A Case Report of a LVAD Driveline Infection Diagnosed by Point-of-care Ultrasound.

INTRODUCTION: As the prevalence of patients with left ventricular assist devices (LVAD) presenting to the emergency department (ED) increases, clinicians must be aware of LVAD-associated infections. CASE REPORT: A well-appearing, 41-year-old male with history of heart failure status post prior-LVAD placement presented to the ED for swelling of his chest. What appeared initially as a superficial infection was further assessed with point-of-care ultrasound and found to represent a chest wall abscess involving the driveline, ultimately resulting in sternal osteomyelitis and bacteremia. CONCLUSION: Point-of-care ultrasound should be considered an important tool in the initial assessment of potential LVAD-associated infection.

Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest.

OBJECTIVES: Our primary objective was to assess the accuracy of Doppler ultrasound versus manual palpation in detecting any pulse with an arterial line waveform in cardiac arrest. Secondarily, we sought to determine whether peak systolic velocity (PSV) on Doppler ultrasound could detect a pulse with a systolic blood pressure (SBP) ≥ 60 mmHg. METHODS: We conducted a prospective, cross-sectional, diagnostic accuracy study on a convenience sample of adult, Emergency Department (ED) cardiac arrest patients. All patients had a femoral arterial line. During a pulse check, manual pulse detection, PSV and Doppler ultrasound clips, and SBP were recorded. A receiver operator characteristic curve analysis was performed to determine the optimal cut-off of PSV associated with a SBP ≥ 60 mmHg. Accuracy of manual palpation and Doppler ultrasound for detection of any pulse and SBP ≥ 60 mmHg were compared with McNemar's test. RESULTS: 54 patients and 213 pulse checks were analysed. Doppler ultrasound demonstrated higher accuracy than manual palpation (95.3% vs. 54.0%; p < 0.001) for detection of any pulse. Correlation between PSV and SBP was strong (Spearman correlation coefficient = 0.89; p < 0.001). The optimal cut-off value of PSV associated with a SBP ≥ 60 mmHg was 20 cm/s (area under the curve = 0.975). To detect SBP ≥ 60 mmHg, accuracy of a PSV ≥ 20 cm/s was higher than manual palpation (91.4% vs. 66.2%; p < 0.001). CONCLUSIONS: Among ED cardiac arrest patients, femoral artery Doppler ultrasound was more accurate than manual palpation for detecting any pulse. When using a PSV ≥ 20 cm/s, Doppler ultrasound was also more accurate for detecting a SBP ≥ 60 mmHg.

Case report: transient small bowel intussusception presenting as right lower quadrant pain in a 6-year-old male.

In children presenting to the emergency room with right lower quadrant pain, ultrasound is the preferred initial modality. In our patient, a 6-year-old male with a sudden onset of severe right lower quadrant pain, the differential is broad, including appendicitis and intussusception. In order to narrow our differential and secure the diagnosis, our first modality was ultrasonography. With the increased use of point-of-care ultrasound in the emergency department, the diagnosis of appendicitis and ileo-colic intussusception has been made more frequently. In addition, other entities such as transient small bowel intussusception may be identified. As in our case, obstruction secondary to intussusception must be ruled out with observation, serial abdominal exams, clinical improvement, or further imaging.

Myocardial heat shock protein 70 expression in young and old rats after identical exercise programs.

Synthesis of inducible heat shock protein 70 (HSP70) is impaired in aged animals following acute stresses including exercise. In this study we determined whether aging affects expression of this cytoprotective protein following chronic exercise participation. Male Fischer 344 rats, final ages 6 and 24 months, exercised identically for 10 weeks on a treadmill (15 degrees incline, 15 m/min for up to 60 minutes, 5 days/week). In 6-month-old animals, exercise increased HSP70 in heart (44%), liver (216%), and skeletal muscle (126%) (p <.05 vs sedentary). In 24-month-old animals, exercise increased HSP70 in muscle (69%), but not in heart or liver. In heart, antioxidant enzyme activities and HSP70 messenger RNA were measured and found to be unaffected by exercise at both ages. Our results indicate an age-related decrease in HSP70 production in heart and liver following chronic exercise. Furthermore, the aged heart does not increase its antioxidant enzyme defenses to compensate for the HSP70 deficit.

Effect of exercise, heat stress, and hydration on immune cell number and function.

PURPOSE: The purpose of this study was to determine the effect of thermal stress and hydration status on immune function during exercise. METHODS: Ten trained men completed four cycle ergometer rides at 55% VO2peak under the following conditions: EN (euhydrated neutral; 22 degrees C, 30% RH), DN (dehydrated neutral), EH (euhydrated hot; 38 degrees C, 45% RH), and DH (dehydrated hot). During EN and EH, a carbohydrate/electrolyte beverage was consumed at a rate matching sweat loss, and during DN and DH, no fluid was ingested. Blood samples were drawn pre- and postexercise, and at 2 and 24 h of recovery. Cell counts were determined by automated counting and flow cytometry. Neutrophil activity was assessed as superoxide production, lymphocyte function was determined via PHA-stimulated mitogenesis, and natural killer (NK) cell activity was measured with a 51Cr-release assay. Cortisol was assayed via RIA. RESULTS: Lymphocytes proliferation was depressed 2 h after exercise in all conditions (P < 0.05); however, when expressed on a per cell basis, function was greater in the DH and EH conditions. NK activity (max x 10(3) cells) was greater post compared with preexercise in all conditions (EH = 25.5 +/- 16.8, DH = 26.2 +/- 10.5, EN = 19.3 +/- 11.0, and DN = 16.5 +/- 8.7) but was not different between conditions. Leukocyte, neutrophil, lymphocyte, and NK cell counts were also elevated postexercise with the former two remaining elevated 2 h postexercise in the EH and DH conditions. Cortisol was greater postexercise in EH (22.1 +/- 1.3) and DH (27.7 +/- 1.3) compared with EN (17.8 +/- 2.1) and DN (18.9 +/- 1.6 microg x dL(-1). CONCLUSION: Euhydration did not affect cell number or function when compared with a dehydrated state; however, the hot environment caused more severe disturbances in these measures compared with a neutral environment.