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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Page 3 of 23

Bronchoscopy during non-invasive ventilation in a patient with acute respiratory distress syndrome

Abstract

A 72-year-old man was transferred to our hospital for refractory severe acute respiratory syndrome. On arrival, he was intubated and mechanically ventilated. Furthermore, he required veno-venous extracorporeal membrane oxygenation. Two days later, he was extubated and supported with periods of non-invasive ventilation (NIV), with a new mask. Because of large amounts of bronchial secretions that he was not able to expectorate, flexible fiberoptic bronchoscopy (FFB) was performed to remove the secretions, without interrupting NIV support. During the procedure, the patient remained hemodynamically stable, breathing spontaneously and with just a mild reduction in oxygen saturation (SpO2) (97.9% vs. 96.8%). This case report highlights the possibility of performing upper endoscopic procedures, such as FFB, during non-invasive ventilation in patients in whom this respiratory support is required and its interruption may be harmful.

Key words: non-invasive ventilation, acute respiratory distress syndrome, flexible fiberoptic bronchoscopy, intensive care unit

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Endovascular targeted coil embolization using dual vessel approach for traumatic direct carotid-cavernous fistula following severe head trauma: technical notes

Abstract

Direct carotid cavernous fistulas (dCCFs) represent different entitles from spontaneous cavernous sinus (CS) dural arteriovenous fistulas (CSAVFs). Traumatic dCCFs are direct arteriovenous communications between the internal carotid artery (ICA) and cavernous sinus, resulting from a traumatic tear of the horizontal or posterior ascending intracavernous segment of the ICA by skull fracture fragments. They are account for 0.2–0.3% of craniofacial trauma and a serious problem that results in neuro-ophthalmologic symptoms. Intracerebral hemorrhage followed by cortical venous reflux is a most serious complication. Although embolization of dCCFs with detachable balloons was previously accepted worldwide as the first-line therapeutic option because it is technically simple, these devices are currently unavailable and other treatment options have included coil embolization of the fistula to preserve the internal carotid artery. Therefore, sinus packing by coil embolization is now a first-line therapy, but there is the disadvantage of neuro-ophthalmologic symptoms by nerve palsy occurred in CS. In this study, we treated two patients with dCCFs caused by severe head trauma who underwent dual vessel approach to endovascular targeted coil embolization and successful resolution. We concluded that dual vessel approach to endovascular targeted coil embolization is an effective and safety technique among patients with traumatic dCCFs.

Key words: endovascular treatment, brain injury, dural arteriovenous fistulas, cavernous sinus, superior ophthalmic vein

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Ticking time bomb: abdominal aortal aneurism detected at prehospital level

Abstract

The cause of sudden death is increasingly more frequent due to abdominal aortal aneurism (AAA). This ticking “time bomb” in the abdomen is particularly inconvenient for diagnosis and treatment at the prehospital level. We present a rare case of prehospitally detected AAA that like the ticking time bomb threatened to rupture.

Case scenario. A 66 years old male called Emergency Medical Services (EMS) due to unbearable pain (9/10 at the pain intensity scale) of crescendo type in the right gluteal region and the right hip. Four days before, due to a sudden feeling of pain within the above quoted region he underwent neurological, orthopedic and urological examinations. The diagnosis of coxarthrosis/coxalgia was made. He was treated with analgesics with suggested rest. Anamnestically, he was previously healthy, without family history of AAA. He is a several-year smoker and hypertonic. Physical findings: conscious, orientated, eupnoic, afebrile, normal skin color, with visible mucosa, excessive sweating and obesity. Auscultatory findings of the lungs and heart were also within normal limits. SaO2 = 99%. Blood pressure (BP) on both hands was 170/100 mmHg. ECG: sinus rhythm with a frequency of 80/min, without acute ST-T changes. The abdomen above the chest was with palpable pulsating tumefaction (size 5-6 cm) in the right inguinum that was respiratory immovable. Lazarević sign negative. Prehospital diagnosis was made: suspected AAA. On admission: treated as the emergency case, after multislice computed tomography (MSCT) and angiographic findings indication for emergency surgical intervention was made. He was of good general condition and satisfactory local status. Ten days after surgery the patient was released from hospital with prescribed antihypertensive and antiaggregant therapy, and was also forbidden smoking.

Conclusion. The reported case is the confirmation that AAA represents a ticking “time bomb” in the organism that requires emergency prehospital recognition, emergency care and high emergency transport to a hospital.

Key words: aneurism, abdominal aorta, ticking time, bomb, prehospital, detection

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Clonidine for neonatal abstinence syndrome: a single neonatology department’s experience

Abstract

Clonidine has been shown effective in reducing sympathetic hyperactivity in neonatal abstinence syndrome (NAS). The aim of this study was to analyze clinical and laboratory characteristics of a group of newborns treated with clonidine for NAS due to maternal drug addiction and due to withdrawal from opioid analgesic therapy. Only one full–term newborn presented with metabolic acidosis and hyperkalemia; in others no clinical or laboratory adverse effects were detected. This report emphasizes the importance of alertness to potential adverse effects of clonidine therapy, and discusses possible pathophysiological aspects of hyperkalemia and metabolic acidosis during treatment for NAS.

Key words: newborn, sympathetic hyperactivity, metabolic acidosis, hyperkalemia

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Invasive malplacentation of lower uterine segment in first trimester patient with obstetric shock development

Abstract

We present a case of invasive malplacentation of the lower uterine segment found in a first trimester, 38-year old woman following curettage for missed abortion. Uncontrolled hemorrhage and obstetric hemorrhagic shock developed, resulting in abdominal hysterectomy, with resuscitation. The patient made a full recovery.

Key words: invasive placentation, first trimester, hysterectomy, obstetric shock

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