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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Tag: pneumothorax

Unrecognized B line mimicked pneumothorax on M mode ultrasound

 

Key words: lung ultrasound, B-line, pneumothorax

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Bilateral Pneumothorax and Subcutaneous Emphysema following Endoscopic Retrograde Cholangiopancreatography with Sphincterectomy

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic procedure in the management of pancreatic and extrahepatic biliary tract diseases. Although rare, it is related to several complications including retroperitoneal duodenal perforation. The perforation results in air accumulation in the retroperitoneal, pleural or subcutaneous space. We present a case of 63-year-old female with massive bilateral pneumothorax and subcutaneous emphysema following therapeutic ERCP.

Key words: endoscopic retrograde cholangiopancreatography, pneumothorax, subcutaneous emphysema, complications of endoscopic retrograde cholangiopancreatography

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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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Identification of lung sliding: a basic ultrasound technique with a steep learning curve

Abstract

Introduction. One of the basic premises of sonographic lung imaging is the concept of lung sliding. Identification of clear lung sliding excludes pneumothorax (PTx) at that specific local point.
Methods. Fifty-seven 4th year medical students were given a 20-minute lecture on sonographic identification of lung sliding and exclusion of PTx. After the lecture, students were asked to correctly position the probe, identify shown structures and on each attempt (six attempts in a row) state whether lung sliding is present or not.
Results. There were 57 students in the sample. Fifty students (87.7%) successfully positioned the probe (all 4 positions) for PTx identification. All but five students (91.2%) recognized the anatomic structures of the thorax. Mean number of correctly identified cases per student was 5.1 ± 1.1. In 292 (85.4%) cases, the answer was correct. In 298 (87.1%) cases, students were confident in the correct answer. Students who were confident in the right answer gave the right answer significantly more often when compared to others (90.3% vs. 52.3%, p < 0.001). Sensitivity of this method for 4th year medical students was 82.6% and its specificity was 87.9%. For correct identification of lung sliding in the sixth attempt, students on average needed 4.5 correct attempts.
Conclusion. Our study suggests that 4th year medical students with no prior experience in lung ultrasonography can easily acquire knowledge and skills needed to detect thoracic wall structures and identify lung sliding with a high degree of sensitivity and specificity.

Key words: medical students, ultrasonography, pneumothorax

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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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