Acquired Cardiac Dextroposition: A Step in the Right Direction?

Despite tremendous advancements in electrocardiography machine algorithms, accurately diagnosing dextrocardia, pseudodextrocardia, and limb lead reversal remains a serious challenge. We present the case of a patient with acquired cardiac dextroposition, or "pseudodextrocardia," in which the electrocardiography machine algorithm incorrectly interpreted the finding as "dextrocardia vs limb lead reversal." ().

Utilization of WATCHMAN FLX for surgically incomplete left atrial appendage occlusion: a multicentre case series.

Background: In patients with non-valvular atrial fibrillation, the vast majority of thrombi originate in the left atrial appendage (LAA). Thus, occluding the LAA significantly reduces one's risk for developing an ischaemic stroke. To date, many different surgical methodologies in LAA occlusion (LAAO)/exclusion have been studied and utilized.

Catheter-directed thrombolysis as an emergent intervention for failed vacuum thrombectomy of pulmonary embolism.

Acute pulmonary embolism [PE] in the setting of hemodynamic instability and right ventricular strain is a complex presentation and typically is associated with high mortality rates. Prompt recognition and early intervention are critical to the survival of these patient. In such cases, current guidelines recommend use of systemic thrombolytics, along with as needed cardiopulmonary support.

To intervene or not to intervene: A case of symptomatic neurocysticercosis complicated by ventriculitis.

Although well described in the current literature, Neurocysticercosis [NCC] remains an enigma when confronted by practitioners. This is in part due to the haphazard nature of the parasitic infection on the central nervous system [CNS]. These include single or multiple anatomic sites of infection, stage of parasitosis, and the resultant inflammatory response.

Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy.

Background: It is currently unclear if active left ventricular (LV) unloading should be used as a primary treatment strategy or as a bailout in patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Objectives: This study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS.

Methods: Data from 421 patients with CS treated with VA-ECMO and active LV unloading at 18 tertiary care centers in 4 countries were analyzed.

Inside Looking Out: Updated Competency Model for Professional Rehabilitation Nursing Practice.

Background: The original Association of Rehabilitation Nurses (ARN) Competency Model for Professional Rehabilitation Nursing published in 2016, and updated in 2020, provides a framework for rehabilitation nursing practice.

Aim: This companion, but stand-alone, article to a 2022 publication further explicates and informs the updated Competency Model from inside looking out toward an increasing application for evidence-based practice (EBP).

Approach: An eight-member 2020 ARN Task Force used an iterative process to review the original four domains and related competencies and came to consensus for the updated model.

Amniotic fluid embolism-induced cardiopulmonary collapse successfully treated with combination VA-ECMO and Impella CP.

Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. Prompt and aggressive resuscitative strategies are crucial in promoting survivability. We present a case of AFE resulting in cardiopulmonary collapse and subsequent cardiac arrest where we were able to safely deliver the baby and resuscitate the mother with veno-arterial extracorporeal membrane oxygenation and Impella CP-a novel combination known as ECPELLA.

Management of Phenibut Use Disorder and Withdrawal in a Geriatric Patient.

Phenibut is a misused substance which has shown an increase in use over the past decade. Marketed as a "dietary supplement," it is not approved in the United States for use and is not regulated by the Food and Drug Administration. The substance, however, is readily available for purchase through online markets.

Utilizing Provocative Maneuvers Intraoperatively in Conjunction With IVUS to Diagnose vTOS: The New Gold Standard.

Current methodologies of diagnosing and managing venous thoracic outlet syndrome (vTOS) remain controversial, as pertinent studies using modern advancements in medicine are limited. We present a case in which we innovatively used a modified Wright's test during venography coupled with intravascular ultrasound, which allowed us to definitively determine the etiology of a vTOS. ().

Mask-Induced Partial Transection of the External Ear Requiring Complex Surgical Reconstruction.

During the COVID-19 pandemic, wearing masks to prevent the spread of infection has been imperative. Though many wear N-95 masks with circumferential head straps, the use of surgical ear loop-style masks has increased. Dermatologic complications, such as contact dermatitis, psoriasis, and local irritation, have been described in several reports.

Conservative management of a large idiopathic pulmonary artery aneurysm: A case report.

Introduction And Importance: Pulmonary artery aneurysms are rare anomalies of the pulmonary vasculature. They are often asymptomatic and frequently an incidental finding on imaging or autopsy. It is imperative to closely monitor pulmonary artery aneurysms as they can result in sudden dissection, rupture, and death.

Percutaneous repositioning of Impella RP: the Snare-Manoeuvre-Prolapse technique-a case report.

Background: Impella RP (Abiomed, Danvers, MA, USA) is indicated for right ventricular failure after left ventricular assist device insertion or biventricular shock. Once the peel-away sheath is removed, Impella RP repositioning can only be achieved with manual manipulation of the catheter itself. This method does not always accomplish appropriate positioning of the catheter and can result in continued haemodynamic instability.

An Innovative Approach to Calcaneal Decubitus Ulcerations Through Calcaneal Decorticalization with Use of Localized Bone Marrow and Negative-Pressure Wound Therapy: A Case Study.

Heel decubitus ulcerations are relatively common occurrences that can be limb threatening. There are many options to treat these ulcerations, ranging from conservative wound care to serial debridement with flap reconstruction. However, not all patients are good candidates for major reconstructive surgery.

Efficacy of VERIGENE® Blood Culture Assays in Accurately and Rapidly Detecting Gram-Negative and Gram-Positive Pathogens.

Background: Rapid administration of appropriately indicated antibiotics is crucial in septic patients. Sepsis data supports that there is a higher risk of mortality for each hour delay from triage to antibiotic therapy, as well as for inappropriate antibiotic selection. There are a variety of rapid microbial detection systems, such as VERIGENE®, used in acute care facilities to rapidly detect bacteremia and identify resistance markers.

Updated Competency Model for Professional Rehabilitation Nursing: Practice Applications.

Background: The Competency Model for Professional Rehabilitation Nursing is a lens through which nurses can view their practice; the four domains provide a template that guides that practice.

Purpose: The aim of this study was to describe a task force's review procedures and share the updated model.

Appraisal Process: A rehabilitation nursing task force appraised the model over the course of 1 year.

Initial distribution of COVID-19 vaccines to front-line hospital workers and community first responders-A prospective descriptive study.

As one of the initial ten sites in Ohio designated to receive and distribute the first COVID-19 vaccines in December 2020, we initiated a self-reported IRB-approved research survey to describe the demographics, side-effects, and missed work time experienced by front-line health care workers in an urban tertiary care center and a rural regional hospital. First responders from both the urban and rural surrounding communities were also included in the initial Tier 1A vaccine distribution. The primary outcome measure was to identify the most frequently experienced side effects from the Pfizer and Moderna vaccines, based on type of vaccine, first or second dose, age, gender, race and occupation.

Unexpected severe intra-abdominal injuries resulting from a ground-level fall in an elderly patient with a large staghorn calculus.

A 70-year-old woman on warfarin was transported to the emergency department after a ground-level fall, injuring her left backside. Criteria for geriatric trauma activation was not met. An episode of haematuria created suspicion for an intra-abdominal injury, prompting a point-of-care ultrasound (POCUS) Focused Assessment with Sonography for Trauma scan, which was positive.

A New WATCHMAN Sizing Algorithm Utilizing Cardiac CTA.

Background: The WATCHMAN left atrial appendage (LAA) occlusion device has emerged as an alternative for anticoagulation in patients with non-valvular atrial fibrillation who cannot tolerate oral anticoagulation therapy. Cardiac computed tomography (CTA) is increasingly being utilized to guide WATCHMAN device sizing, however no consensus algorithm exists. We present our experience with a new cardiac CTA LAA ostium area based sizing algorithm.

When Harry Met Sally: Single-Session INARI FlowTriever and Impella RP.

Percutaneous mechanical thrombectomy devices have revolutionized the treatment of massive pulmonary embolism (PE) by providing a rapid, non-thrombolytic based method to re-establish right-sided circulation while reducing bleeding complications. However, with massive PE, the acute increase in right ventricular afterload results in a compounded hemodynamic compromise, which may necessitate the need for advanced cardiac support. This case exemplifies the need for a comprehensive and synergistic approach to the management of massive PE.

Single-Session Treatment of Upper Extremity Deep Venous Thrombosis and Central Venous Catheter Malfunction Using the ClotTriever System.

Intravenous catheters account for the majority of cases of upper extremity deep vein thrombosis (UEDVT), with a higher incidence in patients suffering from malignancy. Sequelae of UEDVT are similar to that of lower extremity DVT, comprising post-thrombotic syndrome and pulmonary embolism. While there are several treatment options for UEDVT including systemic anticoagulation, catheter-directed thrombolysis, and percutaneous mechanical thrombectomy, due to the absence of consistent guidelines regarding its management, treatment is often individualized based on patient characteristics, clinical factors, and technical considerations.

Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study.

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle.

Fecal microbiota transplantation in the treatment of Crohn disease.

Fecal microbiota transplantation (FMT) is an alternative treatment option with minimal risk for patients with Crohn disease. This article explains FMT and how it effectively targets the gut microbiota changes associated with the pathogenesis of Crohn disease.