Case report: methylene blue for cardiogenic shock

Cardiogenic shock is the primary cause of death in hospitalized patients with acute myocardial infarction, particularly when left ventricle failure occurs. The best management of shock secondary to right or left ventricle failure is reestablishing blood flow in the infarct-related artery. (1) Despite quick treatment, cardiogenic shock causes 50% of deaths within the first 24 hour of the event. (2) A new paradigm for cardiogenic shock assumes that the pathophysiology of the disease includes the participation of guanylate cyclase, leading to the production of nitric oxide that contributes to the vasodilation and the poor response to vasopressors of some patients with this complication. (2)


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Induced hypothermia in cardiogenic shock: a case report

Induced hypothermia (IH) has been used for over 60 years (1) as an adjuvant therapy in a group of critically ill patients. Described by Fay in the 1940s, (2) IH has been used in operating rooms since the early 1950s for patients undergoing cardiac surgery and neurosurgery. The use of IH after cardiac arrest was first reported in 1957 by Benson et al. (3) The beneficial effects of hypothermia in animal tests during periods of ischemia result in a wide range of biological effects and it is not a simple mechanism of action. When IH is used in any clinical


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White lung: the effects of trauma

Diaphragmatic rupture occurs in 0.8-5% of patients with major blunt thoraco-abdominal trauma and up to 70% of diaphragmatic tears are missed initially. Elevation of a single hemi diaphragm can be attributed to adjacent pleural, pulmonary or subphrenic disease, or it can occur secondary to a phrenic nerve palsy. (1) Rarely, it is related to an intrinsic weakness of the diaphragm or eventration. Because diaphragmatic rupture is often associated with thoracic or abdominal injuries that require surgical treatment, the diagnosis is usually made intraoperatively in many cases. Special attention has to be given to minor changes in the diaphragm or to basal lung atelectasis or consolidation. If possible, the post-injury thorax films should always be compared with previous chest radiographs.


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The use of dexmedetomidine for refractory agitation in substance abuse patient

In the Intensive Care Unit (ICU), patients are vulnerable to develop psychomotor disturbances with increase in both motor and psychological activities, often accompanied by loss of action control and disorganization of thought. Various terms have been used including agitation, anxiety and delirium. (1) Predisposing factors such as alcohol and substance abuse, male gender, advancing age, dementia and sensory impairment can further aggravate the symptoms. (1-3) It is a recognized problem that may complicate patients’ recovery and until now remain a challenging issue as it is difficult to diagnose and treat.


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Successful recruitment in severe unilateral pneumonia using airway pressure release ventilation and lateral decubitus position

A 25 year-old Caucasian male with no past medical history of note presented with tetraplegia after hitting his head following a dive into a shallow pool. An MRI of the cervical spine showed bilateral facet dislocation of C4/C5 with spinal cord injury and edema from C4 to C6. A posterior facet joint reduction, instrumentation and fusion, anterior C4/C5 discectomy and fusion was performed forty-eight hours later and he was transferred to the surgical intensive care unit (SICU) for postoperative ventilation.
On day two of SICU admission, he developed left sided pneumonia as evident by fever, purulent secretions and new infiltrates


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Acute transverse myelitis in systemic lupus erythematosus: report of a case

Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause multiple organ damage. It is more common in females with a ratio of 9:1 with respect to males. (1)
Neuropsychiatric manifestations in patients with SLE are common, and when these manifestations are developed, the course of the disease and the prognosis are significantly worse. (2)
The reported prevalence of neuropsychiatric manifestations in SLE is highly variable. There are studies that report prevalence as high as 80-90%. (3) According to latest reports, the prevalence is between 30-40%, and the presentation is possible even before the diagnosis of the disease. (4)


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Repeated acute respiratory failure: the strongyloidiasis hyperinfection syndrome

A 63 year-old gentleman with a history of mitral valve repair and recent travel to the Philippines presented to our hospital with complaints of dry cough for three days. His clinical exam was remarkable for diffuse rhonchi. Initial chest radiograph was non-revealing. The patient clinical condition deteriorated in the emergency department (ED) with rapidly progressive respiratory insufficiency and interval development of radiographic infiltrates (Figure 1). The patient was then admitted to the intensive care unit (ICU) and broad-spectrum antibiotics started. As the patients’ symptoms and radiological findings worsened bronchoscopy and bronchoalveolar lavage were emergently performed. The later yielded no organisms


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Gastric Emptying of Oral Nutritional Supplements Assessed by Ultrasound

Fasting has been the standard of many medical procedures such as upper endoscopic procedure, surgery, bronchoscopy and abdominal ultrasound imaging. Generally, the fasting recommendations follow The Canadian Anesthetist’s Society (CAS) and American Society of Anesthesiologists (ASA) guidelines. In that recommendation, patients only received clear liquid which contains simple carbohydrate or water two to six hours prior to surgery. After three hours of meal body has to provide nutritions for itself by gluconeogenesis.
In addition to nutritional issues, gastric irritation and dehydration occur as well. All these conditions can have adverse effects on the patients pre and post-surgical outcomes.
Oral ...


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An Unusual Presentation of Staphylococcal Induced Paravertebral Myositis Causing Septic Shock

Background: Paravertebral myositis is uncommon, and this case highlights a number of important therapeutic and diagnostic considerations. We discuss the role of appropriate antimicrobial therapy and the potential dilemma regarding the use of immunoglobulin in the septic patient. The key elements of treatment are early recognition, and the early initiation of appropriate antibiotics, typically a β-lactamase resistant anti-staphylococcal agent and clindamycin. Clindamycin is added to anti-staphylococcal treatment due to its ability to reduce exotoxin production, a result of its ability to suppress translation of toxin genes.
Methods: We present a case report of a Staphylococcus aureus (S. aureus) induced paravertebral myositis resulting in septic shock.
Conclusions: It remains that the role of IVIG in the management of sepsis is as yet not clearly defined, at present it is neither advocated nor dismissed by current guidelines, given the presence of both positive and negative findings in recent metaanalysis.


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Asynchronous Independent Lung Ventilation in the Management of Bronchopleural Fistula

Ventilation of lungs with parenchymal injury which can be caused by either disease or trauma has always been a diffi cult task for both respiratory therapists and physicians. There have been great many advances made in mechanical ventilators and ventilator modes over last decade. This has included the introduction of modes such as High Frequency Oscillator Ventilation (HFOV) [1] and Airway Pressure Release Ventilation (APRV).
Coupled with these new modes has also been a better understanding of how to best recruit and stabilize the lungs [2] and how to best use therapist driven protocols which may help to decrease the percentage of Acute Lung Injury (ALI) that we see today. Sometimes as respiratory care practitioners, we are exposed to trauma patients, which may present with massive amounts of parenchymal damage to the lungs, which we may have to modify on how to ventilate and oxygenate these patients. Some patients may have such severe unilateral lung pathology, that it will be difficult to oxygenation and ventilate, we should make a better effort to avoid high peak pressures and thus decrease the risk of barotrauma to uninjured lung tissue. In such a case, we may wish to consider asynchronous independent lung ventilation with one of these new modes.


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