Showing posts with label cardiovascular. Show all posts
Showing posts with label cardiovascular. Show all posts

Wednesday, October 21, 2015

Cardiopulmonary Resuscitation and a Metronome: A Study That Puts the Two Together to Improve Chest Compression Administration


By: Lewis First, MD, MS; Editor-in-Chief     

          When one thinks of a metronome, it’s usually to help a child or adult practice keeping the tempo in a piece of music they are trying to play.  Yet Zimmerman et al. (doi: 10.1542/peds.2015-1858) decided to try a metronome in a prospective simulation-based crossover randomized controlled trial of residents, fellows, nurses, and medical students randomly assigned to do chest compressions on a manikin with or without a metronome to keep the tempo of those compressions. 
        The authors looked at rate and depth of compressions as the participants did rounds of compressions with and without the metronome going.  Rather than compress the findings of this study in this blog, we will encourage you to read the study for yourselves and see if your resuscitation room warrants buying a metronome as a valuable addition to the equipment you already have available in your office, emergency or inpatient setting.   Beat a path to reading this article to learn more.

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Monday, August 24, 2015

Infection-Related Hospitalizations in Childhood and Adult Cardiometabolic Disease: An Association You May Not Know About


By: Lewis First, MD, MS; Editor-in-Chief 
         
     We are always looking for early determinants of adult disease processes so we might be able to intervene sooner and abate serious morbidity up the road—but sometimes we discover a determinant that we had not suspected to be a contributor.  Take childhood infections for example and their influence, or at least their association with adult cardiometabolic disease.   
     Burgner et al. (doi:10.1542/peds.2015-0825) report this week on their study of a longitudinal cohort of children in Finland who were followed from ages 3- to 9-years onward until they were 30 to 45 years of age with data being accessible in terms of infection-related hospitalizations since birth as well as their degree of adiposity, body mass index and metabolic syndrome in adulthood.   
      The authors controlled for various confounders and discovered that early childhood infectious disease-related hospitalizations correlated significantly with increased BMI and metabolic syndrome even when age, sex, birthweight, childhood BMI, family income and other factors were controlled for.  In fact, the more infection-related hospitalizations, the higher the increase in adult BMI.  If this seems puzzling to you, it did to us initially as well until we read this study and learned from the discussion as to what role these infection-related inpatient stays might have with adult cardiometabolic outcomes.   
      You’ll want to weigh in to the results of this study—and then think about your patients from years back with recurrent hospitalizations for infections and whether or not they are tackling cardiac-related metabolic complications as adults as this study certainly suggests.

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Wednesday, July 29, 2015

Think Prenatal Ultrasound and Newborn Pulse Oximetry Screening Will Find All Neonatal Coarctations? Think Again!


By: Lewis First, MD, MS; Editor-in-Chief      

Bridget Coila
     We have been taught to carefully check newborns for distal pulses and listen for murmurs in the first few days after birth to make sure we are not missing a coarctation of the aorta.  Add in prenatal ultrasound screening and newborn pulse oximetry screening and you might think no coarctation will escape early detection.   
      Well, Lannering et al. (doi: 10.1542/peds.2015-1155) prove that assumption wrong in a review of infants seen with this cardiac disorder between 2003 to 2012 in their referral area.  The authors find that almost 50% of the 90 cases diagnosed were not identified prenatally or screened positive in the nursery leaving a large number to be picked up on follow-up visits or because the infant became sick upon discharge as the ductus closed.   
      If there was ever a reason to make sure we are doing good bread and butter physicals on our newborns, not just in the nursery but in their early postnatal visits to the office, this article will make you a believer.  Take heart and read more about what the authors recommend to avoid missing this important neonatal cardiac disorder.

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