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This book is a dedicated resource for those sitting the Part A of the MCEM (Membership of the College of Emergency Medicine) examination. It forms an essential revision guide for emergency trainees who need to acquire a broad understanding of the basic sciences, which underpin their approach to clinical problems in the emergency department. Common clinical scenarios are used to highlight the essential underlying basic science principles, providing a link between clinical management and a knowledge of the underlying anatomical, physiological, pathological and biochemical processes. Multiple choice questions with reasoned answers are used to confirm the candidates understanding and for self testing. Unlike other recent revision books which provide MCQ questions with extended answers, this book uses clinical cases linked to the most recent basic science aspects of the CEM syllabus to provide a book that not only serves as a useful revision resource for the Part A component of the MCEM examination, but also a unique way of understanding the processes underlying common clinical cases seen every day in the emergency department. This book is essential for trainees sitting the Part A of the MCEM exam and for clinicians and medical students who need to refresh their knowledge of basic sciences relevant to the management of clinical emergencies.
Echocardiography is essential in the practice of pediatric cardiology. A clinical pediatric cardiologist is expected to be adept at the non-invasive diagnosis of congenital heart disease and those who plan to specialize in echocardiography will need to have knowledge of advanced techniques. Echocardiography in Pediatric and Congenital Heart Disease addresses the needs of trainees and practitioners in this field, filling a void caused by the lack of material in this fast-growing area. This new title comprehensively covers the echocardiographic assessment of congenital heart disease, from the fetus to the adult, plus acquired heart disease in children. Topics covered include: ultrasound physics laboratory set-up a protocol for a standard pediatric echocardiogram quantitative methods of echocardiographic evaluation, including assessment of diastolic function in depth coverage of congenital cardiovascular malformations acquired pediatric heart disease topics of special interest, such as 3D echocardiography, transesophageal echocardiography, and fetal echocardiography The approach of this book is a major advancement for educational materials in the field of pediatric cardiology, and greatly enhances the experience for the reader. An accompanying DVD with moving images of the subjects covered in the textbook will further enhance the learning experience.
Introduction: The CNAP technology (CNSystems Medizintechnik AG, Graz, Austria) provides noninvasive continuous recording of the arterial pressure waveform based on the volume clamp method. Recently, an algorithm for measuring cardiac output (CO) using pulse contour analysis of the CNAP-derived arterial waveform became available. In this study, we compared CO measurements and trending capability of the novel CNAP-CO (CNCO) with intermittent invasive CO measurements derived from the pulmonary artery catheter (PAC; PAC-CO) in cardiosurgical intensive care unit patients. Methods: In this interim analysis, we analyzed simultaneously obtained CNCO and PAC-CO measurements in 41 patients during the first hours after off pump coronary artery bypass surgery. We performed 3 independent sets of 5 consecutive thermodilution measurements each per patient. The average of the 3 closest of the 5 PAC-CO measurements was used for comparison with the average of the corresponding CNCO values. Four pairs of measurements were excluded due to artifacts resulting in 119 paired measurements for analysis. In addition, we analyzed 27 cardiac outputu2013modifying manoeuvres to evaluate trending ability. We conducted 2 separate comparative analyses: 1) CNCO calibrated to the first simultaneously measured PAC-CO value (CNCOcal) vs. PAC-CO and 2) CNCO auto-calibrated to biometric patient data ( CNCObio) vs. PAC-CO.Agreement between the two methods was statistically assessed by Bland-Altman analysis and by calculating the percentage error (PE). For evaluating trending ability, we calculated the concordance rate (CCR; exclusion zone 0.5 L/min). Results: For CNCOcal, the Bland-Altman analysis revealed a mean difference of -0.2 L/min, a standard deviation of u00b10.5 L/min and limits of agreement of -1.1 to +0.8 L/min. The PE and CCR were 19% and 100%, respectively. For CNCObio, the Bland-Altman analysis showed a mean difference of +0.6 L/min, a standard deviation of u00b11.1 L/min and limits of agreement of -1.6 to +2.8 L/min. The PE and CCR were 45% and 94%, respectively. Conclusion: In this clinical study in cardiosurgical intensive care unit patients, CNCOcal showed good agreement (PE 19%) and good trending capability (CCR 100%) when compared with intermittent pulmonary artery thermodilution. For CNCObio, we observed a higher PE (45%) but acceptable trending capability (CCR 94%).