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Lignocaine Associated Systemic Toxicity (LAST)

  Lidocaine Associated Systemic Toxicity (LAST) Lidocaine Associated Systemic Toxicity (LAST) is a potentially life-threatening condition that occurs due to the excessive absorption of local anesthetics, particularly lidocaine, into the systemic circulation. LAST can result from inadvertent intravascular injection, overdose, or rapid absorption from highly vascularized areas.   Pathophysiology: Lidocaine, like other local anesthetics, works by blocking sodium channels, inhibiting the initiation and propagation of nerve impulses. However, when systemic levels of lidocaine become excessively high, these sodium channels are blocked in vital organs such as the heart and brain, leading to serious complications. Clinical Presentation: LAST can manifest with a variety of symptoms that often progress through two stages: Neurological Symptoms : Early signs include circumoral numbness, metallic taste, tinnitus, and dizziness. As toxicity increases, more severe symptoms such as seizures, altered
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CRASH-3 TRIAL (Tranexamic Acid in Head Injury)

 
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SALSA Trial

The "Slow Continuous Infusion Therapies of Hypertonic Saline for Patients With Symptomatic Hyponatremia:  The SALSA Randomized Clinical Trial" published in JAMA, is a significant clinical trial that specifically investigated the use of slow continuous infusion therapies of hypertonic saline with fast bolus replacement, for patients with symptomatic hyponatremia.  Background:   Symptomatic hyponatremia is a condition in which patients have low sodium levels in the blood, leading to neurological symptoms and potentially life-threatening complications. Rapid correction of sodium levels is necessary in such cases to alleviate symptoms and prevent harm. Objective:   The SALSA trial aimed to assess the efficacy and safety of two different strategies for correcting symptomatic hyponatremia using hypertonic saline solutions.  Methods: The study was a randomized clinical trial involving patients with symptomatic hyponatremia. Participants were divided into two groups:  Bolus Therapy G
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BLUNT TRAUMA TO EYE VARIOUS FINDINGS

Blunt trauma to the eye can result in a wide range of findings and injuries, depending on the force and direction of the impact. The Trauma can be due to Direct Injury Contre-coup Injury Shearing forces and shock waves. The eye is a delicate organ with several components, and trauma can result into open or closed globe injuries. Following are some of the findings and injuries commonly associated with blunt trauma to different components of the eye:         Eyelids and Surrounding Tissues: ü   Contusions and bruising of the eyelids and periorbital area. May give an appearance of Raccoon Eyes. ü   Lacerations or cuts on the eyelids. ü   Swelling and edema of the eyelids.         Conjunctiva: ü   Subconjunctival hemorrhage, which appears as redness on the white part of the eye. ü   Chemosis, which is swelling of the conjunctiva.         Cornea: ü   Corneal abrasions or scratches, causing pain, redness, and foreign body sensation. ü   Corneal edema, which can r
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MOPETT Trial (Multicenter Observational Study of Pulmonary Embolism Thrombolysis)-2013

  MOPETT trial (Multicenter Observational Study of Pulmonary Embolism Thrombolysis)  was a randomized controlled trial that evaluated the efficacy and safety of low-dose thrombolysis in patients with acute intermediate-risk pulmonary embolism (PE).  The trial included 121 patients who were randomly assigned to receive either low-dose alteplase (50 mg) or low-dose heparin plus placebo.  The primary endpoint of the trial was the development of pulmonary hypertension at 28 months. The secondary endpoints were recurrent PE at 28 months and major bleeding events.  The results of the trial showed that  l ow-dose alteplase significantly reduced the risk of developing pulmonary hypertension at 28 months compared to low-dose heparin plus placebo (28% vs. 56%) . There was no significant difference between the two groups in the risk of recurrent PE or major bleeding events.  The MOPETT trial provides evidence that low-dose thrombolysis is an effective and safe treatment option for patie
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RAMPART TRIAL-Rapid Anticonvulsant Medication Prior to Arrival Trial

The RAMPART Trial Status epilepticus is a life-threatening medical emergency that occurs when a seizure lasts for more than 5 minutes or when there are multiple seizures without a return to consciousness in between . It is important to treat status epilepticus as quickly as possible, as the longer it goes untreated, the greater the risk of brain damage and death. The RAMPART trial (Rapid Anticonvulsant Medication Prior to Arrival Trial) was a randomized clinical trial that compared the efficacy of intramuscular (IM) midazolam to intravenous (IV) lorazepam in the prehospital treatment of status epilepticus. The trial enrolled 1,080 adults and children with status epilepticus who were treated by paramedics. The primary outcome of the trial was the proportion of patients who had seizure cessation within 10 minutes of receiving the first dose of medication. The secondary outcomes included the proportion of patients who had seizure cessation within 20 minutes, 30 minutes, and 60 minutes of
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CLOVERS Trial- Crystalloid Liberal or Vasopressor Early Resuscitation in Sepsis

Crystalloid Liberal or Vasopressor Early Resuscitation in Sepsis (CLOVERS) Trial:  The Crystalloid Liberal or Vasopressor Early Resuscitation in Sepsis (CLOVERS) trial aimed to compare the impact of an early restrictive fluid strategy (with early vasopressor use) versus a liberal fluid strategy on 90-day mortality in patients with sepsis-induced hypotension.  Background:  In sepsis management, intravenous fluids are administered to improve organ perfusion, but they carry risks such as dilutional coagulopathy and organ dysfunction. Vasopressors are also used, but their use comes with potential complications. Prior observational data suggested that a restrictive fluid strategy with early vasopressor use might be superior. The CLOVERS trial aimed to provide further insights into this matter.  Design:  The trial was a multicenter, randomized, unblinded superiority trial conducted as part of the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network. Patients were randomly assi
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