"Kcentra" approved for Reversing Coumadin

FDA approved "Kcentra" for reversing Coumadin in adults with acute major bleeding. Plasma is the only agent approved thus far.

It is a human prothrombin complex concentrate prepared from pooled donors.

Link to FDA announcement.

EKG: Apparent Atrial Flutter (Artifact due to muscle tremor)

13 yr old girl, transferred to ICU for Atrial Flutter noted in the trace below. She also had muscle tremors and neurologically obtunded. EKG & Pulse oximeter trace on in the upper panel.

(Click on the image to enlarge)

The following Doppler trace was obtained by placing the sampling cursor midway between Mitral inflow and Aortic outflow (2D image is upside down as is the standard in adult cardiology). There is one-to-one correspondence of mitral inflow to aortic outflow indicating lack of Atrial flutter with 2:1 or 3:1 conduction. Conclusion: Sinus tachycardia. When muscle tremors subsided, the baseline was normal with small P waves (& QRS complexes) were noted due to a concomittant pericardial effusion.

ICU Monitor: Freeze Frame Function to analyze traces

(Click on the image to enlarge)

When you want to analyze a trace i.e. identify the waves in a CVP trace, you can use the "Freeze" function. The "frozen" traces have a vertical, dotted line at every second. These lines coincide between traces, enabling you compare the EKG trace, Arterial trace and CVP trace. These can be used to identify the waves in CVP trace.

In this example, CVP trace has taller v wave compared to a wave. v wave corresponds to the peak of arterial trace - i.e. ventricular systole. Note: Arterial ejection peak is somewhat delayed from the electrical systole (QRS complex) due to the delay between electrical systole and mechanical systole and a slight delay in arrival of the peak of arterial trace to the femoral artery and right radial artery. (In this panel, trace labelled ABP is right radial artery line and the trace labelled ART is left femoral line).

Quiz: EKG, Postop. Repair of AVSD

5 mo old, Postop. day 3 after AVSD repair.
(Click on the image to enlarge)

1) What is different between first half and second half of the EKG trace?

2) What type of pacing is being done?

3) What is the pacing rate?

4) What is the atrial rate?

5) What is the native ventricular rate?

6) What is the diagnosis for the underlying rhythm?