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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Posttraumatic hepatic artery pseudoaneurysm presenting as gastrointestinal bleeding

Abstract

Posttraumatic hepatic artery pseudoaneurysm is a rare, but life threatening condition which should be considered in patients with a history of blunt abdominal trauma who present with abdominal pain or gastrointestinal bleeding. We report a case of a patient with such a pseudoaneurysm discovered five months after a bicycle accident resulting in hepatic rupture that was treated conservatively. The patient presented with fatigue, dizziness, inability to tolerate major exertion and gastrointestinal bleeding. After extensive diagnostic procedures, a right hepatic artery pseudoaneurysm was found. The condition was treated successfully with transcatheter coil embolization.

Key words: blunt abdominal trauma, hepatic artery, pseudoaneurysm, embolization, gastrointestinal bleeding, abdominal pain

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Monitoring of a middle latency auditory evoked potential index during postresuscitation care with induced therapeutic hypothermia

Abstract

A 48-year-old man suddenly suffered a cardiac arrest at the supermarket and underwent bystander cardiopulmonary resuscitation. During transportation to our emergency center, ventricular fibrillation occurred and defibrillation was successful. Restoration of spontaneous circulation (ROSC) with sinus rhythm occurred 12 min after sudden cardiac arrest. On arrival at the emergency center 2 min after ROSC, middle latency auditory evoked potential index (MLAEPi) was measured and MLAEPi monitoring was continued to post-resuscitation care with induced therapeutic hypothermia (TH). This case highlights the usefulness of MLAEPi monitoring during primary care in the emergency center and postresuscitation care, including TH, for predicting neurological outcome.

Key words: resuscitation, cardiopulmonary arrest, monitoring, prognosis

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Coblation tonsilloadenoidectomy – treatment of choice for very small children

Abstract

Tonsillectomy is one of the most common operative procedures in childhood. According to the Croatian national guidelines for the treatment of sore throat (ISKRA guidelines), apsolute indications for tonsillectomy are recurrent tonsillitis (>4 per year) and sleep disordered breathing (including snoring and obstructive sleep apnea). Most children in Croatia undergo conventional cold steel tonsillectomy with bipolar diathermy coagulation using reusable surgical accessories. Estimated blood loss during this type of surgery is about 10% of complete blood volume. That is why, tonsillectomy is performed mostly in children 3 years of age and above because their weight and blood volume. Coblation tonsillectomy results in less postoperative blood loss and less postoperative morbidity and is therefore the method of choice for operating on very small children.

We present the case of a 3-year-old girl with somatic retardation (height 92 cm, weight 9,280 kg) who underwent coblation tonsilloadenoidectomy. As far as we now, this procedure has never been performed in a child of lower weight.

Key words: tonsillectomy, body weight, obstructive sleep apnea, weight gain

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Safety in the neonatal and infant transport system: report on three cases with evidence-based comments on safety during transportation

Abstract

Infant transport has been carried out in Slovenia since 1976. Applying the principles of safe transport was essential to avoid unexpected exposure of critically ill infants to unnecessary and adverse events. Besides organizational and technical prerequisites for safe transportation, evidence-based clinical knowledge and practical competence are of utmost importance. Furthermore, the ongoing possibility of consulting other colleagues during transportation, choose the optimal form of retrieval of very sick infants, is sometimes needed and preferred. Three different cases are presented here where skilled medical teams decided how to transport critically ill infants, and at what risks and costs. All three transports were successfully completed with good outcomes despite difficult clinical conditions prior to and during retrieval.

Key words: safety, neonatal transport, pneumothorax, prostaglandin infusion, extracorporeal membrane oxygenation

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Umbilical Vein Catheterization – When Complications Occur A Case Report

Abstract

Although umbilical venous catheterization is a routine procedure in premature newborns, it is associated with various, potentially life threatening, complications. We present a case of a premature baby diagnosed with a hepatic parenchymal liquid collection as a complication of umbilical vein catheterization in our Neonatal Intensive Care Unit.

The child was born in the 25th gestational week (GW) and was doing well until the12th day of life when his general condition deteriorated. He appeared anxious and his oxygen saturation (SaO2) decreased. There was slight abdominal distension and tenderness over the abdominal wall, with weak bowel movements, and a palpable liver. Abdominal ultrasound (US) showed an enlarged liver with a well-defined hypoechoic area, with inhomogeneous echogenicity. Such findings were suggestive of fluid extravasation to the liver through a malpositioned umbilical venous catheter. The umbilical catheter was withdrawn, antimicrobial treatment initiated, and eventual complete regression of the collection was seen eleven days after extravasation. Rapid, unexplained clinical deterioration of a newborn with an umbilical vein catheter should always raise the suspicion of a complication due to catheterization. Such a catheter should be carefully revised and, if there is any doubt, removed. Timely diagnosis and adequate treatment is essential, and potentially life-saving.

Key words: newborn, umbilical vein catheterization, complication, malposition, liver

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