[Color Doppler echocardiography of the flow convergence region in vitro: effect of the orifice shape on proximal velocity profile]

The flow convergence method serves to determine flow across orifices (like valve leaks) by color Doppler. Both the PISA method (proximal isovelocity surface areas) and the PVP method (proximal velocity profile) were developed in vitro at circular orifice plates. Therefore, we studied the influence of a non-circular orifice shape on the color map of the flow convergence. Steady flow across orifices of the following shapes was imaged by color Doppler: Oval (6 x 2 mm), slit (12 x 1.5 mm), three-star (diameter 100, area 30 mm2), circular twin-orifice (two circular orifices diameter 2 mm at 10 mm distance from each other) and oval twin-orifice (two ovals 6 x 2 mm at 10 mm distance). As reference we imaged circular orifices with a similar opening area. The alias method was used to locate discrete velocities within the color map, and the proximal velocity profile along the flow center line was analyzed (mean of 24 subsequent images). The local velocity was plotted (y-axis) against its distance to the orifice (x-axis) providing proximal velocity profile curves. The more the orifice shape differed from circular, the more the proximal velocity profile was shifted downward: The profile proximal to the oval was not different from the reference profile proximal to the circular orifice. The profile proximal to the slit was considerably slowed, and proximal to the three-star was even slightly slower (local velocity -12 %, -23 % and -29 % at 14, 8 and 5 mm distance to the orifice). If the circular reference orifice corresponded to total flow across the twin-orifice, the proximal velocity profile of the latter was also shifted markedly downward (-20 %, -18 % and -23 % at 14, 8 and 5 mm distance to the circular twin-orifice). However, if the reference profile corresponded to flow across only one opening of the twin-orifice, the proximal velocity profile of the latter was shifted considerably upwards (+60 %, +71 % and +50 % at 14, 8, and 5 mm distance). Deviation of the orifice shape from circular leads to lower local velocities within the flow convergence; thus neglecting this orifice shape would result in underestimation of flow by the flow convergence method. However, presence of parallel neighboring flow increases the local velocities; neglecting this effect would lead to corresponding overestimation of flow.

Emergency resuscitation in children. The role of intraosseous infusion

Intraosseous infusion is a temporary procedure for use in pediatric emergencies when intravenous access is difficult. Multiple drugs and fluids can be safely administered through the intraosseous route. Dosage and rate of infusion are essentially the same as with intravenous infusion.