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Case Reports in Critical Care

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https://www.readbyqxmd.com/read/29755795/double-bolus-alteplase-therapy-during-cardiopulmonary-resuscitation-for-cardiac-arrest-due-to-massive-pulmonary-embolism-guided-by-focused-bedside-echocardiography
#1
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
https://www.readbyqxmd.com/read/29686908/icatibant-for-angiotensin-converting-enzyme-inhibitor-induced-angioedema-in-intubated-patients-case-series-and-literature-review
#2
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
https://www.readbyqxmd.com/read/29666712/eustachian-valve-endocarditis-echocardiographic-diagnosis-in-a-critical-care-patient
#3
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
https://www.readbyqxmd.com/read/29666711/creutzfeldt-jakob-disease-presenting-as-expressive-aphasia-and-nonconvulsive-status-epilepticus
#4
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
https://www.readbyqxmd.com/read/29666710/acute-chest-syndrome-progressing-to-ards-in-a-patient-of-25-week-gestation
#5
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
https://www.readbyqxmd.com/read/29593914/rituximab-induced-pulmonary-edema-managed-with-extracorporeal-life-support
#6
Jacob R Miller, Warren Isakow, Muhammad F Masood, Patrick Aguilar, Kristen M Sanfilippo, Keki R Balsara, Akinobu Itoh
Though rare, rituximab has been reported to induce severe pulmonary edema. We describe the first report of ECLS utilization for this indication. A 31-year-old female with severe thrombotic thrombocytopenic purpura developed florid pulmonary edema after rituximab infusion. Despite advanced ventilatory settings, she developed severe respiratory acidosis and remained hypoxemic with a significant vasopressor requirement. Since her pulmonary insult was likely transient, ECLS was considered. Due to combined cardiorespiratory failure, she received support with peripheral venoarterial ECLS...
2018: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29464127/use-of-high-flow-nasal-cannula-oxygen-therapy-in-a-pregnant-woman-with-dermatomyositis-related-interstitial-pneumonia
#7
Tomohiro Shoji, Takeshi Umegaki, Kota Nishimoto, Natsuki Anada, Akiko Ando, Takeo Uba, Munenori Kusunoki, Kanako Oku, Takahiko Kamibayashi
A 33-year-old pregnant woman was referred to our hospital with respiratory distress at 30 weeks of gestation. Chest computed tomography (CT) scans revealed pulmonary infiltrates along the bronchovascular bundles and ground-glass opacities in both lungs. Despite immediate treatment with steroid pulse therapy for suspected interstitial pneumonia, the patient's condition worsened. Respiratory distress was slightly alleviated after the initiation of high-flow nasal cannula (HFNC) oxygen therapy (40 L/min, FiO2 40%)...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29423323/use-of-cytosorb-in-traumatic-amputation-of-the-forearm-and-severe-septic-shock
#8
Heinz Steltzer, Alexander Grieb, Karim Mostafa, Reinhard Berger
Severe trauma associated with later disability and mortality still constitutes a major health and socioeconomic problem throughout the world. While primary morbidity and mortality are mostly related to initial injuries and early complications, secondary lethality is strongly linked to the development of systemic inflammatory response syndrome, sepsis, and ultimately multiple organ dysfunction syndrome. We herein report on a 49-year-old male patient who was admitted to the hospital after a traumatic amputation of his right forearm that was cut off while working on a landfill...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29423322/a-pediatric-case-of-diffuse-alveolar-hemorrhage-secondary-to-poststreptococcal-glomerulonephritis
#9
Alison Markland, Gregory Hansen, Anke Banks, Rajni Chibbar, Darryl Adamko
This report summarizes a case of a 4-year-old girl with poststreptococcal glomerulonephritis and diffuse alveolar hemorrhage, an atypical presentation in this age group and type of vasculitic disease. We propose that her rapid improvement in clinical status was due to her treatment, continuous renal replacement therapy (CRRT). This mechanism would have impacted recovery by removing factors such as endothelial microparticles, superantigens, and immune complexes that have been postulated as the pulmonary-renal link...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29410923/a-case-of-a-34-year-old-female-with-acute-hypoxemic-respiratory-failure-and-proximal-muscle-weakness
#10
Alex Diaz, Surit Sharma
Wound associated botulism is an unusual presentation. Early detection of this potentially life-threatening illness can significantly shorten length of hospital stay and improve prognosis. We present a case of a 34-year-old female with a history of heroin abuse who presented to the ED with acute respiratory failure, diplopia, and proximal muscle weakness. There was early concern for wound botulism as the instigating process. After discussion with the CDC, she was given equine serum heptavalent botulism antitoxin...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29348946/group-a-streptococci-associated-necrotizing-fasciitis-following-cat-bite-in-an-immunocompromised-patient
#11
Sudheer Nambiar, Asha Karippot, Joe Devasahayam, Tony Oliver
Necrotizing soft tissue infections are characterized clinically by fulminant tissue destruction, systemic signs of toxicity, and high mortality. Accurate diagnosis and appropriate treatment must include early surgical intervention and antibiotic therapy. Mortality rate is very high and could be even higher in an immunocompromised host. We present a 57-year-old female with history of rheumatoid arthritis on oral corticosteroid and methotrexate therapy with painful swelling of the left hand following a cat bite that was diagnosed as having group A streptococcus pyogenes-associated necrotizing fasciitis...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29333300/cyclic-nonrespiratory-pulse-pressure-oscillations-caused-by-atrioventricular-dissociation
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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