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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Category: Case reports (Page 1 of 22)

Treatment of non-oliguric hyperkalaemia with inhaled salbutamol in premature infants with severe respiratory distress syndrome

Abstract

Non-oliguric hyperkalaemia (NOHK) in neonates is defined as a plasma potassium level > 6.5 mmol/L in the presence of urine output ≥ 1 mL/kg/h during the first 72 hours of life. It is characterized by a rapid rise of serum potassium to excessively high values, a high risk of cardiac arrhythmias and no occurrence after 72 hours of birth. NOHK commonly occurs in premature neonates, especially in those with a gestational age <28 weeks, with only a few reports of this entity in moderate or late preterm neonates. The effectiveness and safety of different treatments for NOHK is uncertain and currently there is no firm treatment recommendation. We describe the case of a moderately premature neonate (32+ 2 weeks gestation), with severe neonatal respiratory distress syndrome, who developed NOHK that was treated with inhaled salbutamol. When salbutamol is used for the treatment of NOHK, an initial paradoxical rise in potassium levels should always be taken into account to avoid cardiac arrhythmias.

Key words: non-oliguric hyperkalaemia, premature, infants, salbutamol, hyperkalaemia

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The dentist who sat on her chair and lost a leg. N2O?

Abstract

A 35-year-old female dentist laid on her chair to test an N2O machine, and after only a few minutes of inhaling the N2O, she developed acute pyramidal syndrome. The patient started walking again eight months later, but still suffers from lower limb motor deficit, in spite of intensive rehabilitation. Genetic tests later showed that the patient had Type 3 homocystinuria.

This is the first case report of acute neurological toxicity after brief administration of N2O. We suggest starting vitamin B12 and folic acid supplements promptly in patients who experience neurological symptoms after receiving N2O.

Key words: case report, neurological toxicity, nitrous oxide, adverse reaction, homocystinuria, dental care

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Juvenile pelvic extragenital endometrioma with acute abdomen in a 15-year-old girl

Abstract

We describe a case of a 15-year-old girl with a several month history of chronic pelvic pain, due to a 5 cm pelvic tumour, presenting with acute abdomen. Urgent diagnostic laparoscopy revealed multiple pelvic adhesions and a focal extragenital pelvic tumour. After laparoscopy, ultrasound and magnetic resonance imaging and laboratory procedures (with normal value of oncomarkers) were performed, followed by explorative laparotomy and total tumorectomy. An extragenital pelvic endometrioma was verified on histopathological analysis.

Key words: acute abdomen, pelvic pain, juvenile, endometriosis, extragenital, puberty

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Optic neuritis caused by aspergilloma within Onodi cell pyomucocele in a 62-year-old woman

Abstract

Onodi cells are anatomical variants of the posterior ethmoidal cells, which are greatly pneumatized laterally, and to some degree superiorly, to the sphenoid sinuses. The clinical importance of the Onodi cell is that it contains the optic canal and lies in close proximity to the optic nerve. Although the incidence of Onodi cell pathologies such as mucocele is extremely low, they may cause ophthalmological complications due to the close anatomical proximity between the Onodi cell and the optic nerve. Optic neuritis caused by aspergillosis of the Onodi cell, presenting in the Emergency Department as an aspergilloma within a pyomucocele, has not been reported previously. Here, we describe the first such case; the aspergilloma within the pyomucocele was completely removed via surgical endoscopy.

Key words: optic neuritis, onodi cell pyomucocele, aspergilloma, CT, MRI

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Ed overcrowding – matematic models for integrated solutions and decisions

Dear Editor In Chief,

We are writing to You in line with an very interesting point of view regarding the Emergency Department (ED) development. The paper titled Improving  Emergency  Department Capacity Efficiency, published in your Journal 2016; 12(1): 52-57, as an original articles, spotlight solution for ED crowding.

So we are proposing a mathematics models for reciprocal accommodation of patients flows to the response capacity of the ED.

ED overcrowding is not just a reality but a huge problem, not only on satisfaction of staff and patients, but also in terms of ED performance. It is already known that, prolonged stay in ED is associated with lower compliance of ACC rules for care of ACS/NSTEMI (1) and increased mortality for hospitalized patients.(2,3)

Theoretically, there are two possible approaches: modulating demand (categorization and stratification of entries, triage, types and volume of auxiliary resources patients, use bifocal FastTrack for reducing time of wait) or enhancing capacity.

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