Reverse Wenckebach "pseudo-supernormal" conduction or paroxysmal atrioventricular block.

Paroxysmal atrioventricular-block is a poorly-recognized cause of atrioventricular conduction abnormality leading to syncope and can be fatal. Here we report a case of paroxysmal atrioventricular-block presenting as syncope treated effectively with pacemaker implantation and review the current literature on prevalence, known mechanisms and treatment for it. Importantly we provide the diagnostically important differentiating points between vagally mediated block and paroxysmal atrioventricular-block as well as the highlight the vastly varying prognosis between the two.

Shifting gears: jump-start interdisciplinary patient care.

Effective patient care planning and education requires an interdisciplinary approach that accelerates collaborative practice and timely patient outcomes. Is it time for you to head in this direction?

Asthma screening of high school athletes: identifying the undiagnosed and poorly controlled.

Background: It is believed that there are many high school-age athletes who have undiagnosed asthma or exercise-induced asthma (EIA). The screening of these athletes for EIA will allow them to be identified and treated.

Objectives: 1) To obtain reliable peak expiratory flow rate (PEFR) measurements and administer questionnaires to high school-age athletes to evaluate their asthma risk.

Treatment of renal cell carcinoma with 5-fluorouracil and alfa-interferon.

Objectives: Renal cell carcinoma is relatively resistant to both chemotherapy and immunotherapy. Response, survival, duration of response, and toxicity of treatment were evaluated in patients with advanced renal cell carcinoma receiving a continuous intravenous infusion of 5-fluorouracil (5-FU) and low dose subcutaneous alfa-2b-interferon.

Methods: Between 1989 and 1994, 21 patients with advanced renal cell carcinoma underwent treatment with continuous intravenous infusion of 5-FU, 200 mg/m2/day, and subcutaneous injections of recombinant interferon alfa-2b (IFN-alpha), 1 x 10(6) U/day.

MR evaluation of epiglottic disruption.

Epiglottic disruption is an uncommon injury usually associated with significant supraglottic trauma. This injury may be overlooked because of the difficulty in examining the larynx or other associated severe injuries. We present two cases of clinically unsuspected epiglottic disruption that were first seen on MR images of the neck.

Quality performance development for education: implementation of a plan.

Measuring or evaluating the impact of educational interventions has presented a challenge for the educator. Implementing a quality performance improvement (QPI) plan addressing education processes and outcomes provides an expansion and extension of QPI, as well as validates the pivotal and evolving role of the educator in measuring patient care outcome. This article describes an education-based QPI plan using the 10-step process identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

The syringe aspiration technique to verify endotracheal tube position.

This prospective, clinical study was performed to determine the utility of the syringe aspiration technique (SAT) to verify endotracheal tube (ETT) position. Ninety consecutive patients requiring urgent intubation in the emergency department or prehospital setting were enrolled in the study. The SAT correctly identified intratracheal ETT placement in 88 patients and esophageal misplacement in 2 patients.