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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Mediastinal tube placement in a premature infant with cardiorespiratory derangement due to ventilator associated pneumomediastinum

Abstract

While mediastinal free air in the ventilated newborn is usually benign, tension pneumomediastinum can lead to further cardiorespiratory compromise due to the compression of mediastinal structures, including the heart and large blood vessels. The authors present a case of life-threatening pneumomediastinum in a ventilated preterm leading to abrupt onset of cardiorespiratory failure. An 8 French (Fr) drainage catheter was placed in the anterior mediastinum using the 2nd right intercostal space as an insertion site, with prompt hemodynamic improvement. A brief description of the drainage technique and a literature review is presented.

Key words: hemodynamics, mechanical ventilation, pneumomediastinum, pneumothorax, thoracocentesis

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Serious complications of an obstructive upper airway infection in a young child

Abstract

A 15-month old boy was admitted to our intensive care unit (ICU) cyanotic, unresponsive, apneic, pulseless, with fixed, dilated pupils and a Glasgow Coma Score (GCS) of 3/15. Prompt cardiopulmonary resuscitation (CPR) was initiated and cardiac function was resumed after 10 minutes. The boy was intubated but could not be ventilated because of a thick, viscous secretion obstructing the trachea and causing total airway obstruction. Bronchoscopy revealed laryngotracheitis as the reason for airway obstruction. A computed tomography (CT) scan of the brain showed diffuse edema and ischemic brain injury, which were considered responsible for the boy’s comatose situation. Clinical status remained unchanged for 11 days, after which the boy was transported to another hospital. In children presenting with upper airway obstructing syndromes, not responding to therapy, the diagnosis of bacterial tracheitis should be considered and the child should be monitored in a pediatric intensive care unit.

Key words: children, respiratory infection, airway obstruction, bacterial tracheitis

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Migration of foreign body from mouth to nose

Abstract

A man appeared in the Emergency Department complaining of discomfort in his neck because he had swallowed a toothpick while taking a nap. The examining physician could find no foreign body in the patient’s mouth or pharynx. An additional examination using a fiberscope disclosed the existence of a foreign body in the nose. The toothpick was thought to have migrated to the nose from the pharynx after it was swallowed. Foreign bodies of various sizes may migrate to the nose from other parts of the body. Therefore, protocols must be designed for additional examination of the nose.

Key words: airway, foreign bodies, migration, toothpick

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