Monday December 11, 2006
Expected drop in Hb after cardiac angiogram


Patients going for cardiac angiogram frequently requires blood transfusions either pre or post procedure. Particularly, patient who determined to need emergent CABG should have enough backup transfusion avaiable.

To keep yourself prepared, it would be nice to know that coronary angiography on average drop 1.8 g/dL of Hb per procedure.



References: Click to get abstract/article

1. Blood loss from coronary angiography increases transfusion requirements for coronary artery bypass graft surgery - The Journal of Cardiothoracic and Vascular Anesthesia , volume 14, issue 2, Pages 177-181 (April 2000)

Sunday December 10, 2006
Hemodialysis in Salicylate overdose with normal level

Hemodialysis is recommended in salicylate overdose patients with a level at or above 100 mg/dL (cut it to half if history suggest chronic ingestion). But if there is any sign of neurological manifestation, dialysis is indicated despite normal level.
Salicylate cause "neuroglycopenia" (lower CNS glucose level) despite normal serum glucose. As patient gets more and more acidotic, salicylate enters CNS and by direct effect cause neuroglycopenia. 7 indications of Hemodialysis in Salicylate poisoning

1. Mental status change
2. Pulmonary edema
3. Cerebral edema
4. Associated or with renal failure
5. Level at or above 100 mg/dL(half if chronic ingestion)
6. If fluid overload prevents alkalinization
7. Patient continue to deteriorate clinically


References: Click to get abstract/article

1. Toxicity, Salicylate - emedicine.com
2.An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose -Emerg Med J 2002; 19:206-209
3. Salicylic acid - intox.org