Scenario 1. A 23 yr old patient with antepartum hemorrhage was taken to OT for Caesarean section. She had profuse bleeding on table but could be controlled following delivery of baby, with blood transfusion and colloids. The chest on auscultation revealed fine basal creps and she had persistent hypotension.A central venous catheter was introduced through the right internal jugular vein. Confirmation of placement done by aspiration for free flow and rapid infusion of fluids.But the free flow was not obseved at a catheter length of 14 cm or13 cm but free flow observed at 11 cm.The patient remained ventilated and was shifted to the icu and CXR was taken The tip of the catheter appeared to be in the right subclavian vein with a slight angulation. A repeat procedure was deferred as the patient had coagulopathy and that the clinical confirmatory tests are satisfactory. The next day afternoon patient was complaining of raspiratory distress with tachypnea and pain on right side of chest. Auscultation revealed absent breath sounds on right side with dullness on percussion. A repeat CXR showed displacement of catheter tip, with massive pleural effusion on the right side which was drained subsequently.
Monday, June 21, 2010
Jehovah's witnesses, a fellowship of more than 1 million americans, object to the administration of blood in any form for any indication.This objection is based on "THE HOLY BIBLE" Acts 15:28,29 which states "For it has seemed good to the Holy Spirit and to us to lay on you no greater burden than these requirements: that you abstain from what has been sacrificed to idols, and from blood, and from what has been strangled, and from sexual immorality. If you keep yourselves from these, you will do well. Farewell.” According to them blood removed from the body should be discarded "You should pour it upon the ground as water" (Deuteronomy 12:24.)This makes pre operative blood conservation technique like preoperative phlebotomy and storage impracticalThe search for an oxygen carrying blood substitute started with world war II as the military realized the difficulties of whole blood transport and storage.Subsequently several trials were made to bring out an ideal blood substitute using chemicals which can carry oxygen.
1)Perfluorocarbon compounds:Of the various substances that carry or facilitate the transport of oxygen the perfluorocarbons gave the most promising results.They were created by replacing H2 atoms of hydrocarbons with flurine. This was following the first real success in "fluid breathing system" proposed by Leland Clark in 1966. He found that oxygen and carbondioxide are very much soluble in fluorocarbon liquids and can be used for artificial ventilation of the lungs which are immersed in these compounds where satisfactory oxygen uptake and giving out of CO2 takes place by the alveoli through the liquid media, in the absence of external oxygen supply.He performed his experiment in anaesthetised rat where the animal is paralysed intubated and immersed in PF liquid.After bubbling oxygen through the liquid this is pumped into the animal's lungs and recirculated. Most of the animals kept in the fluid for upto an hour survived for several weaks. Subsequently trials were made in humans during war time. Figure: Demonstrating a living mouse immersed in perfluorocarbon compound along with a goldfish.