Ginger Tsai-Nguyen

Bartonella endocarditis with glomerulonephritis in a patient with complete transposition of the great arteries

ABSTRACT We describe a patient with history of dextro-transposition of the great vessels, ventricular septal defect, and pulmonary valve replacement who presented with fatigue, prolonged fever, and leg edema. He was found to have kidney injury, pancytopenia, and liver congestion. Echocardiogram revealed thickened leaflets with prolapsing vegetation on the pulmonary valve. Given the negative blood cultures, high Bartonella henselae immunogobulin G titer (≥1:1024) and positive immunoglobulin M titer (≥1:20), he was diagnosed with Bartonella endocarditis complicated with glomerulonephritis.

Use of neuromuscular blocking agents in acute respiratory distress syndrome

ABSTRACT Acute respiratory distress syndrome is the result of an acute inflammatory response of the lungs, causing severe hypoxemia. A variety of therapeutic modalities have been extensively studied, with only a few demonstrating improvement in survival. Specifically, mechanical ventilation with use of low tidal volumes, prone positioning, and treatment with neuromuscular blocking agents have proven beneficial. This article focuses on the utilization of neuromuscular blocking agents in this entity. In particular, we briefly review the mechanism of action of neuromuscular blockades, the latest published evidence supporting their use in acute respiratory distress syndrome, and current recommendations for their utilization in clinical practice.

Adrenal Crisis and Autoimmune Polyglandular Syndromes

We report a 67-year-old woman who presented with adrenal crisis as a manifestation of autoimmune polyglandular syndrome 2, a polygenic disorder characterized by concurrent primary adrenal insufficiency and either autoimmune thyroid disease or type 1 diabetes mellitus.

Neuroendocrine carcinoma of the prostate gland.

Small cell prostate carcinoma (SCPC) has a clinical course and prognosis that is markedly different from that of common adenocarcinoma of the prostate. The patient in this case presented with fever of unknown origin, dyspnea, and near spinal cord compression. He was subsequently found to have widely metastatic high-grade neuroendocrine carcinoma of prostatic origin. This case emphasizes that despite the commonality of prostate cancer, there are rare presentations of this common disease.

348: EVALUATION OF NEW INTERN ACLS RHYTHM INTERPRETATION USING SIMULATION LAB

Learning Objectives: Rhythm recognition is the most important aspect of Advanced Cardiac Life Support (ACLS); correct identification leads the provider down a set pathway of interventions. We set out to evaluate new interns’ ability to recognize basic ACLS rhythms and the initial management step as they are expected to be ACLS trained prior to residency and respond to our institution’s codes. Methods: At Baylor University Medical Center in Dallas, 20 interns participated in a #3G Sim Man mega code scenario during their orientation. Recognition and management of an initial rhythm and five pulse/rhythm checks were executed. They were asked to anonymously identify the rhythms and the next best management step. A total of six rhythms (Supraventricular tachycardia (SVT), Torsades de Pointes (TdP), Ventricular Fibrillation, pulseless electrical activity, monomorphic ventricular tachycardia, and third degree AV block) were shown. Afterward, participants had a lecture reviewing code blues and rhythms by an intensivist. They then returned to the simulation lab and the six rhythms were again shown in random order which they were anonymously asked to identify and state the next best management step. Results: Of the 20 participants, 80% (16) had completed their ACLS within 6 months (mo.) of orientation: 20% (4) 3-6 mo. prior, 55% (11) 1-3 mo. prior, 5% (1) < 1 mo. prior; 20% (4) completed ACLS > 6 mo. prior. For those within the past 6 months, the average score on the initial quiz was 67%. For those > 6 mo. ago, the average score was 56%. In order to attain credit, both rhythm identification and initial management had to be correct. The total average score was 65%. The two rhythms that had more incorrect answers were SVT and TdP. After the code rhythm review and feed back from an intensivist, the post quiz average was 95%. Conclusions: Time from ACLS training affects interns’ ability to recognize rhythms and determine the right management strategy. A review course for all interns before residency starts is important because it improves their ability to recognize correct rhythms. Simulation training can assist with this goal.

210: DOES CODE BLUE SIMULATION TRAINING DURING INTERN ORIENTATION IMPROVE COMFORT LEVEL AND ANXIETY?

Crit Care Med 2015 • Volume 43 • Number 12 (Suppl.) + 1×initial PaO2. We grouped the patients according the score into quartile. Their incidence rate of ROSC per 1 minute were 0.012 (95% CI, 0.009–0.015), 0.023 (0.019–0.028), 0.038(0.032–0.045) and 0.062 (0.053–0.073), respectively. Conclusions: This is the first attempt to estimate the incidence rate and cumulative incidence of ROSC during ACLS in ER. We hope it be a useful reference for ER physicians when discussing termination of resuscitation with patient family members.