Hypercoagulation after Cardiac Arrest: Should we give clot dissolving drug in each case?

Intra- and post-arrest care for out-of-hospital cardiac arrest (OHCA) requires careful management of the complex interaction between clot formation (coagulation) and its natural resolution (fibrinolysis).

In over 70% of cases, OHCA is caused by a clot in the heart artery, lung artery, acute coronary syndrome (ACS), or pulmonary thromboembolism (PTE).

When OHCA occurs, lack of pulsatile blood flow leads to rapid clot formation in larger blood vessels and structures.

CPR mechanically disrupts further clot formation by restoring a modest amount of laminar blood flow from the heart to systemic vasculature.

Once return of spontaneous circulation occurs, the clot burden accumulated during pulselessness is distributed throughout the entire vasculature and vital organs. In response, the human body experiences a brief period of systemic fibrinolysis.

Brief hypo-coagulable state (if not treated with anticoagulation) is replaced by a prolonged hypercoagulable state causing microcirculatory occlusion, profound lactic acidosis and progressive multiorgan failure.

Points to think:  Once we know most cardiac arrest are due to a clot and after cardiac arrest more clots will form, why shouldn’t all patients with cardiac arrest be given clot dissolving IV drug during CPR. This may also make CPR more effective

Non-invasive Stool Test Effective for Colon Cancer Screening

Fecal immunochemical tests (FITs), used annually, are effective for screening for colorectal cancer in average-risk, asymptomatic adults, according to a new meta-analysis published online February 25 in the Annals of Internal Medicine. The US Preventive Services Task Force currently recommends screening for CRC for persons aged 50 to 75 years using any of several options: fecal occult blood testing (a category that includes FIT), sigmoidoscopy, colonoscopy, and other tests. It does not recommend one screening modality over another.

Colonoscopy is considered to be the "gold standard" for CRC screening. Most countries, especially those in which healthcare finances are limited, use annual or biennial stool blood tests or a combination of stool testing and lower endoscopy for screening.

1 in 2 children with cancer are left undiagnosed and untreated

A modelling study published in The Lancet Oncology journal estimates that there are almost 400,000 new cases of childhood cancer annually, while current records count only around 200,000.

The new model makes predictions for 200 countries and estimates that undiagnosed cases could account for more than half of the total in India. In contrast, in North America and Europe only three per cent of cases remain undiagnosed.

The most common childhood cancer is acute lymphoblastic leukaemia. Universal health coverage, a target of United Nations Sustainable Development Goals, must include cancer in children as a priority to prevent needless deaths.