The Passion of Christ and the Passion Fruit Flower

 

The Passion of Christ

This is a picture of the passion fruit flower. This flower is also known as the “flower of five wounds”. The purple flower is believed to resemble the wounds of Jesus Christ.

The Passion of Christ includes the time period from the night prior to the crucifixion of Jesus until his death upon the cross. Much emphasis has been placed on this time period to emphasize the sufferings of Jesus leading to his death and His ultimate sacrifice for sin. This time period is traditionally marked by His time in the Garden of Gethsemane, and includes His prayers, betrayal by Judas Iscariot, abandonment and denial by His disciples, arrest, trials, beatings, and period of time on the cross.

Jesus died on the cross and rose from the dead on the third day. His resurrected body was witnessed by many people, including His disciples. Jesus is alive today.

Before Jesus ascension to heaven he spoke of His Great Commission to His disciples. Jesus said in Matthew 28: 18-20. “All authority in heaven and on earth has been given to me. Therefore, go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always to the very end of the age”.

Heart failure with preserved ejection fraction.

This is an interesting topic. The ejection fraction is a measurement of left heart function obtained during echocardiography. The question is how does the heart fail when the measured EF is normal? 

Heart failure is an important cause of shortness of breath which has to be differentiated from lung causes of shortness of breath.  Often the distinction between the two conditions is not obvious clinically without further investigations. Relevant investigations include ECG, NT proBNP (blood test), echocardiography, chest x-ray and coronary angiography.  

Heart failure with preserved ejection fraction is a type of heart failure with normal or near normal ejection fraction and objective evidence of diastolic dysfunction.  

More than half of heart failure patients have heart failure with a maintained ejection fraction. The illness primarily affects the elderly, accounting for 4.9 percent of the population over the age of 60. It appears to be more common in women, and it is projected to become more widespread as people live longer. 

Link to this interesting article which I have read:

Heart failure with preserved ejection fraction | Radiology Reference Article | Radiopaedia.org

Feger, J., Worsley, C. Heart failure with preserved ejection fraction. Reference article, Radiopaedia.org. (accessed on 24 Mar 2022) https://doi.org/10.53347/rID-93980

Tracheostomy for Ventilated Patient

Doctors struggle to accurately predict which patients will require prolonged mechanical ventilation.  Doctors need a clear understanding of the nature and typical course of chronic critical illness.

Communication about chronic critical illness should begin before its onset and, ideally, as early as the initiation of mechanical ventilation (or even at decision-making about whether to initiate ventilation).  Doctors should inform not only of the risk of death in the ICU, but also the chance the patient might survive but remain dependent on the ventilator and other intensive therapies for a prolonged period. 

These initial discussions allow a longer time for doctors to “cultivate prognostic awareness” i.e. the capacity to understand prognosis and the likely illness trajectory and help patients and families prepare psychologically and practically for further developments.

Based on the available evidence, routine placement of tracheostomy prior to day 10 of mechanical ventilation is not indicated. General consensus is that a tracheostomy should be placed after day 10 if the patient is likely to require more than a few additional days of ventilation i.e. the patient will neither be liberated from the ventilator nor die in the near future i.e. the patient is chronically critically ill.

Benefits of tracheostomy include:

Improved patient comfort

Easier oral care and suctioning

Reduced need for sedation or analgesia

Reduced accidental extubation

Improved weaning from mechanical ventilation

Easier facilitation of rehabilitation

Earlier communication and oral nutrition

Facilitated transfer to lower level of care

Early Complications:

Bleeding

Air leak causing subcutaneous emphysema, pneumothorax, pneumomediastinum

 

Damage to the swallowing tube (esophagus)

 

Injury to the nerve of the vocal cords (recurrent laryngeal nerve)

 

Tracheostomy tube can be blocked by blood clots, mucus, or pressure of the airway walls.

Late Complications:

Accidental removal of the tracheostomy tube

 

Infection in the trachea and around the tracheostomy tube

 

Trachea may be damaged by pressure from the tube resulting in bacterial infections and scar tissue formation

Delayed Complications:

Thinning of the trachea from the tube rubbing against it (tracheomalacia)