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Case Reports in Critical Care

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https://www.readbyqxmd.com/read/29333300/cyclic-nonrespiratory-pulse-pressure-oscillations-caused-by-atrioventricular-dissociation
#1
László Rudas, Péter Hankovszky, András Lovas, Éva Zöllei, Zsolt Molnár
Dynamic preload assessment tests, especially pulse pressure variation (PPV) and stroke volume variation (SVV), are increasingly acknowledged in mechanically ventilated patients as being predictors of fluid responsiveness. However, the limitations of this method are often neglected or overlooked. One of the prerequisites for PPV and SVV evaluation, in addition to intermittent positive pressure ventilation, is a "regular heart rhythm," which may be an ambiguous term. We present a case where, despite a regular (paced) rhythm, atrioventricular dissociation was present and resulted in marked PPV elevation, which subsequently disappeared once sinus rhythm returned...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29318053/miliary-tuberculosis-presenting-with-ards-and-shock-a-case-report-and-challenges-in-current-management-and-diagnosis
#2
Keevan Singh, Saara Hyatali, Stanley Giddings, Kevin Singh, Neil Bhagwandass
Miliary tuberculosis, complicated by ARDS and septic shock, is a rare and lethal presentation of this disease. Here we present a case of such a patient, following which we discuss the management of tuberculosis in the ICU and some of the challenges that may be faced. A young HIV negative female presented to us with an acute history of worsening shortness of breath on a background of weight loss, nonproductive cough, and fever. CXR and CT scan showed bilateral miliary type opacities and the patient was admitted to the hospital...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29318052/acute-hypoxic-and-refractory-respiratory-failure-induced-by-an-underlying-pfo-an-unusual-case-of-platypnea-orthodeoxia-and-transient-complication-after-transcatheter-closure
#3
Carlos Salazar, Romeo A Majano
Platypnea orthodeoxia (PO) is an infrequent condition of dyspnea with hypoxemia, increased by adopting an upright position and is relieved in decubitus. This condition may occur in patients with hidden intracardiac shunts, usually across a persistent foramen ovale (PFO). The incidence of PFO in general population is quite common, around 27%; however, the concurrent presentation with PO, especially in acute refractory respiratory failure, is extremely rare. PFO closure in this setting is still the treatment of choice with significant improvement or complete resolution of symptoms after closure with an overall periprocedural complication in the first 24 hours of approximately less than 5%...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29312788/a-case-of-leptospirosis-associated-severe-pulmonary-hemorrhagic-syndrome-successfully-treated-with-venovenous-extracorporeal-membrane-oxygenation
#4
Nao Umei, Shingo Ichiba
Background: In patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS), hypoxemia is the most common cause of death despite maximal mechanical ventilation. Case: A 50-year-old male sushi chef who had never traveled outside Japan presented with a 2-day history of fever and muscle pain. On admission, the patient had thrombocytopenia, renal insufficiency, and jaundice. His condition continued to deteriorate, with decreasing platelet count, worsening renal function, hyperbilirubinemia, hypotension, and respiratory distress...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29279777/ornithine-transcarbamylase-deficiency-if-at-first-you-do-not-diagnose-try-and-try-again
#5
Christan D Santos, Robert A Ratzlaff, Jennifer C Meder, Paldeep S Atwal, Nicole E Joyce
Ornithine transcarbamylase (OTC) deficiency is well known for its diagnosis in the neonatal period. Presentation often occurs after protein feeding and manifests as poor oral intake, vomiting, lethargy progressing to seizure, respiratory difficulty, and eventually coma. Presentation at adulthood is rare (and likely underdiagnosed); however, OTC deficiency can be life-threatening and requires prompt investigation and treatment. Reports and guidelines are scarce due to its rarity. Here, we present a 59-year-old woman with a past history of irritable bowel syndrome who underwent a reparative operation for rectal prolapse and enterocele...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29270322/a-case-of-mdma-associated-cerebral-and-pulmonary-edema-requiring-ecmo
#6
A Thakkar, K Parekh, K El Hachem, E M Mohanraj
A 20-year-old female presented with confusion, generalized tonic-clonic seizures, and severe hyponatremia after ingesting 3,4-methylenedioxymethamphetamine (MDMA). Brain computed tomography (CT) demonstrated cerebral edema. Her hospital course was rapidly complicated by respiratory failure and shock requiring intubation and vasopressors. Refractory acute respiratory distress syndrome (ARDS) was diagnosed which was unresponsive to conventional and salvage therapies, requiring initiation of extracorporeal membrane oxygenation (ECMO), leading to normalization of oxygenation parameters...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29225976/intensive-care-in-a-patient-with-toxic-epidermal-necrolysis
#7
J Wallenborn, M Fischer
Toxic epidermal necrolysis (TEN) is a serious adverse drug reaction with high lethality, which usually requires intensive-medical care. A 44-year-old man developed generalized exanthema with increasing exfoliation and mucosal involvement after taking allopurinol, ibuprofen, and etoricoxib. The clinical diagnosis of TEN was histologically confirmed. Prednisolone therapy with 3 mg/kg body weight (BW) was not able to prevent further progress to finally 80% of the body surface, and infliximab 5 mg/kg BW was given as a single dose...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29201468/a-case-report-of-recurrent-takotsubo-cardiomyopathy-in-a-patient-during-myasthenia-crisis
#8
Anusha Battineni, Naresh Mullaguri, Shail Thanki, Anand Chockalingam, Raghav Govindarajan
Introduction: Patients with myasthenia crisis can develop Takotsubo stress cardiomyopathy (SC) due to emotional or physical stress and high level of circulating catecholamines. We report a patient who developed recurrent Takotsubo cardiomyopathy during myasthenia crisis. Coexisting autoimmune disorders known to precipitate stress cardiomyopathy like Grave's disease need to be evaluated. Case Report: A 69-year-old female with seropositive myasthenia gravis (MG), Grave's disease, and coronary artery disease on monthly infusion of intravenous immunoglobulin (IVIG), prednisone, pyridostigmine, and methimazole presented with shortness of breath and chest pain...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29181204/a-case-of-invasive-pneumococcal-infection-with-septic-shock-and-rare-complications
#9
John R Woytanowski, Nausheen Hakim, Caytlin Deering, Sara Schultz
Invasive pneumococcus is a serious illness with potentially devastating outcomes. A 64-year-old female with a medical history of psoriatic arthritis and diabetes was transferred from an outside hospital for ventilator dependent respiratory failure and altered mental status. She initially presented with worsening back pain and was found to have leukocytosis with bandemia and acute renal failure but she was in septic shock upon arrival to our tertiary care center. Her blood cultures grew Streptococcus pneumoniae and MRI of the brain revealed pus within the posterior lateral ventricles and multiple infarcts...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29158922/hypoxemic-respiratory-failure-from-acute-respiratory-distress-syndrome-secondary-to-leptospirosis
#10
Shannon M Fernando, Pierre Cardinal, Peter G Brindley
Acute respiratory distress syndrome (ARDS), characterized by hypoxemic respiratory failure, is associated with a mortality of 30-50% and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation and thereby necessitating Intensive Care Unit (ICU) admission. The most common precipitant is community-acquired bacterial pneumonia, but other putative pathogens include viruses and fungi. On rare occasions, ARDS can be secondary to tropical disease...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29158921/a-nearly-lethal-screw-an-unusual-cause-of-recurrent-bradycardia-and-asystole-episodes-after-fixation-of-the-cervical-spine
#11
Amit Frenkel, Yair Binyamin, Evgeni Brotfain, Leonid Koyfman, Aviel Roy-Shapira, Ilan Shelef, Moti Klein
We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF) of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR)...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29130003/spontaneous-tumor-lysis-syndrome-due-to-uterine-leiomyosarcoma-with-lung-metastases
#12
Vivek Alaigh, Debapriya Datta
Tumor lysis syndrome (TLS) is an oncologic emergency characterized by a combination of metabolic derangements (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia) caused by rapid turnover from cell destruction in certain cancers. These metabolic derangements can lead to seizures, cardiac arrhythmias, renal failure, and death. TLS is usually seen after the initiation of chemotherapy for hematologic malignancies. TLS occurring spontaneously, without initiation of chemotherapy, is rare and its occurrence in solid tumors is rarer still...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29119027/dosing-of-ertapenem-in-an-extreme-obesity-a-case-report-of-250%C3%A2-kg-patient
#13
Jana Lass, Kadri Tamme, Karin Kipper, Joel Starkopf
Limited available data for dosing in obesity of the medicines used in this case are discussed, with the emphasis on ertapenem. The case illustrates the difficulties in dosing medicines to morbidly overweight patients. The number of such patients is increasing but data on adequate doses of medicines are scarce. We demonstrate that ertapenem 1,5 g i.v. once daily provided adequate drug exposure for susceptible bacteria in a 250 kg patient with normal renal function. The case suggests the usefulness of therapeutic drug monitoring of antibiotics, especially in critically ill patients...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29119026/thiamine-deficiency-leading-to-refractory-lactic-acidosis-in-a-pediatric-patient
#14
Alicia M Teagarden, Brian D Leland, Courtney M Rowan, Riad Lutfi
Thiamine plays a critical role in energy metabolism. Critically ill children and adults may develop thiamine deficiency with ultimately increased mortality due to potentially irreversible consequences of severe type B lactic acidosis. We report a case of an unvaccinated term neonate with malignant pertussis requiring extracorporeal membrane oxygenation and continuous renal replacement therapy, who developed profound lactic acidosis of unknown etiology. After countless evaluations for likely causes, the patient was ultimately determined to have thiamine deficiency and her acidosis resolved rapidly with vitamin supplementation...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29109870/acute-onset-panhypopituitarism-nearly-missed-by-initial-cosyntropin-testing
#15
Claudine A Blum, Daniel Schneeberger, Matthias Lang, Janko Rakic, Marc Philippe Michot, Beat Müller
Introduction: Diagnosis of adrenal crisis and panhypopituitarism in patients with septic shock is difficult but crucial for outcome. Case: A 66-year-old woman with metastasized breast cancer presented to the ED with respiratory insufficiency and septic shock after a 2-day history of the flu. After transfer to the ICU, corticosteroids were started in addition to antibiotics, as the patient was vasopressor-nonresponsive. Diabetes insipidus was diagnosed due to polyuria and treated with 4 mg desmopressin...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29098094/severe-undifferentiated-vasoplegic-shock-refractory-to-vasoactive-agents-treated-with-methylene-blue
#16
Farheen Manji, Benjamin Wierstra, Juan Posadas
Methylene blue is a phenothiazine-related heterocyclic aromatic molecule presently used in the treatment of methemoglobinemia. Recently, it has been implicated in the treatment of severe refractory vasoplegic shock caused by anaphylaxis, sepsis, or postcardiopulmonary bypass. We present a case of a 27-year-old male with profound vasoplegic shock of unknown etiology which was refractory to vasopressors who responded within hours to a single dose of methylene blue. Additionally, we review the evidence of methylene blue's role in the treatment of shock...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29057127/heat-stroke-a-medical-emergency-appearing-in-new-regions
#17
Sofie Søndergaard Mørch, Johnny Dohn Holmgren Andersen, Morten Heiberg Bestle
Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29038737/significant-bradycardia-in-critically-ill-patients-receiving-dexmedetomidine-and-fentanyl
#18
Channing Hui, Maria Cardinale, Balaji Yegneswaran
PURPOSE: To report a case series of three patients who developed significant bradycardia while receiving the combination of dexmedetomidine and fentanyl for sedation and analgesia. MATERIALS AND METHODS: This is a case series of patients obtained from a mixed medical, surgical, and cardiac ICU in a community teaching hospital. Three intubated patients receiving fentanyl and dexmedetomidine infusion developed sudden bradycardia requiring intervention. In all three cases, adjustments to therapy were required...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28928991/stress-cardiomyopathy-managed-with-extracorporeal-support-after-self-injection-of-epinephrine
#19
Bourenne Jeremy, Fresco Raphaëlle, Kerbaul François, Michelet Pierre, Gainnier Marc
A 28-year-old man was admitted to the ICU for self-injection of Epinephrine. This injection resulted in the rapid development of a catecholamine-induced cardiomyopathy (inverted Takotsubo) with a severe cardiogenic shock. The importance of ventricular dysfunction required the implementation of a temporary arteriovenous circulatory support until the recovery of myocardial stunning. This case allows redefining the role of circulatory assistance during cardiotropic agents intoxication.
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28912978/anoxic-brain-injury-presenting-as-pseudosubarachnoid-hemorrhage-in-the-medical-intensive-care-unit
#20
O'Dene Lewis, Samina Afreen, Supo Folaranmi, Marie Fidelia-Lambert, Vishal Poddar, Alicia Thomas
Anoxic encephalopathy is frequently encountered in the medical intensive care unit (ICU). Cerebral edema as a result of anoxic brain injury can result in increased attenuation in the basal cisterns and subarachnoid spaces on computerized tomography (CT) scans of the head. These findings can mimic those seen in acute subarachnoid hemorrhage (SAH) and are referred to as pseudosubarachnoid hemorrhage (pseudo-SAH). Pseudo-SAH is a diagnosis critical care physicians should be aware of as they treat and evaluate their patients with presumed SAH, which is a medical emergency...
2017: Case Reports in Critical Care
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