ABSTRACT
Early predictors of prognosis in comatose patients post cardiac arrest help inform decisions surrounding continuation or withdrawal of treatment and provide a framework on which to better inform relatives of the likely outcome. Markers defined prior to the widespread use of therapeutic hypothermia post arrest may no longer be reliable and an up-to-date analysis of the literature is presented.
Subject(s)
Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/etiology , Coma , Out-of-Hospital Cardiac Arrest/complications , Out-of-Hospital Cardiac Arrest/physiopathology , Persistent Vegetative State/diagnosis , Persistent Vegetative State/etiology , Brain Damage, Chronic/physiopathology , Brain Damage, Chronic/therapy , Clinical Decision-Making , Coma/physiopathology , Electroencephalography/statistics & numerical data , Family/psychology , Humans , Hypothermia, Induced/statistics & numerical data , Medical Futility/psychology , Out-of-Hospital Cardiac Arrest/therapy , Persistent Vegetative State/physiopathology , Predictive Value of Tests , Prognosis , Recovery of Function , Survival RateABSTRACT
Type A aortic dissection is a life-threatening event to both mother and baby, and accounted for 14% of maternal cardiac deaths in the 2006-2008 UK Confidential Enquiries into Maternal Deaths. Difficulty exists in the diagnosis of this rare but potentially curable condition, the mortality of which increases with delay in diagnosis. We present a case of acute type A aortic dissection in a previously well multiparous woman, treated successfully by aortic root repair immediately following caesarean section. The acute presentation of aortic dissection and diagnostic clues that may have expedited the diagnosis are discussed. A brief literature review is presented of the perioperative management of patients undergoing cardiothoracic surgery post-caesarean section and the modifications to standard techniques that are required.
Subject(s)
Aortic Aneurysm/surgery , Aortic Dissection/surgery , Pregnancy Complications, Cardiovascular/surgery , Adult , Cardiopulmonary Bypass , Cesarean Section , Female , Humans , PregnancyABSTRACT
Without sufficient greenhouse gases in the atmosphere, the early Earth would have become a permanently frozen planet because the young Sun was less luminous than it is today. Several resolutions to this faint young Sun-frozen Earth paradox have been proposed, with an atmosphere rich in CO2 being the one generally favored. However, these models assume that there were no mechanisms for melting a once frozen ocean. Here we show that bolide impacts between about 3.6 and 4.0 billion years ago could have episodically melted an ice-covered early ocean. Thaw-freeze cycles associated with bolide impacts could have been important for the initiation of abiotic reactions that gave rise to the first living organisms.