Refractory Hypotension During Implantation of a 70 mL Total Artificial Heart in a Patient With Pectus Excavatum: A Case Report.

The Syncardia total artificial heart system is the only commercially approved durable device for treating biventricular heart failure patients awaiting heart transplantation. Conventionally, the Syncardia total artificial heart system is implanted based on the distance from the anterior aspect of the 10th thoracic vertebra to the sternum and the patient's body surface area. However, this criterion does not account for chest wall musculoskeletal deformities. This case report describes a patient with a pectus excavatum who developed compression of the inferior vena cava after Syncardia total artificial heart implantation and how transesophageal echocardiography guided chest wall surgery to accommodate the total artificial heart system.

Incorporating patient safety into early undergraduate medical education: teaching medical students to perform surgical time outs during anatomy.

OBJECTIVES: To introduce surgical safety checklists and time outs to future physicians through early incorporation of time outs in the first year gross anatomy course. SETTING: The Wayne State University School of Medicine Anatomy Lab. PARTICIPANTS: Approximately 300 first year medical students per year participated in the intervention. INTERVENTIONS: An educational presentation on medical errors focusing on surgical errors was developed. Students in 2017-2018 viewed the presentation and completed two time outs, one with the first anatomy dissection and a second with the last dissection. Preintervention and postintervention surveys were completed and results compared. Students completed a second postintervention survey after the second time out. Students in 2018-2019 were asked to complete the time outs before every dissection. Time out procedure sheets were collected to determine completion rates. The intervention was further modified for academic year 2019-2020 and time out sheets were again collected. OUTCOME MEASURES: Four domains of learning were surveyed: (1) major components and goals/limitations of universal protocol, (2) medical error lexicon, (3) components of a time out, and (4) confidence in completing time out checklists. RESULTS: Postintervention surveys demonstrated significant improvement in each domain. Students found time outs easy to complete and developed confidence in performing time outs. Following a successful pilot, time outs were incorporated into every dissection. Students continued to perform this procedure despite absence of adverse consequences for not doing so. CONCLUSION: Students found the time outs easy to complete and developed the confidence and ability to perform a surgical time out early in their medical education. The new skills, knowledge and attitudes that these medical students have developed will hopefully improve the care they provide to patients, thereby advancing the practice of quality improvement and patient safety in the clinical setting.

A General Base Condensation of Diynes to a Spirocyclopropenyl System.

When a cold (200 K) THF solution of 1,6-heptadiyne is exposed to potassium tert-butoxide, in the presence of 18-crown-6, a green, EPR active solution is spontaneously formed. The intensity of the EPR signal can be augmented by exposure to alkali metal. Analysis of the EPR splitting pattern indicates that the signal originates from the anion radical of 7,14-di-trans-1,5- [14]annuldiyne. Allowing the green-colored solution to warm to ambient temperatures causes an immediate color change (to deep purple) and loss of the EPR activity. Reduced pressure distillation of the solution affords a colorless THF solution containing (spiro[2.6]nona-2,6,8-triene), which is only the second spirocyclopropene compound reported. The base condensation of the diyne is of a general nature as the same spirocyclopropenyl system is obtained from 1,6-heptadiyne, 1,7-octadiyne, and 1,8-nonadiyne. Laser irradiation (337 nm) of tungsten hexacarbonyl in the presence of the spirocyclopropenyl compound yields the stable organometallic: eta2-olefin pentacarbonyl complex.