A & A case reports
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This case report describes the intraoperative use of extracorporeal life support (ECLS) for an elective thoracoscopic maze procedure in which the patient could not tolerate one-lung ventilation because of hypoxia. Potential pitfalls associated with the anesthetic management of elective intraoperative ECLS include managing native cardiac ejection and ECLS flows to provide optimal oxygenation and cardiac output. Particular attention must be paid to cardiac and respiratory physiology when ECLS is used in a patient with normal cardiac function.
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Powerful entities are pushing physicians to become more involved with quality improvement (QI). We report a QI project to standardize and improve the ergonomics of the anesthesia medication and supply cart. ⋯ A combination of competing regulations, administrative overprocessing, and the lack of dedicated QI financial resources made simple improvements a challenge. The costs of participating in QI deserve attention.
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Residency programs are charged with teaching, assessing, and documenting resident competency for a multitude of skills. Documentation of competency requires demonstrating specific milestones mandated by the Accreditation Council for Graduate Medical Education. ⋯ A simulation format was chosen to allow standardized objective assessment of the resident's skill level at an early stage of training, with possible identification of and intervention for skills needing improvement. Our experience may serve as a template for other programs and specialties developing processes for assessing and documenting improvement in skill and competency over the course of residency training.
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Arrhythmia and palpitation are common during pregnancy. Right ventricular outflow tract tachycardia, a rare cause of palpitations occurring even in the absence of structural heart disease, is uncommon during pregnancy. Nevertheless, the presence of right ventricular outflow tract tachycardia in pregnancy requires careful cardiac evaluation with a focus on managing arrhythmogenic activity while maintaining patient comfort and safety. We report a case of right ventricular outflow tract tachycardia in a pregnant 32-year-old woman, whose arrhythmia was detected 2 weeks before labor and persisted through the peripartum period.
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The Statlock(™) is an IV stabilization device developed by Bard Access Systems, Inc. We describe the use of a modified Statlock with tracheostomy ties to provide a secure anchor for an endotracheal tube in a child with toxic epidermal necrolysis. We review the benefits and drawbacks of previously described devices in patients with similar conditions (burns, epidermolysis bullosa, Stevens Johnson syndrome). We demonstrate creation of this system with readily available supplies to provide an accessible and stable airway in patients with facial injury precluding adhesive use.