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Sources of error in blood gas analysis Essentially, this chapter is a short list of reasons as to why your ABG (or venous biochemistry)  measurement may be wrong, i.e. not reflective of what is happening in the patient. In 99% of cases, it is a problem with the collection storage and transport of the sample, because these are factors which are subject to human input and thus human error. The self-calibrating blood gas analyser is a dutiful and dependable serv...
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How the blood gas analyser measures ABG variables Question 9.1 from the second paper of 2008 asks of the bewildered candidates: "Outline  how pH, PCO2 and PO2  are measured in a blood gas analyser and briefly state the underlying principle behind  each of those measurements." The pass rate of 47% was pleasantly surprising, suggesting that many (if not all) of the candidates arose from an intellectually robust anaesthetic background. Judgi...
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CLINICAL PICTURE| VOLUME 395, ISSUE 10235, P1516, MAY 09, 2020 Myocarditis in a patient with COVID-19: a cause of raised troponin and ECG changes Denis Doyen, Pamela Moceri, Dorothée Ducreux, et al Lancet 2020; 395: 1516 A 69-year old man, from Lombardy, Italy, was admitted to our unit because of acute respiratory distress syndrome that required mechanical ventilation; he was in Nice, France, on holiday. He had previously been fit and well; he had a history of...
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Massive Splenomegaly from Disseminated Mycobacterium avium–intracellulare Infection Lucas R. Massoth, Abner Louissaint, Jr. N Engl J Med 2020; 382:1041DOI: 10.1056/NEJMicm1905550 A 29-year-old man with HIV infection presented with abdominal pain and drenching nights sweats. Computed tomography of the abdomen revealed massive splenomegaly caused by disseminated Mycobacterium avium–intracellulare infection.
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IMAGES IN CLINICAL MEDICINE Skin Discoloration from Amiodarone Robert P. Murphy and Michelle Canavan N Engl J Med 2020; 382:e5DOI: 10.1056/NEJMicm1906774 An 81-year-old man with a history of atrial fibrillation and hypertension presented to the emergency department after a fall. His medications were apixaban, ramipril, bisoprolol, amlodipine, and amiodarone. Physical examination revealed blue and gray pigmentation, sometimes referred to as ceruloderma, wit...
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IMAGES IN CLINICAL MEDICINE Crazy Paving in Pulmonary Alveolar Proteinosis Brian W. Allwood and Sami Bennji N Engl J Med 2020; 382:275DOI: 10.1056/NEJMicm1908563 A 34-year-old man with a 20-pack-year smoking history presented to the emergency department with a 4-month history of progressively worsening dyspnea and nonproductive cough. The oxygen saturation was 65% while the patient was breathing ambient air. He appeared to have dyspnea at rest, his fi...
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IMAGES IN CLINICAL MEDICINE Crepitus and Subcutaneous Emphysema Yehia Saleh and Ahmad Alratroot N Engl J Med 2020; 382:e1DOI: 10.1056/NEJMicm1907386 An 86-year-old woman with a history of severe emphysema presented to the emergency department with sudden-onset shortness of breath. Two weeks earlier, she had been treated for community-acquired pneumonia that was complicated by a pneumothorax on the right side, leading to the temporary insertion of a chest t...
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IMAGES IN CLINICAL MEDICINE Multiple Renal Arteries Sahib Y. Tuteja and Bence Forgac N Engl J Med 2019; 381:862DOI: 10.1056/NEJMicm1902894
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ICU Management & Practice, Volume 18 - Issue 1, 2018 Understanding LVAD & artificial hearts Regarding the growing number of patients with long-term mechanical assist devices, intensivists need to understand the physiology of the devices, their functioning, potential complications and their management. Long-term mechanical circulatory support (MCS) is being used increasingly for patients at risk of dying from heart failure and cardiogenic shock (Ponik...
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IMAGES IN CLINICAL MEDICINE Epiglottitis Nikita Chapurin and Alexander Gelbard N Engl J Med 2019; 381:e15DOI: 10.1056/NEJMicm1816761 A previously healthy, fully immunized 48-year-old man presented to an urgent care clinic with a 3-day history of odynophagia, fever with temperatures of up to 40°C, and progressive shortness of breath. A lateral radiograph of the neck showed the “thumb sign” (Panel A, arrow), which was suggestive of an enlarged epiglottis. ...
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