100 Black Men Revamp Med School Summer Camp

100 Black Men Revamp Med School Summer Camp

To saline or not to saline

Is it really benefical to instill 3 cc of mucomyst into and endotracheal tube and then suction the solution immediately after the instillation? What the heck is going on with that?

Let's take a look at Mucomyst (N-acetylcyteine): N-acetylcyteine is a derivative of a naturally occuring amino acid, L-cysteine and it contains sulfhydryl group (-SH) which have the ability to cleave disulfide bonds in proteins. The most important variables at affect the mucolytic and proteolytic effects of Mucomyst at pH and time of incubation. Studies demonstrate that there is about a 20% improvement in the effectiveness of Mucomyst when the pH is 8.0 - 9.0 as compared to a pH below 7.5 with an incubation period of 60 minutes.

Read the article: Clinical Experiences with Acetylcysteine as a Mucolvtic Agent.

Respiratory Pharmacology made easy

http://ppahs.org/2014/05/08/harold-oglesby-noted-opioid-safety-expert-and-patient-safety-advocate-joins-physician-patient-alliance-for-health-safety-advisory-board/

Fiducial Placement and Pleural Dye Marking wtih ENB

http://www.youtube.com/watch?v=0YbZDYR1zl4&feature=related

STEREOTACTIC RADIOTHERAPY

WITH REAL-TIME TUMOR TRACKING

FOR NON-SMALL CELL LUNG

CANCER: CLINICAL OUTCOME

 

NC van der Voort van Zyp, J-B Prevost, MS Hoogeman,

J Praag, B van der Holt, PC Levendag, RJ van Klaveren,

P Pattynama, JJ Nuyttens




Purpose

To report the clinical outcome of treatment using real-time tumor tracking for 70 patients

with inoperable stage I non-small cell lung cancer (NSCLC).

Methods

Seventy inoperable patients with peripherally located early stage NSCLC were treated with

45 or 60 Gy in 3 fractions using the CyberKnife. Pathology was available in 51% of patients.

Thirty-nine patients had a T1-tumor and thirty-one had a T2-tumor. Markers were placed

using the vascular, percutaneous intra-, or extra-pulmonary approach, depending on the risk

of pneumothorax.

Results

The actuarial 2-year local control rate for patients treated with 60 Gy was 96%, compared

to 78% for patients treated with a total dose of 45 Gy (p=0.197). All local recurrences (n=4)

occurred in patients with T2-tumors. Overall survival for the whole group at two years was

62% and the cause speci

fi c survival was 85%. The median follow-up was 15 months. Grade

3 toxicity occurred in two patients (3%) after marker placement. Treatment-related late grade

3 toxicity occurred in 7 patients (10%). No grade 4 or 5 toxicity occurred.

Conclusion

Excellent local control of 96% at 1- and 2-years was achieved using 60 Gy in 3 fractions for

NSCLC patients treated with the real-time tumor tracking. Toxicity was low.

Curosurf admin

http://www.youtube.com/watch?v=c7XoHIjMtm0

APRV Ventilation Part 1

ARPV Ventilation Part2

APRV ventilation 3

Medscape Hematology-Oncology Expert Column

From Medscape Hematology-Oncology Expert Column

Clinical and Molecular Biomarkers in Non-Small-Cell Lung Cancer
Posted 10/29/2008
Vincent Miller, MD; Trever Bivona, MD, PhDAuthor Information

Abstract
Recent advances in understanding the molecular basis of non-small-cell lung cancer (NSCLC) have heralded a revolution in personalized cancer medicine predicated on the detection and therapeutic exploitation of somatically mutated alleles of critical oncogenes such as the epidermal growth factor receptor (EGFR). This review summarizes an emerging paradigm for genome- and pathway-based molecular biomarkers whose goal is individualized clinical deployment of agents that modulate aberrant signal transduction pathways driving lung carcinogenesis. As such, these strategies hold promise for significantly improved survival in patients with NSCLC.
Introduction
NSCLC is the leading cause of cancer mortality in the United States and is histologically subdivided into adenocarcinoma, squamous-cell carcinoma, and large-cell carcinoma.[1] Adenocarcinoma, the most frequent subtype of NSCLC, is further subclassified as papillary, acinar, solid, or mixed subtype, with most tumors containing significant proportions of more than 1 subtype. The clinical, radiographic, and histopathologic heterogeneity of lung adenocarcinomas makes it imperative that molecular tests are developed that allow better classification of this disease and, in turn, therapies geared to individuals or subgroups of patients rather than continued empiricism.
For those diagnosed with advanced NSCLC, cytotoxic chemotherapy, when administered to chemotherapy-naive patients, extends median survival from 4 months without treatment to approximately 12 months.[2] The real but modest improvements in clinical outcome with cytotoxic chemotherapy provided, in part, the impetus for more detailed understanding of the molecular underpinnings of lung adenocarcinoma and the therapeutic development of targeted small-molecule inhibitors. Large-scale collaborative efforts such as the human genome project, cancer genome atlas sequencing project, and the lung cancer tumor sequencing projects have yielded insight into genomic alterations in tumors, thus identifying potential diagnostic and therapeutic targets[3]; among those targets identified is EGFR. The recognition that kinase inhibitors of EGFR are effective in patients harboring clinical and molecular predictive biomarkers has revolutionized the management of NSCLC. As such, the management of NSCLC exemplifies an emerging paradigm for personalized cancer medicine, relying upon the employment of biomarkers for tailored therapy.

Full article at http://www.medscape.com/viewarticle/582340_2

Lung Cancer

A moving tribute:

Intubation w/ glidescope

Lung recruitment

Introduction to BiPAP

LMA insertion

Bronchoscopy

www.thoracic-anaesthesia.com

Check out this bronchoscopy simulator at www.throacic-anesthesia.com

Its very interesting.

CEU Credits

The Essentials to Eliminating Bad Bugs
1 CEU credit
January 28, 2009
2-3pm ET
www.premeirinc.com/about/events-education/advisorlive/index.jsp

A very interesting article to review:

The use Esophageal Pressure to Titrate PEEP in the Treatment of Acute Lung Injury
www.medscape.com/viewarticle/58476

MEDSCAPE.COM CME CREDITS:

Inhaled Corticosteriods May Not Reduce Mortality in COPD
http://cme.medscape.com/viewarticle/584132

Silver-Coated Endotracheal Tube Reduces Risk for Ventilator-Associated Pneumonia
http://cme.medscape.com/viewarticle/579239

New Guidelines Intergrate palliative with Standard Care for Respiratory Disease
http://cme.medscape.com/viewarticle/573150

Impact of Cancers and Cardiovascular Diseases in Chronic Obstructive Pulmonary Disease
http://cme.medscape.com/viewarticle/18810

Upcoming Pulmonary Health Seminar

The Pulmonary Health Seminar will take place: September 20, 2008 at 0730 in the Marsh Auditorium. Several excellent speakers are scheduled to present including the following:

M. Douglas Mullins, MD
Interventional Bronchoscopy Case presentations

Bonnie Entwistle, RN, BSN
EtCO2 Monitoring During Procedural Sedation

Rita Allen, RN BSN
Methods to decrease infection rates in a critical care unit.

Gifford Lorenz, MD.
Pulmonary Exercise Testing: Why do it and what the numbers mean.


Paul Garbarini, MS, RRT
Are your patients at risk?

This program has been approved for 6.25 contact hours Continuing Respiratory Care Education (CRCE) credit by the American Association for Respiratory Care, 9425 N. MacArthur Blvd. Suite 100 Irving, TX 75063

This continuing nursing education activity was approved by the Georgia Nurses Association, an accrediated approver by the American Credentialing Center's Commission on Accreditation. 6.2 contact hours.

The Pulmonary Health Seminar will be free to all St. Joseph’s/Candler Health Employees, but pre-registration will be required by all attendees.

Clinical Ladder Program

Clinical Career Ladder

Any respiratory therapist may apply for acceptance into the Clinical ladder program. The respiratory therapist will be responsible to determine for which level he/she qualifies based on the ‘Universal and Rung Specific Requirements’

Universal requirements:
Current BLS, ACLS, PALS, and NRP
AARC membership
Prior Annual evaluation score = successful or outstanding
Completion of annual competency program
Competency exam score of 85% or higher
Participation in at least two approved department Performance Improvement Projects
(large PI projects may be shared by multiple therapists with Clinical Ladder Committee approval)
No written disciplinary actions within the prior year.

Rung 1
Min. CRT/CRTT
Experience > 1 yr w/ SJCHS
CEUS/ year 18
Skills: Trained for adult and neonatal intubation, assist with two departmental performance improvement projects.

Rung 2
Min. CRT + 1 additional certification (RRT, CPFT, RFPT, Perinatal/Pedi/,AC-E
Experience > 2 years w/ SJCHS
CEU/Year 21
Projects: assist w/ two department performance improvement projects plus one program from the list below
Skills: Successful demonstration of Arterial line insertion, intubation, ICU trained or Peds/L&D/Nsy trained.

Rung 3
Min RRT + 1 additional certification
(CPFT, RPFT, Perinatal/Pedi, AE-C
CEUs/Year; 25
Skills: Advanced airway management, assist bedside bronchoscopy, hemodynamic course completion, ekg class completion
Project: two programs form the list

The Clinical Ladder Program is designed to recognize and reward licensed Respiratory Therapist, practicing at the bedside, as clinical and professional excellence is achieved. The applicant must be employed on a full or part-time (>30/wk) basis at St. Joseph’s/Candler 1 year prior to applying to the Clinical ladder. The applicant must have been employment by Candler Health System within the Respiratory Therapy Department.