to baseline value by 4(th) post-operative day in both groups. VAS was similar in both groups. There was no significant difference in the consumption of opioids and diclofenac in both groups. Complete block was achieved in 48 patients (80%) in paravertebral group and 42 patients (70%) in inter pleural group. CONCLUSION: To conclude, lung functions are well-preserved in patients undergoing modified radical mastectomy under general anesthesia supplemented with paravertebral or IPB. IPB is as effective as PVB for post-operative pain relief. PVB has the added advantage of achieving a more complete block.