Fatal hyperthermia following acute cervical spinal cord and head injury

Abstract
A 22-year-old man with schizophrenia presented with cervical spine damage caused by a crush injury. Upon admission, we performed anterior cervical decompression and fusion of vertebrae C5, C6, and C7. The patient experienced treatment-resistant hyperthermia with a body temperature >40°C. He did not show any evidence of drug use that might induce malignant hyperthermia. He also did not exhibit symptoms of common forms of malignant hyperthermia, including rigidity of the arms and legs, myoglobin in the urine, or anesthesia toxicity. The patient’s condition did not improve, and he died of hypotension 15 hours after admission. We speculate that the cause of death was malignant hyperthermia due to acute cervical spinal cord injury. The physiological origin of hyperthermia in this patient is unknown. Recognition of hyperthermia symptoms and risk factors in patients with cervical spinal cord injury may enable early intervention to prevent progression to fatal fever.
Fatal hyperthermia following acute cervical spinal cord and head injury


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Pseudo hydropneumothorax: The importance of history taking in critical care

Abstract
History taking is an important part of the diagnosis of every patient. With the advancement of technology and limited time, this art seems forgotten. We hereby present an image of pseudo hydropneumothorax, which can have wide differential diagnoses. Proper history taking in critical care setting can help in early diagnosis; decrease length of hospital stay and diagnostic costs.
Pseudo hydropneumothorax- The importance of history taking in critical care


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Therapeutic hypothermia in cardiogenic shock post cardiac arrest supported with left ventricular assist device (Impella 5.0 LP)

Abstract
We report a 48-year-old male suffering from cardiac arrest secondary to ventricular fibrillation. After the return of spontaneous circulation, the therapeutic hypothermia protocol was initiated (33 oC). However, given the persistent cardiogenic shock, the hypothermia protocol was interrupted. A decision was made to insert an Impella 5.0 LP for hemodynamic support via the left femoral artery. After stabilization, cooling was resumed (Arctic sun) for 24 hours, which was well tolerated hemodynamically. After 5 days of support, patient was weaned off all vasopressors. The Impella was removed, after which the patient was awoken and extubated with complete neurological recovery.


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Toxic epidermal necrolysis

The case
A 36-year-old lady presented with history of intermittent high-grade fever for the last 5 days. There was also history of yellowish discolouration of skin and sclera for the last 3 days, generalized body swelling and hemorrhagic rashes all over the body for the last 1 day. On further probing it was found that she had received an unknown intravenous antibiotic 2 days back from a local physician. She was intubated and mechanically ventilated as she became hypoxic due to airway edema. Other supportive measures were administered. The skin lesions initially presented as erythematous rashes, which over the next few days progressed, to urticarial plaques, bullae, followed by epidermal sloughing. A diagnosis of toxic epidermal necrolysis secondary to idiosyncratic drug reaction was made.
Toxic epidermal necrolysis


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The obesity supine sudden death syndrome in the perioperative patient

Abstract
The obesity supine death syndrome (OSDS) is a disease characterized by sudden cardiac arrest in the morbidly obese patient. We present the case of a 50-year-old man who in the immediate postoperative period developed hypoxemia, bradycardia and irreversible cardiac arrest. After a careful review of the perioperative events and a literature review, we attributed his demise to the OSDS. This syndrome is characterized by sudden desaturation following supine position in patients with a body mass index (BMI) in excess of 50 kg/m2. While the pathophysiology of OSDS is not fully understood, perioperative clinicians require an awareness of this condition to avoid this potential fatal outcome.
The Obesity supine sudden death syndrome in the perioperative patient


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