Category Archives: English

How does VSD (Ventricular Septal Defect) occur?

How does VSD (Ventricular Septal Defect) occur?

A VSD is the most common heart defect present at birth. It often occurs as a single defect with no known cause but is also found in children with multiple problems.

About one in three children with a heart abnormality discovered at birth has a VSD. VSDs account for one in five heart abnormalities found during childhood and for one in 10 found in adults.

A VSD may occur when a heart attack weakens the muscle of the septum. Blood pressure in the left ventricle breaks opens the weakened septum, pushing blood into the right ventricle through the new opening. Rarely, trauma to the heart may cause a VSD.

What is morbid obesity?

What is Morbid Obesity?

Morbid obesity is a disease of excess weight which is chronic and lifelong. Excessive fat storage results into morbid obesity which increases the BMI (Body Mass Index) beyond 35.

What is Body Mass Index (BMI)?

BMI or Body Mass Index is a measure of calculating a person’s excess weight. It is calculated by the following formula:

BMI = Weight (in Kilograms)/ Height (in Meters)2

Western Asian
Average built 21-25 18-22.5
Overweight 25-30 22.5-27.5
Obese 30-40 27.5-37.5
Morbidly obese <40 <37.5

How does morbid obesity differ from being overweight/obese?

  • Being overweight and obese are reversible conditions that can be treated by medical management whereas morbid obesity requires surgical intervention.
  • The body mechanisms that control a person’s weight are set in such a manner in the morbidly obese patient that they gain weight easily.
  • These patients find it difficult to lose weight and even more difficult to sustain.

 

Stroke

Stroke

All small or big recovery needs time and patience…!!

Stroke is also known as Brain Attack. Stroke means when a person may die due to lack of oxygen or caused by the blockage of blood flow or damage in any artery of the brain.  Lack of oxygen gives rise to death of brain cells. Thus affected area cannot work properly which might result in an inability to move limbs on one or more side of the body, inability to understand, speech problems, or an inability to see one or more side of the visual area. The risks for Brain Stroke are High blood pressure, eating tobacco, smoking, obesity, etc.

Brain Stroke is of two types:

  1. Ischemic Stroke: Ischemic clots are those when clots block the blood flow to the brain cells. These clots can form anywhere in brain’s blood vessels that lead to the brain.
  2. Hemorrhagic stroke: Hemorrhagic Strokes are those when a blood vessel in the brain breaks or ruptures. The result is blood seeping into the brain tissue, causing damage to brain cells.

BLOOD CANCER

BLOOD CANCER

We are only given today and never promised Tomorrow..!!!

Blood Cancer is a type of a Cancer which starts in the Bone where the Blood is produced. We have three types of Cells i.e. Red Blood Cells, White Blood Cells and Platelets. Blood Cancer starts due to uncontrolled growth of abnormal blood cells. This prevents the role or functions that fight against the infection or bacteria.

There are three types of Blood Cancer:

Leukemia is a type of Blood Cancer related to White Blood Cells wherein the infection blocks up the Bone Marrow thus prohibiting production of new red blood cells and platelets which plays an important role in making of healthy blood.

Lymphoma is a type of Blood Cancer which affects the lymphatic system, which helps to protect the body from infectious disease and is an important part of the immune system. Lymphocytes live longer, multiply and collect in your lymph nodes and other tissues resulting blocks in lymph fluids.

Myeloma is a type of Blood Cancer of plasma cells. Plasma Cells are found in the bone marrow which produces antibodies that fight against the infections. In Myeloma it produces abnormal cells which weaken our immune system and stops the production of Cells.

Tit Bits of Refractory hypoxemia & Journey of ventilator care

 

Much progress has been made in the treatment of neonatal respiratory failure over the past few decades. In particular, antenatal steroids and exogenous surfactant replacement have decreased neonatal mortality and morbidity in premature infants(2), (3), (4). However, lung injury and pulmonary morbidities secondary to mechanical ventilation remain an ongoing problem in the care of premature infants and refractory hypoxemia in infants. Of utmost concern, chronic lung disease (CLD) develops in up to one third of preterm infants who have respiratory distress syndrome (RDS) who receive positive pressure mechanical ventilation HFOV-data suggest that early use of high-frequency ventilation, compared with conventional ventilation; high-frequency oscillatory ventilation is not associated with a poorer neuromotor outcome, rather in few studies early use rather than rescue use has been proven to be having less neuromotor insult at 2 years follow up(1).

There are many randomized control trials available now in today’s era of evidence based medicine, which says improved gas exchange and less treatment failure with HFOV, both in the patients initially allocated to HFOV as a primary mode and in those that failed conventional CMV and crossed over to HFOV too. There was no difference in the incidence of chronic lung disease, IVH, or death between the HFOV & CMV but hospital stay and ICU stay was markedly reduced in HFOV Group(5). Cases like PPHN, air leak syndrome and Congenital diaphragmatic hernia (CDH) claim much better results and response with HFOV when used alone or with Nitric oxide therapy in selected scenarios.

 

In all of above mentioned 4 cases; a considerable benefit of capillary ABG Program was utilized. Capillary ABG for neonates is a well proven method in all developed countries as method of choice in doing ABG is these tiny babies avoiding multiple peripheral arterial pricks. Its unique feature of full panel ABG analysis with lactate and electrolytes in just 60 micro L blood, requiring no additional cost gives a relief to clinician as well as Neonate. Sooner As a next step CIMS kids-Department of pediatric and neonatal critical care is going to support such kind of above said neonates and infants with Nitric oxide therapy in near future.

References:-

  • Neuromotor outcome at 2 years of very preterm infants who were treated with high-frequency oscillatory ventilation or conventional ventilation for neonatal respiratory distress syndrome. Truffert P – Pediatrics – 01-APR-2007; 119(4): e860-5
  • Liggins G.C., Howie R.N.: A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 50. 515-525.1972; Citation
  • Crowley P.A.: Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to 1994. Am J ObstetGynecol 173. 322-335.1995;
  • Soll R.F.: Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2. 2000; CD000511
  • Clark R.H., Yoder B.A., Sell M.S.: Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr 124. 447-454.1993

CASE 1 (CIMS Neonatal & Paediatric Critical Care Services)

CIMS Neonatal & Paediatric Critical Care Services

We are sharing our use of SLE5000 (HFOV) with one of the most recommended technology which has unique feature of combining conventional mode with HFOV-providing ability to switch over to CMS to HFOV and vise versa.

Case 1 :

Diagnosis – Severe RDS (HMD) 26 weaker/900gms/male/aga with severe grunting presented at 32 hours of life with 60% Oxygen saturation and gasping respiration. Intubation was performed and ventilation was commenced (CMV).Child had extremely non compliant lungs with severe acidosis with Ph of 6.7 and Pco2 of 72 with Pao2 of 46.Rescue surfactant was given immediately but very transient response was achieved being late presentation. Commenced on HFOV with MAP of 18, Delta P of 40 and fio2 of 90 %. Gradually, child started improving lung recruitment was better on X-ray on day 3 of ventilation. Weaning was soon started with ABG analysis at 2,8,14 and 20 hours of starting HFOV and henceforth 8-12 hourly once ABG as per need clinically. On day (4) settings were minimal on HFOV with MAP of 10,Delta P of 25 and

Fi02 of 0.45.We switched over to CMV mode and continued weaning on traditional SIMV+PC mode for 3 days, sooner child was prepared for extubation which was successful.

Discussion –disease with Homogenous lung damage like HMD, ARDS can have best result with HFOV if used early in the setting how it was used in these patients. Newer Modalities and mode of HFOV like HFOV+CPAP is getting a wide acceptance during weaning of such patient and same was used in above patient for approximately 26 hours before extubation by Naso pharyngeal tube in situ. Recent data says that early and protocol based use of HFOV is not associated with any adverse outcome rather neurodevelopment is unaffected at all (1).

References:-

> Neuromotor outcome at 2 years of very preterm infants who were treated with high-frequency oscillatory ventilation or conventional ventilation for neonatal respiratory distress syndrome. Truffert P – Pediatrics – 01-APR-2007; 119(4): e860-5 (1)

> Soll R.F.: Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2. 2000; CD000511 (4)

 

 

 

 

 

CIMS Neonatal & Paediatric Critical Care Services

CIMS kids-Department of paediatric and neonatal critical care is committed to serve all kids who are in their critical phase of life during Treatment of various diseases requiring critical care. We share experience of HFOV in 4 extremely critical neonates and infants  where neonates/infants got excellent recovery in a significantly rapid time frame.

 

High Frequency ventilation- A name in paediatric critical care ; which drew lot of attention and proven its efficacy in extremely sick lungs due it’s unique feature of lung protective ventilation using very high respiratory rates (Between 3.5 to 15 hertz (210 – 900 breaths per minute) and very small tidal volumes (usually below anatomical dead space) by stretching alveoli at required PEEP.

Out of many type of HFV (High frequency ventilation); Oscillation is proven to be the best among other modes like HFJV (Jet), HFFI (Flow interruption). We are sharing our use of SLE5000 (HFOV) with one of the most recommended technology which has unique feature of combining conventional mode with HFOV-providing ability to switch over to CMS to HFOV and vise versa.

Which is specifically useful in neonatal patients in difficult weaning.

Where should it be used? : It is used in patients who have refractory hypoxemia that cannot be corrected by normal mechanical ventilation such as is the case in the following disease processes: i.e. HMD, Pneumothoraces (air leak), ARDS, ALI and other oxygenation diffusion issues i.e. RSV pneumonia, pulmonary hemorrhage etc. In some neonatal patients, HFOV may be used as the first-line ventilation mode due to the high susceptibility of the premature infant to lung injury from conventional ventilation.

 

More in next post..

How to perform CPR

How to perform CPR

The victim should lie on a flat, hard surface. The place should not be crowded.

 

Follow the Chain of survival

One thing to remember is, assuming that you are alone, when you find someone down, first establish if they really need CPR: are they breathing? do you see any signs of movement?

Remember to look, listen and feel, for any signs of movement, for breath sounds and for air movement by placing your ear over their mouth.

 

Fifteen Facts Every Family Should Know about CPR

Fifteen Facts Every Family Should Know about CPR

  1. No family can rely on 108 or emergency doctors alone. When someone stops breathing, or the heart stops beating, he or she can typically survive for only 4 to 6 minutes before lack of oxygen can result in brain damage or death. CPR can buy extra time until advanced help arrives by artificially circulating oxygen to the brain.
  2. Sudden cardiac arrest is the leading cause of death in adults. Most arrests occur outside the hospital. Immediate CPR doubles a person’s chance of survival from sudden cardiac arrest. Over 1.5 million heart attacks occur each year and approximately 350,000 of these people die before ever reaching a hospital.
  3. About 80 percent of all out-of-hospital cardiac arrests occur in private residential settings. So being trained to perform cardiopulmonary resuscitation (CPR) can mean the difference between life and death of your patient.
  4. The commonest heart rhythm in sudden cardiac arrest is ventricular fibrillation-the heartbeat becomes very fast and is arrhythmic. The only treatment for it is immediate shock (defibrillation), but CPR can provide trickle of blood to brain and heart and increase the chances of survival after normal rhythm is established.
  5. If CPR is started within 4 minutes of collapse and defibrillation provided within 10 minutes, a person has a 40% chance of survival. Over 70% of all cardiac and breathing emergencies occur at home when a family member is present and available to help a victim.
  6. Approximately, 95 % of sudden cardiac arrest victims die before reaching the hospital.
  7. CPR saves lives. Statistics show that the earlier CPR is initiated, the greater the chances of survival. In fact, it is estimated that 100,000 to 200,000 lives of adults and children could be saved each year if CPR were performed early enough.
  8. CPR is not just for heart attacks! Approximately 10 million adults and children suffer disabling injuries at home each year, resulting from accidents which may require CPR.
  9. Some of the common causes of “sudden death” that may require CPR include:
    • Electric Shock
    • Heart Attacks
    • Drowning
    • Severe Allergic Reactions
    • Choking
    • Drug Overdose
    • Suffocation
  10. The number 1 killers — a combination of heart attacks and accidents — claim a life every 10 seconds in India.
  11. One in five men and women aged 45 and above (20 % of adults) have had a heart attack or stroke. Approximately, 50% of all heart attacks occur in people under age 65.
  12. One in ten people have the opportunity to use CPR in their lifetime.
  13. One thing you need to remember is, in case of an adult he or she always needs a shock to the heart as soon as possible, because they have most likely suffered from a heart attack.
  14. In case of infants and children, it is rarely a heart attack. They mostly need air, because as we all know, the young ones tend to put anything and everything into their mouths and proceed to choke on it.
  15. After sudden cardiac arrest Brain Damage Time Table….

     

    0 Minutes Breathing stops. Heart will soon stop
    beating
    0-4 Minutes Clinical Death
    4-6 Minutes Brain Damage Possible
    4+ Minutes Biological Death
    6-10 Minutes Brain Damage Likely
    10 + Minutes Brain Damage

Cardiopulmonary Resuscitation (CPR)

What is CPR?

Cardiopulmonary resuscitation (CPR) is an emergency technique used to treat patients who have gone into sudden cardiac arrest. CPR can be performed by a health care professional or by a trained lay person. CPR is conducted until a person receives more advanced emergency care.

Performed immediately, CPR increases a person’s likelihood of survival by more than 40 %.

 

Sudden cardio-pulmonary arrest is a condition where a patient stops breathing on his own and/or heart stops beating normally and blood circulation to body parts stops. Permanent brain damage or death can occur within minutes if blood flow stops. Therefore, it is critical that blood flow and breathing be continued until trained medical help arrives.

The Importance of CPR

The goal of CPR and first aid training is to educate about the skills required to save lives along with prevention and safety that would greatly reduce risks of numerous preventable accidents.

Being ready for emergencies like stroke, cardiac arrest, choking, or heart attack can increase a victim’s chances for survival if one has the knowledge and training for CPR and first aid.

Knowing how to conduct CPR and initiate it increases the survival time of a victim until advanced medical help or Emergency Medical Services (EMS) or Ambulance arrives.

More on CPR in a next post.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CIMS GlobL Healthcare Excellence Awards 2018

October 30, 2018
CIMS Family is honoured to be the recipient of “Among Best Hospital (Cardiology & Oncology) in Gujarat” on October 27, 2018 at the “Prime Time Global Healthcare Excellence Awards 2018”, New Delhi. A very special thanks to our CIMS Staff for their commitment and the patients who have always trusted us. CIMS GlobL Healthcare Excellence Awards 2018

CIMS Hospital has been awarded the Certificate of Excellence as the Best Multispecialty Hospital in Gujarat

August 31, 2018
We proudly announce that CIMS Hospital has been awarded the Certificate of Excellence as the Best Multispecialty Hospital in Gujarat at the International Healthcare Awards, 2018 held in Delhi. The Award is a testimony to the hard work and dedication of the entire CIMS Family which has inspired trust in us leading to rising patient volumes.

Certificate course in EMG & NCV Technology

May 15, 2018

Renal Transplant (CIMS/RIC/2018/09) on 15/05/2018

May 15, 2018
Renal Transplant is done on 15/05/2018, which was approved by Hospital based Ethical committee and Government Authorization committee. Relationship between Donor and Recipient : Wife - Husband

We are proud to announce that CIMS Hospital has been recognized as the Times Health Icon 2018 in 2 categories

March 19, 2018
We are proud to announce that CIMS Hospital has been recognized as the Times Health Icon 2018 in 2 categories Multispecialty Hospital- Oncology and Multispecialty Hospital-Critical Care.

CIMS Heart Transplant Team completes another successful Heart Transplant on 06-02-2018, 5th row in a short term.

February 8, 2018

Felicitation Ceremony of Heart Transplant Donors and Recipients held in the presence of Honorable Chief Minister of Gujarat, Shri Vijay Rupani, CIMS cardiac and heart tranplantation doctors by CIMS Hospital.

January 12, 2018
Felicitation Ceremony of Heart Transplant Donors and Recipients held in the presence of Honorable Chief Minister of Gujarat, Shri Vijay Rupani, CIMS cardiac and heart tranplantation doctors by CIMS Hospital.