A 17-month-old infant with multiple aorto-pulmonary collateral arteries (MAPCAs) and pulmonary hypertension presented for diagnostic catheterization. On the day of the procedure, the infant was asymptomatic with oxygen saturation in the 90’s on 1.0 L/min O2 nasal cannula. His parents denied any recent illness. During the procedure, one coil was inadvertently embolized into the right lung result...

Background: Transcutaneous CO2 monitoring presents an opportunity for Paco2 measurement in the presence of inaccurate or absence end-tidal (ETCO2) monitoring. Whilst it is regularly used neonates to prevent frequent blood sampling, seldom adult anaesthesia intensive care medicine. We demonstrate three clinical examples using transcutaneous (TCM) where gas sampling ETCO2 was either unavailable c...

Monitoring is a routine part of emergency department (ED) care. From vital sign measurement to the provision of critical care, monitoring physiologic function provides clinicians with potentially relevant clinical information as a “snapshot” in time or in continuous fashion. In the former case, it allows for screening and triage, and in the latter, it allows for ongoing evaluation of response t...

OBJECTIVE Endotracheal intubation of newborn infants is a mandatory competence for many pediatric trainees. The Neonatal Resuscitation Program recommends a 20-second limit for intubation attempts. Intubation attempts by junior doctors are frequently unsuccessful, and many infants are intubated between 20 and 30 seconds without apparent adverse effect. Little is known about the proficiency of mo...

A 72 year-old woman with cholangiocarcinoma presented for endoscopic retrograde cholangio pancreatography (ERCP) for diagnostic intraductal endoscopy under GETA. During the technically difficult procedure the patient became suddenly hypoxic, hypotensive, bradycardic, and progressed to PEA code (ETCO2 5 mmHg). ACLS was initiated. Transesophageal echo demonstrated massive right heart air accumula...

Continuous monitoring of mixed venous oxygen saturation (SvO2) and arterial oxygen saturation (SaO2) was used to guide cardiovascular and pulmonary physiologic manipulations in three patients. An index, termed the "shunt index" (SI), of venoarterial admixture (Qva/Qt) was calculated at the bedside. SI correlated significantly in each patient with Qva/Qt (p less than .01). In one of the patients...