Fixed dose ketamine for prehospital management of hyperactive delirium with severe agitation.

Introduction: Patients exhibiting signs of hyperactive delirium with severe agitation (HDSA) may require sedating medications for stabilization and safe transport to the hospital. Determining the patient's weight and calculating the correct weight-based dose may be challenging in an emergency. A fixed dose ketamine protocol is an alternative to the traditional weight-based administration, which may also reduce dosing errors.

Sufficient Cartilage for Most Talar Articular Defects Can Be Harvested From the Non-Loadbearing Talus: A Cadaveric Analysis.

Purpose: To assess the quantity of morselized cartilage that can be harvested from the non-load-bearing portion of the talus for immediate reimplantation.

Methods: Non-load-bearing talar cartilage was harvested from 5 cadaveric specimens using a standard arthroscopic approach. Cartilage was separated from the talus in maximum dorsiflexion at the junction of the talar head and neck, grasped, and morselized into a graft using a cartilage particulator.

Assessment of Safe Cartilage Harvesting Quantity in the Shoulder: A Cadaveric Study.

Purpose: To evaluate the volume and yield of morselized cartilage that can be harvested from the shoulder for immediate reimplantation and repair.

Methods: A standard arthroscopic approach was used to harvest non-load-bearing cartilage from 5 cadaveric shoulder specimens. Cartilage was separated from the humerus, grasped, added to the cartilage particulator, and morselized to form a cartilage paste.

Return to sporting activity after ulnar nerve transposition for isolated neuritis in competitive overhead athletes.

Background: Although ulnar neuritis can occur secondary to ulnar collateral ligament pathology, stress fractures, and traction apophysitis, isolated ulnar nerve dysfunction can lead to medial elbow pain. The purpose of this study was to evaluate the short-term outcomes of overhead athletes undergoing anterior ulnar nerve transposition for ulnar neuropathy.

Methods: All overhead athletes who underwent isolated ulnar nerve transposition between 2009 and 2016 for refractory ulnar neuritis were identified.

Anatomic total shoulder arthroplasty with an inlay glenoid component: clinical outcomes and return to activity.

Background: Biomechanical studies show that inlay glenoid components in total shoulder arthroplasty (TSA) can reduce edge loading and opposite-edge lift-off forces with humeral translation compared with onlay glenoids. However, clinical data for these implants are lacking. We report clinical outcomes and return to activities after anatomic TSA with an inlay glenoid component and a stemless ovoid humeral head in an active, young patient population.

Preoperative Doxycycline Does Not Reduce Propionibacterium acnes in Shoulder Arthroplasty.

Background: Propionibacterium acnes (P. acnes) is the most common bacteria associated with infection after shoulder arthroplasty. These bacteria can be grown on culture of skin after standard preoperative skin preparation and antibiotics.

Septal Leaflet Versus Chordal Detachment in Closure of Hard-to-Expose Ventricular Septal Defects.

Background: Different techniques have been used for exposure of ventricular septal defect (VSD) margins when there is crowding of the VSD anatomy by tricuspid valve subvalvar apparatus. This study compared surgical outcomes for the two techniques of tricuspid valve leaflet detachment and the rarely described tricuspid valve chordal detachment for hard-to-expose VSDs.

Methods: Patients undergoing transatrial VSD repair were identified from our institutional database.

Comparing del Nido and Conventional Cardioplegia in Infants and Neonates in Congenital Heart Surgery.

Background: The aim of this study was to evaluate outcome measures after the use of del Nido (dN) cardioplegia compared with conventional multidose high-potassium (non-dN) cardioplegia in neonates and infants.

Methods: We retrospectively analyzed data in patients, aged younger than 1 year, undergoing cardiopulmonary bypass (CPB) from January 2012 to August 2015. We changed our cardioplegia protocol from non-dN to dN administered in a single or infrequently dosed strategy in September 2013.

Migration of a Needle From the Chest Wall Into the Right Ventricle in a 10-Year-Old Child.

Cardiac foreign bodies are rare in children and the nature or timing of the injury may be hard to ascertain. We report a case of a 10-year-old boy who presented with a 28-mm solid core needle in the left chest wall that advanced into his right ventricle, possibly from soft tissue manipulation. Computed tomography, intraoperative fluoroscopy, and echocardiography were necessary to locate the needle and successfully remove it surgically.

Novel Approach to Construct Absent Intrapericardial Branch Pulmonary Arteries.

Unilateral or bilateral absence of branch pulmonary arteries is a rare congenital heart defect. Various reconstructive techniques have been previously described, each with its inherent limitations. We present a novel technique of constructing a branch pulmonary artery that maintains potential for growth.

Comparative Review of Outcomes in Patients With Congenital Heart Disease Requiring Cardiopulmonary Support for Failure to Wean From Cardiopulmonary Bypass or for Refractory Sudden Cardiac Arrest.

Background: We reviewed the outcomes of patients who underwent cardiopulmonary support (CPS) for either refractory sudden cardiac arrest or failure to wean from cardiopulmonary bypass (CPB).

Methods: Between January 2005 and July 2013, 37 patients with congenital heart disease (CHD) underwent 39 instances of CPS for sudden cardiac arrest as extracorporeal cardiopulmonary resuscitation (E-CPR; group I, n = 19) or for failure to wean from CPB (group II, n = 20). Univariate analyses determined which variables differed among the groups and which had significant association with hospital survival.

Late postoperative prosthetic pulmonary valve endocarditis in a 13-year-old girl with repaired tetralogy of fallot.

Prosthetic pulmonary valve endocarditis has infrequently been described outside large cohort reviews, which have typically focused on infections of the left-sided heart valves. Hence, the pathogenesis, clinical presentation, and management principles of prosthetic pulmonary valve endocarditis have not been well differentiated from those of infected aortic and mitral valves. More patients with repaired tetralogy of Fallot are reaching adulthood and will need pulmonary valve implantation.

Avoiding coronary injury in congenital heart surgery by laser-assisted indocyanine green dye imaging.

Many patients with congenital heart disease require a staged surgical approach to achieve optimum circulation. During repeat operations, coronary anatomy can be difficult to ascertain because of epicardial scarring or underlying anomalous coronary anatomy. Uncertainty about coronary artery location increases the risk of reoperation.

Rapid cardiopulmonary support in children with heart disease: a nine-year experience.

Background: We developed a novel mechanical rapid cardiopulmonary support system (CPS) in 1996 to eliminate what we believed were shortcomings of conventional extracorporeal membrane oxygenation (ECMO) circuits when used in patients with congenital heart disease. We reviewed the use of this system over a nine year period to determine if we had been successful in improving results compared with ECMO and if outcomes have changed over this time.

Methods: All children supported with CPS (110 procedures) were reviewed.