2009 Oct 20 - Tutorial: HELLP Syndrome
Organised by the Hong Kong College of Physicians, Date : 20 October 2009, Venue : AG Seminar Room, Queen Elizabeth Hospital; Speaker : Dr CHAN Wan Pang, Consultant(O&G), PMH; Chairman : Dr TONG Chak KwanSenior Medical Officer(ICU), PMH
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2009 Jun 16 - Tutorial: Endocrine Emergency in ICU: Update on Management
CCM Specialty Board Tutorial at Queen Elizabeth Hospital, 16 June 2009
Speaker : Dr HO Yiu Yan, AndrewAssociate Consultant(M&G), TMH; Chairman: Dr LEE Wai ChuenDate : 16 June 2009; Time : 6:00pm to 8:00pm; Venue : AG Seminar Room, Queen Elizabeth Hospital
2009 Oct 20 - Tutorial: Hypertensive Complications of Pregnancy and Obstetric Aspect of Cardiopulmonary Resuscitation in Pregnancy
Organised by the Hong Kong College of Physicians
Date : 20 October 2009
Venue : AG Seminar Room, Queen Elizabeth Hospital
Speaker : Dr CHAN Wan PangConsultant(O&G), PMH
Chairman : Dr TONG Chak KwanSenior Medical Officer(ICU), PMH
Click Read More to download the presentation file2009 Dec 29 - Tutorial: The management of liver failure and complications of liver transplant
Organised by the Hong Kong College of Physicians
Date : 29 December 2009; Venue : AG Seminar Room, Queen Elizabeth Hospital
Speaker : Dr Alexander CHIU, Specialist in CCM, QMH
Chairman : Dr SO Sheung On, Senior Medical Officer (ICU),KWH
Figure. A patient on Molecular Adsorbent Recirculation System (MARS) in Queen Mary Hospital
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2009 Dec 29 - Tutorial: Critical care pearls in management of massive haemoptysis
Organised by the Hong Kong College of Physicians
Date : 29 December 2009; Venue : AG Seminar Room, Queen Elizabeth Hospital
Speaker : Dr TONG Wing Lok, Associate Consultant (ICU), KWH
Chairman : Dr SO Sheung On, Senior Medical Officer (ICU),KWH
Figure. A right-sided double-lumen endobronchial tube
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2009 Nov 17 - Grand Round: I Can Breath But Not See
Organised by the HKSCCM & HKACC
The HKSCCM/HKACCN Interhospital Grand Round; Date: 17th November 2009
Presenter and Chairman: Dr CHAN Ka Hing Jacky and Dr CHING Chi Keung, Tseung Kwan O Hospital
Left: Dr CHAN Ka Hing Jacky, Right: Dr CHING Chi Keung
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2009 Nov 17 - Grand Round: A Limping Girl Who is Getting Dyspnoeic
Organised by the HKSCCM & HKACC
The HKSCCM/HKACCN Interhospital Grand Round; Date: 17th November 2009
Presenters: Dr HO Ka Yee, Jasperine, and Dr TANG Kam Shing, Tuen Mun Hospital
Left: Dr TANG Kam Shing, Right: Dr Ho Ka Yee Jasperine
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2009 Aug 18 - Hypothermia and Heat Stroke
Figure. The Osborne J wave in hypothermia
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2009 Aug 18 - Tutorial: Poisoning
Chairman: Dr CHOW Fu Loi, Consultant(ICU), CMC
Presentation file available for download. Click Read More
2009 Sep 22 - Grand Round: Breathe Without Lungs (ICU, Pamela Youde Nethersole Eastern Hospital)
Presentation file available for download!
Dr KWAN Ming Chit, Arthur, ICU, Pamela Youde Nethersole Eastern Hospital
2009 Sep 22 - Grand Round: A Sleepy Man (ICU, North District Hospital)
Presentation file available for download!
Dr HO Chun Ming, ICU, North District Hospital
2009 Jul 21 - Grand Round: Dive for Life
Lecture: 6:00pm to 7:00pm
Speaker: Dr CHAN Chin Pang, lan, Resident Specialist (M&G), UCH
Chairmen: Dr LEE Kar Lung, Senior Medical Officer (ICU), UCH
Presentation file available for download.
2009 Jul 21 - Grand Round: If a patient with a Medical Disease was admitted to a Surgical Ward
Speaker: Dr NGAI Chun Wai, Wallace; Resident (AICU), QMH
Chairman: Dr CHAN Wai Ming, Consultant (AICU), QMH
Date: 21 July 2009; Time: 1800 - 2000; Venue: Queen Elizabeth Hospital
Presentation file available for download.
2009 May 19 - Grand Round: Echinocandin in the ICU – A clinical and pharmacoeconomics advance
Speaker: Dr. Coleman ROTSTEIN; Professor of Medicine, University of Toronto, Canada
Chairperson: Dr. Pik-Kei Osburga CHAN; Associate Consultant (ICU), QEH
Date and Time: Tuesday, 19 May 2009, 6:00pm - 8:00pm
Location: Lecture theatre, M Block, Queen Elizabeth Hospital
Prof Coleman ROTSTEIN
Presentation file available for download, click Read More!
2009 Apr 29 - Tutorial: Abdominal Trauma: Current Management
Date : 29 April 09; Time : 6:00pm to 8:00pm; Venue : AG Seminar Room, Queen Elizabeth Hospital
Chairman : Dr TANG Kam Shing, Associate Consultant (ICU), TMH
Speakers: Dr TANG Kam Shing, Dr WONG Wai Man
CME Point:
College of Physicians : 2 CME point (Tutorial: 6:00pm to 8:00pm)
College of Anaesthesiologists 2 CME point (Tutorial: 6:00pm to 8:00pm)
NEW! Presentation file of Dr WONG Wai Man available for download.
2009 May 19 - Grand Round: Fungal Infections in ICU
Speaker: Dr IP Kam Yuen Danny; Resident(Anaes.); Queen Elizabeth Hospital, Hong Kong
Chairperson: Dr. Pik-Kei Osburga CHAN; Associate Consultant (ICU), QEH
Date and Time: Tuesday, 19 May 2009, 6:00pm - 8:00pm
Location: Lecture theatre, M Block, Queen Elizabeth Hospital
Dr KY Ip
Presentation file available for download, click Read More!
2009 Apr 29 - Tutorial: Ventilator-Patient Interactions
Date : 29 April 09; Time : 6:00pm to 8:00pm; Venue : AG Seminar Room, Queen Elizabeth Hospital
Chairman : Dr TANG Kam Shing, Associate Consultant (ICU), TMH
Speakers: Dr TANG Kam Shing, Dr WONG Wai Man
CME Point:
College of Physicians : 2 CME point (Tutorial: 6:00pm to 8:00pm)
College of Anaesthesiologists 2 CME point (Tutorial: 6:00pm to 8:00pm)
Presentation file available for download.
2009 Mar 17 - Grand Round: Somebody Like Blue … - Two Cases of Poisoning
CCM Interhospital Meeting
Speaker: Dr CHAN Yuen Sze, Christina; Resident (ICU), Princess Margaret Hospital
Chairman: Dr TSANG Hin Hung; Senior Medical Officer (ICU), Kwong Wah Hospital
Date and Time: Tuesday, 17 March 2009, 6:00pm - 8:00pm
Location: Lecture theatre, M Block, Queen Elizabeth Hospital
2009 Mar 17 - Grand Round: The Key to Survival
Date and Time: Tuesday, 17 March 2009, 6:00pm - 8:00pm
Location: Lecture theatre, M Block, Queen Elizabeth Hospital
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Abstract
Among post-cardiac arrest victims, the survival rate remained low despite recent advancement in basic life support and advanced life support. The in-hospital mortality rate ranged from 65-75% in Western countries.
Post-cardiac arrest syndrome was recognized after resumption of spontaneous circulation which was an unnatural pathophysiological state after successful cardiopulmonary resuscitation. The syndrome is composed of myocardial dysfunction, brain dysfunction, ischemia/reperfusion injury and underlying pathology that precipitating cardiac arrest.
Myocardial dysfunction is a stunning phenomenon which was responsive to treatment and reversible within days. Neuronal injury is selectively located at cerebral cortex, cerebellum, thalamus and hippocampus. A variety of cell death signaling pathways can execute over hours to days after cardiac arrest despite the predominant pathway causing brain injury remained controversial. Immunological heightening, endothelial damage, abnormal coagulopathy and hypercytokinemia in ischemia/reperfusion injury resemble severe septic shock, and victims are at risk of multiple organs failure and infection.
Post-cardiac arrest care is a time-sensitive issue, both inside and outside hospital. The care focuses on reversing the pathophysiological manifestations of the post- cardiac arrest syndrome with proper prioritization. Optimization of post-cardiac arrest care aims at improving survival and neurological outcome.
Concept of early-directed goal hemodynamic optimization after cardiac arrest is emerging to optimize the restoration and balance of oxygen delivery and demand. This concept is in close analogy to Rivers' early goal directed therapy in septic shock.
Early percutaneous cardiac intervention to coronary artery is advisable if coronary artery disease is the culprit of cardiac arrest. The evidence-based therapy in improving outcomes in post-cardiac arrest victims is therapeutic mild hypothermia. Cooling to 32-34C for 12-24 hours in selective patients improved survival and neurological recovery. However, ideal candidate, technique, target temperature, duration, and rewarming rate had not yet established. How hypothermia affects the outcome prediction of comatous survivors needs further investigation.
No well-designed clinical study on optimal glycemic control addressed to post-cardiac arrest patient specifically, although tight glycemic control in studies by Van den Bergh showed better survival outcome in ICU patients. Modest glycemic control (6-8mmol/L) is considered as the clinical bottom line without frequent hypoglycemia.
Bundle care to patients including airways and ventilation management, early-goal directed hemodynamic optimization, early reperfusion, control body temperature, blood glucose and seizure is the key to manage post-cardiac arrest patients.
References
Post-Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication. Circulation. 2008;118:2452-2483
Wilhelm Behringer. Prevention and therapy of postresuscitation neurologic Dysfunction. Current Opinion in Critical Care 2008, 14:305-310
Laurent I et al. Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 2002; 40:2110-2116
F. Gaieski et al. Early goal-directed hemodynamic optimization combined
with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac
arrest. Resuscitation 2009;80: 418-424
Knafelj R et al. Primary percutaneous coronary intervention and mild induced hypothermia in comatose survivors of ventricular fibrillation with ST-elevation acute myocardial infarction. Resuscitation 2007; 74:227-234
P Garot et al. Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction. Circulation 2007;115:1354-1362
Vojka Gorjup et al. Acute ST-elevation myocardial infarction after successful cardiopulmonary resuscitation. Resuscitation 2007; 72: 379-385
Zeiner A et al. Hyperthermia After Cardiac Arrest Is Associated With an Unfavorable Neurologic Outcome. Arch Intern Med.2001;161:2007-2012
Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. NEJM 2002;346(8): 549-556.
Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of
out-of-hospital cardiac arrest with induced hypothermia.
NEJM 2002;346:557-563.
Oddo M et al. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med 2006; 34:1865-1873
Michael Holzer et al. Hypothermia for neuroprotection after cardiac arrest: Systematic review and individual patient data meta-analysis
Crit Care Med 2005; 33:414 -418
Van den Berghe G et al. Intensive insulin therapy in critically ill patients. NEJM 2001;34(19) 1359-1367
Van den Berghe et al. Intensive Insulin Therapy in the Medical ICU
NEJM 2006; 354 (5) 449-461
Losert H, Sterz F, Roine RO, et al. Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12 h after cardiac arrest might not be necessary. Resuscitation 2008; 76:214-220
Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med 2007; 35:2262-2267
Tuomas Oksanen et al. Strict versus moderate glucose control after resuscitation from ventricular fibrillation. Intensive Care Med 2007;33: 2093-2100
Sunde et al. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007;73:29-39
Wijdicks et al. Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation Neurology 2006;67:203-210
R G. Geocadin et al. Cardiac arrest resuscitation: neurologic prognostication and brain death. Current Opinion in Critical Care 2008, 14:261-268
E. Al Thenayan et al. Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest. Neurology 2008;71:1535-1537
Dr Tong Wing Lok
2009 Feb 10 - Tutorial: Scoring Systems in ICU
Dr YAN Wing Wa, ICU, PYNEH, Hong Kong
Presented on 10 Feb 2009 at Queen Elizabeth Hospital
Download presentation file here.
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Date
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10 February 2009
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Time
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6:00pm to 8:00pm
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Venue
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AG Seminar Room,
Queen Elizabeth Hospital
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Tutorial
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6:00pm to 7:00pm
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Topic
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Scoring Systems in ICU |
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Speaker
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Dr YAN Wing Wa
Consultant(ICU), PYNEH
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Tutorial
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7:00pm to 8:00pm
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Topic
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Infection control issues
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Speaker
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Dr LEUNG Wai Shing
ID specialist (Path) KWH
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Chairman
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Dr SO Sheung On
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Senior Medical Officer (ICU), KWH
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CME Point
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College of Physicians
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2 CME point (Tutorial: 6:00pm to 8:00pm)
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College of Anaesthesiologists
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2 CME point (Tutorial: 6:00pm to 8:00pm)
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