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Case Reports in Critical Care

Lee D Murphy, Mouhammad Yabrodi, Riad Lutfi
We describe two pediatric patients with Duchenne muscular dystrophy that presented with acute neurologic deterioration and hypoxic respiratory failure requiring mechanical ventilation. These cases fulfill the clinical criteria for Fat Embolism Syndrome. Early recognition and aggressive supportive therapy with mechanical ventilation, right ventricular afterload reduction, and blood transfusion led to survival without any residual effects from the event. Fat Embolism Syndrome needs to be considered early in the course of patients with Duchenne muscular dystrophy who present with respiratory and neurological symptoms...
2018: Case Reports in Critical Care
Munenori Kusunoki, Takeshi Umegaki, Tomohiro Shoji, Kota Nishimoto, Natsuki Anada, Akiko Ando, Takeo Uba, Kanako Oku, Saya Hakata, Satoshi Hagihira, Takahiko Kamibayashi
Diffuse alveolar hemorrhage (DAH) refers to the effusion of blood into the alveoli due to damaged pulmonary microvasculature. The ensuing alveolar collapse can lead to severe hypoxemia with poor prognosis. In these cases, it is crucial to provide respiratory care for hypoxemia in addition to treating the underlying disease. Here, we describe our experience with a case involving a 46-year-old woman with severe DAH-induced hypoxemia accompanying systemic lupus erythematosus (SLE). Mechanical ventilation was managed using airway pressure release ventilation (APRV) after intubation...
2018: Case Reports in Critical Care
Y H Koh
Heat stroke is a life threatening, multisystem disorder characterized by severe hyperthermia (core body temperature > 41.1°C) with central nervous system dysfunction and/or other end organ damage. Neurological complications, such as disturbances of consciousness, convulsion, profound mental change, disorientation, or even prolonged coma, were present in almost all cases of exertional heat stroke (EHS). We present a case of EHS with severe rhabdomyolysis and acute oliguric kidney injury in a 20-year-old healthy marathon runner, who developed status epilepticus on Day 4 of his admission...
2018: Case Reports in Critical Care
Muhammad Asim Rana, Ahmed F Mady, Abdullah Ali Lashari, Rehab Eltreafi, Nicola Fischer-Orr, Kamal Naser
Thrombotic storm (TS) is a rare, acute, hypercoagulable state characterized by multiple thromboembolic events affecting at least two different areas of the vascular system/organs over a short period of time. Typical triggers include inflammation, infections, minor trauma, surgery, pregnancy, and the puerperium. A single thrombotic event can set off a number of thromboembolic events, often including unusual locations like hepatic, portal, or renal veins, skin (purpura fulminans) , adrenal glands, and cerebral sinus venous thrombosis...
2018: Case Reports in Critical Care
Hannah Kinoshita, Leon Grant, Konstantine Xoinis, Prashant J Purohit
Central pontine myelinolysis (CPM) is rarely reported in pediatric patients with diabetic ketoacidosis (DKA). We report this case of a 16-year-old female with new onset diabetes presenting with DKA, who received aggressive fluid resuscitation and sodium bicarbonate in the emergency department. Later she developed altered mental status concerning for cerebral edema and received hyperosmolar therapy with only transient improvement. Soon she became apneic requiring emergent endotracheal intubation. MRI brain showed cerebral edema, CPM, and subdural hemorrhage...
2018: Case Reports in Critical Care
Keevan Singh, Saara Hyatali, Stanley Giddings, Kevin Singh, Neal Bhagwandass
[This corrects the article DOI: 10.1155/2017/9287021.].
2018: Case Reports in Critical Care
Lampros Kousoulas, Uwe Wittel, Stefan Fichtner-Feigl, Stefan Utzolino
Background: Nontraumatic renal rupture due to pyelonephritis with obstructive uropathy is an uncommon but life-threatening situation. Case Presentation: A 25-year-old female presented to the emergency department with acute worsening of abdominal pain that began four weeks earlier. She was found to have peritonitis, leukocytosis, severe lactic acidosis, and a pronounced anemia and imaging was consistent with nontraumatic renal rupture with retroperitoneal abscess, perforation of the colon, and severe necrotizing fasciitis of the right lower limb...
2018: Case Reports in Critical Care
Matthew Anstey, Shilpa Desai, Luke Torre, Bradley Wibrow, Jason Seet, Emma Osnain
Background: An important long-term complication of critical illness is significant weakness and its resulting functional impairment. Recent advances have aimed to prevent critical illness weakness via early mobilisation of patients, minimising sedation, and optimising nutrition. One other potential treatment may be to provide anabolic support in the recovery phase, especially as patients have decreased levels of anabolic hormones. Case Presentation: We describe a case series of 4 patients who had either (1) profound critical illness myopathy and (2) profound weight loss...
2018: Case Reports in Critical Care
Dovile Leonaviciute, Bo Madsen, Anne Schmedes, Niels H Buus, Bodil S Rasmussen
Metformin poisoning is a life-threatening condition with a high mortality rate. We present a patient case of metformin poisoning following intake of 80 g metformin resulting in severe lactate acidosis with a nadir pH of 6.73 and circulatory collapse, successfully treated with addition of prolonged intermittent hemodialysis (HD) to continuous venovenous hemofiltration (CVVH). The patient's pH became normal 48 hours after metformin ingestion during simultaneous CVVH and addition of 22 hours of intermittent HD in the ICU...
2018: Case Reports in Critical Care
Stefan W Malin, Riad Lutfi, Matthew L Friedman, Alicia M Teagarden
A 5-week-old previously healthy male presented with vomiting and diarrhea leading to hypovolemic shock and profound metabolic acidosis. He was subsequently found to have severe methemoglobinemia. The acidosis and shock improved with fluid resuscitation and methemoglobinemia was successfully treated with methylene blue. An extensive workup, including evaluations for infectious and metabolic etiologies, was unremarkable. However, a detailed dietary history revealed a recent change in diet, supporting a diagnosis of food protein-induced enterocolitis syndrome (FPIES)...
2018: Case Reports in Critical Care
Amanda Grant-Orser, Brennan Ballantyne, Wael Haddara
A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1-V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction...
2018: Case Reports in Critical Care
Caroline Phillips, Clare Harris, Nathaniel Broughton, Thomas Pulimood, Liam Ring
We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative but a cirrhotic liver was incidentally noted and later confirmed via ultrasound. Bedside examination was positive for orthodeoxia, suggesting a diagnosis of hepatopulmonary syndrome (HPS). The finding of significant intrapulmonary shunting on "bubble" echocardiography confirmed the diagnosis...
2018: Case Reports in Critical Care
Benjamin Chaucer, Dustin Whelan, Christopher Veys, Manas Upadhyaya
Background: IV tissue plasminogen activator (tPA) is the treatment of choice for ischemic strokes that present within the treatment window. In the majority of patients, this offers an effective and often life-prolonging treatment in the acute setting. In a rare set of patients treated with IV tPA, side effects can be seen. One rare and potentially dangerous side effect is angioedema. Case Report: We present the case of a patient treated for ischemic stroke who developed angioedema and discuss the etiology and risk factors for this rare, but dangerous side effect...
2018: Case Reports in Critical Care
J Scott Baird
Purpose: Mixed or central venous oxygen saturation has not been described during concurrent heart failure and hypothermia in children, both of which may be associated with hyperlactatemia. This report of an infant with heart failure and hypothermia is significant for increased inferior vena cava (IVC) oxygen saturation and hyperlactatemia. Case Report: A 36-day-old female was fussy for a day and then developed respiratory distress. In the Pediatric ER, she was tachycardic (260 beats/minute) and hypothermic (32...
2018: Case Reports in Critical Care
Oleg Stens, Gabriel Wardi, Matthew Kinney, Stephanie Shin, Demosthenes Papamatheakis
Introduction: To report on the first recorded case of necrotizing soft tissue infection (NSTI) in an immunocompromised individual caused by Stenotrophomonas maltophilia in the Western Hemisphere and highlight the challenges that medical providers face in promptly diagnosing and treating NSTI in this highly vulnerable patient population. Case Presentation: We report a case of NSTI caused by S. maltophilia in a neutropenic patient admitted for treatment of acute lymphoblastic leukemia...
2018: Case Reports in Critical Care
Hafiz B Mahboob, Bruce W Denney
Massive pulmonary embolism (PE) frequently leads to cardiac arrest (CA) which carries an extremely high mortality rate. Although available, randomized trials have not shown survival benefits from thrombolytic use. Thrombolytics however have been used successfully during resuscitation in clinical practice in multiple case reports and in retrospective studies. Recent resuscitation guidelines recommend using alteplase for PE related CA; however they do not offer a standardized treatment regimen. The most consistently applied approach is an intravenous bolus of 50 mg tissue plasminogen activator (t-PA) early during cardiopulmonary resuscitation (CPR)...
2018: Case Reports in Critical Care
Erin K Yeung, Haritha Saikumar, Jose Castaneda-Nerio, Sandra G Adams, Mark Wong
Purpose: A case series of icatibant use in intubated patients with angiotensin-converting enzyme inhibitor- (ACEI-) induced angioedema is presented along with a relevant literature review and recommendations for utilization. Summary: Three intubated patients admitted to the intensive care unit for ACEI-induced angioedema were treated with icatibant. A literature search identified one controlled study and four case reports describing the use of icatibant in intubated ACEI-induced angioedema patients...
2018: Case Reports in Critical Care
Mariana Alves, Rita Faria, António Messias, Carlos Meneses-Oliveira
Eustachian valve endocarditis is rare. A literature review revealed that only 29 cases have been reported and, among them, there is only one mention of an intensive care unit (ICU) admission. We present an 82-year-old man without previous medical records who presented with septic shock with multiple organ dysfunction. The patient was admitted to the ICU and deteriorated with combined shock (septic + cardiogenic). A second ultrasound screen detected a prominent Eustachian valve with mobile multilobulated vegetation attached...
2018: Case Reports in Critical Care
Hafiz B Mahboob, Kazi H Kaokaf, Jeremy M Gonda
Creutzfeldt-Jakob disease (CJD), the most common form of human prion diseases, is a fatal condition with a mortality rate reaching 85% within one year of clinical presentation. CJD is characterized by rapidly progressive neurological deterioration in combination with typical electroencephalography (EEG) and magnetic resonance imaging (MRI) findings and positive cerebrospinal spinal fluid (CSF) analysis for 14-3-3 proteins. Unfortunately, CJD can have atypical clinical and radiological presentation in approximately 10% of cases, thus making the diagnosis often challenging...
2018: Case Reports in Critical Care
Jefferson Chambers, Nichole Smith, Matthew Sehring, Subramanyam Chittivelu
Acute chest syndrome is a complication of sickle cell disease and represents the highest cause of mortality in those afflicted with the disorder. Pregnancy represents an increased risk for complications of sickle cell disease in both the mother and fetus. We present a case of a 20-year-old patient with known sickle cell disease who was at 25-week gestation and developed acute chest syndrome refractory to conventional therapies and requiring emergency cesarean section. Following delivery, the patient developed acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO)...
2018: Case Reports in Critical Care
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