Evaluation and Anesthetic Management for Patients With Cardiac Trauma

2019 ◽  
pp. 348-359
Author(s):  
Daniel Smith ◽  
Eric Ness ◽  
Amanda M. Kleiman
Keyword(s):  
Anesthetic Management ◽  
Clinical Suspicion ◽  
Operating Conditions ◽  
Mechanical Support ◽  
Cardiovascular Collapse ◽  
Cardiac Trauma ◽  
Complex Patients ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Level

Cardiac trauma, either blunt or penetrating, is a life-threatening condition often requiring immediate intervention. Cardiac trauma causes varied hemodynamic effects, from stable arrhythmia to cardiovascular collapse. The diagnosis of cardiac trauma relies on a high level of clinical suspicion paired with imaging, including transthoracic echocardiography. Anesthetic management for cardiac trauma focuses primarily on maintenance of preload and cardiac function while optimizing operating conditions for surgical repair. Depending on the injuries involved, support that includes inotropes, vasopressors, and potentially mechanical support may be required. This chapter discusses the pathophysiology and presentation of cardiac trauma and explores the intricate anesthetic management of these complex patients.

318. POLYURIA IN PREGNANCY - CHALLENGES OF DIAGNOSIS!

2010 ◽  
Vol 22 (9) ◽  
pp. 118
Author(s):  
A. Sakthivel ◽  
A. J. Nankervis ◽  
J. Conn ◽  
J. Oats ◽  
S. Chitturi
Keyword(s):  
Rare Complication ◽  
Clinical Suspicion ◽  
Urinary Frequency ◽  
Osmotic Homeostasis ◽  
Life Threatening ◽  
Acute Fatty Liver ◽  
High Level ◽  
Circulating Levels ◽  
Experienced Symptom ◽  
In Pregnancy

Increased urinary frequency is a widely experienced symptom in pregnancy; true polyuria is less common and can have a number of causes. It is essential, however that it should be recognized and appropriately investigated, as it may be potentially life threatening to mother and fetus. Diabetes insipidus (DI) is a rare complication of pregnancy. It can be the first presentation of pre-gestational DI, gestational DI or DI associated with acute fatty liver of pregnancy. The latter conditions are illustrated by the following two clinical cases. Osmotic homeostasis can be altered in pregnancy due to resetting of the osmostat and degradation of vasopressin by vasopressinase secreted by the placenta in increasing quantities in the 2nd and 3rd trimesters. Liver failure results in the availability of higher circulating levels of vasopressinase. These cases highlight the difficulties and importance of diagnosis and treatment. Pregnant women often report polyuria during the 3rd trimester. It is important to have a high level of clinical suspicion for the pathological causes, despite the non-specific presentation as underlying conditions can have catastrophic sequelae.

scholarly journals Percutaneous Mechanical Support in Cardiogenic Shock: A Review

2015 ◽  
Vol 9s2 ◽  
pp. CMC.S19707
Author(s):  
Fahad Syed Gilani ◽  
Sarah Farooqui ◽  
Rajiv Doddamani ◽  
Luis Gruberg
Keyword(s):  
Cardiogenic Shock ◽  
Pharmacological Therapy ◽  
Mechanical Support ◽  
Significant Morbidity ◽  
First Line ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening ◽  
Hemodynamic Improvement ◽  
Support Devices

Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. Pharmacological therapy is often the first line of treatment but mechanical support can provide substantial hemodynamic improvement in refractory CS. Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance to the failing myocardium. We review the percutaneous devices currently available, the evidence behind their use, and the new advances in percutaneous technology being evaluated for the treatment of CS.

scholarly journals Catastrophic Antiphospholipid Syndrome in Obstetric Practice

2012 ◽  
Vol 61 (3) ◽  
pp. 7-21 ◽  
Author(s):  
Alexander D Makatsariya ◽  
Viktoriya O Bitsadze ◽  
Dzhamilya Kh Khizroeva
Keyword(s):  
Antiphospholipid Syndrome ◽  
Molecular Mechanisms ◽  
Multiorgan Failure ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Small Vessels ◽  
First Case ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fatal Form ◽  
High Level

Catastrophic antiphospholipid syndrome (CAPS) is an uncommon, often fatal, form of the antiphospholipid syndrome that results in a widespread coagulopathy and affects predominantly small vessels supplying organs with the development of multiorgan failure against a background of high level of antiphospholipid antibodies. Thrombotic microvasculopathy is the basis of multiorgan failure and clinically manifests with CNS disturbances, adrenal failure, and the development of acute respiratory distress syndrome. CAPS is a life-threatening condition and requires urgent measures. Optimal treatment for CAPS is not developed yet. CAPS present a multidisciplinary problem. Authors demonstrate 17 cases of CAPS in patients which were managed from 2001 to 2012 years. Molecular mechanisms of pathogenesis and different obstetric and non-obstetric manifestations of CAPS are discussed in the article. There is the description of first case of management of pregnancy and labor of patient with CAPS in her history. The methods of CAPS prevention are described

scholarly journals Traumatic Diaphragmatic Hernia: Anaesthetic Consideration

2018 ◽  
Vol 6 (2) ◽  
pp. 73-75 ◽  
Author(s):  
Raghu Nandan Khadgaray ◽  
Santosh Shah ◽  
Pawan Puspa Baral
Keyword(s):  
Diaphragmatic Hernia ◽  
Anesthetic Management ◽  
Rapid Sequence Induction ◽  
Traumatic Diaphragmatic Hernia ◽  
Cardiorespiratory Function ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Sequence Induction ◽  
High Level ◽  
Anaesthetic Consideration

Any type of trauma may lead to diaphragmatic hernia with blunt forces accounting for majority. Diaphragmatic hernias require a high level of suspicion to detect. Brain, pelvis, long bones, liver, spleen, and aorta are some other organs that can be severely damaged and need different anesthetic management. Gastric decompression, pre-oxygenation, rapid sequence induction and mechanical ventilation with low tidal volume after intubation were used in anesthetic management for thoracotomy and repair. Traumatic diaphragmatic hernia can be life threatening as it may compromise cardiorespiratory function.  

scholarly journals Severe Metformin Poisoning Successfully Treated with Simultaneous Venovenous Hemofiltration and Prolonged Intermittent Hemodialysis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Dovile Leonaviciute ◽  
Bo Madsen ◽  
Anne Schmedes ◽  
Niels H. Buus ◽  
Bodil S. Rasmussen
Keyword(s):  
Mortality Rate ◽  
Lactic Acidosis ◽  
Intermittent Hemodialysis ◽  
Continuous Venovenous Hemofiltration ◽  
Cardiovascular Collapse ◽  
Circulatory Collapse ◽  
Patient Case ◽  
Threatening Condition ◽  
Life Threatening ◽  
Lactate Acidosis

Metformin poisoning is a life-threatening condition with a high mortality rate. We present a patient case of metformin poisoning following intake of 80 g metformin resulting in severe lactate acidosis with a nadir pH of 6.73 and circulatory collapse, successfully treated with addition of prolonged intermittent hemodialysis (HD) to continuous venovenous hemofiltration (CVVH). The patient’s pH became normal 48 hours after metformin ingestion during simultaneous CVVH and addition of 22 hours of intermittent HD in the ICU. The highest metformin level was found to be 991 μmol/L (therapeutic range 3.9–23.2 μmol/L). We conclude that in cases of severe metformin poisoning with circulatory shock and extreme lactic acidosis, the usual CVVH modality might not efficiently clear metformin. Therefore, additional prolonged HD should be considered even in the state of cardiovascular collapse with vasopressor requirement.

scholarly journals DRESS Syndrome due to Nevirapine Treated with Methylprednisolone

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Henrique Pott Junior ◽  
Gisele Cristina Gosuen ◽  
Ana Cristina Gales
Keyword(s):  
Clinical Presentation ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Clinical Suspicion ◽  
Significant Morbidity ◽  
Dress Syndrome ◽  
Infected Female ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Symptoms

Nevirapine-induced DRESS syndrome is uncommon but a potentially life-threatening condition, with significant morbidity and mortality rates due to multiple-organ involvement. The authors report a case of a 47-year-old HIV-infected female patient who presented with fever, right hypochondrium pain, jaundice, and skin rash. The Nevirapine-induced DRESS syndrome was suspected based on clinical presentation and RegiSCAR scoring system. This case highlights the need for a high index of clinical suspicion among HIV-infected patients with severe skin eruption and systemic symptoms.

scholarly journals SAT-469 Vitals for the Prompt Recognition of Myxedema Crisis in a Critically Ill Patient

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Katalina Funke ◽  
Faisal Aljehani ◽  
Aundrea Loftley
Keyword(s):  
Vital Signs ◽  
Critically Ill Patient ◽  
Severe Illness ◽  
High Likelihood ◽  
Myxedema Coma ◽  
Threatening Condition ◽  
Life Threatening ◽  
Low Threshold ◽  
High Level ◽  
Neuroscience Intensive Care Unit

Abstract Myxedema coma is a rare but life-threatening condition if not treated promptly. The time from initial presentation to diagnosis may be prolonged in patients with severe illness whose presenting features are common to myxedema crisis. A 94-year-old male admitted to the neuroscience intensive care unit for acute stroke monitoring after intra arterial thrombolysis was treated for myxedema three days after initial labs revealed severe hypothyroidism and a myxedema score greater than 60. A diagnostic scoring system for the diagnosis of myxedema coma gives points for the following to easily identify patients with high likelihood of decompensated state of extreme hypothyroidism. Given the potential for under recognition of myxedema crisis in severe illness the clinician must pay close attention to vital signs and have a high level of suspicion for myxedema crisis and low threshold for treatment if myxedema score indicates high likelihood despite concomitant critical illness

scholarly journals Blunt Traumatic Aortic Injury

2021 ◽  
Author(s):  
Domenico Calcaterra
Keyword(s):  
Trauma Team ◽  
Aortic Injury ◽  
Complex Patients ◽  
Key Factor ◽  
Threatening Condition ◽  
Life Threatening ◽  
Aortic Injuries ◽  
Definition Of ◽  
Blunt Traumatic Aortic Injury ◽  
Treatment Priorities

Traumatic aortic injuries represent a leading cause of death following motor-vehicular accidents. These injuries curry a very high mortality rate even though a significant number of patients reaches the hospital alive. These injuries are identified in the contest of a polytrauma work up and are almost always associated with multiple other severe traumatic injuries which makes the management of these patients very challenging. The technology advancements seen in recent years with radiologic imaging and the progress of the therapeutic options brought up by the uprise of endovascular therapy, along with the sophistication of the techniques of trauma resuscitation and intensive care management, have improved significantly the overall prognosis of these patients. Although traumatic aortic injuries need to be generally considered a life-threatening condition, their degree of severity may differ significantly from case to case requiring immediate repair in some patients, whereas their repair can be delayed in cases when the severity of the aortic injury does not represent an immediate threat to the patient life. Therefore, the challenge of treatment of the polytrauma patients with an aortic injury is to identify the best strategy of therapy able to prioritize the treatment of the injuries based on their lethal potential. In this contest, the ability of properly defining the severity of the aortic injury is the key-factor to allow the appropriate definition of a treatment strategy able to identify treatment priorities. In our experience, radiologic assessment of the aortic injury in correlation with the evaluation of clinical parameters and a comprehensive polytrauma assessment allows to optimize the ability of the trauma team to establish the most appropriate strategy for the care of this complex patients’ group.

scholarly journals Spontaneous Splenic Rupture Complicating Severe P. falciparum Infection: A Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Eltaib Saad ◽  
Elamin Elsamani ◽  
Walid Abdelrahman
Keyword(s):  
Clinical Presentation ◽  
Splenic Rupture ◽  
Clinical Suspicion ◽  
Successful Outcome ◽  
Spontaneous Splenic Rupture ◽  
Malarial Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Missed Diagnosis ◽  
Rupture Of The Spleen

Spontaneous rupture of the spleen in malarial infection or malarial splenic rupture (MSR) is a rare but life-threatening condition complicating severe malarial infection in tropics and subtropics, and hence it deserves special attention. A high index of clinical suspicion is warranted for the early diagnosis as delayed or missed diagnosis can be potentially fatal. We report on a 32-year-old male who was diagnosed with severe Plasmodium falciparum infection and presented with an acute abdomen due to spontaneous splenic rupture. He was managed conservatively and had a successful outcome. The epidemiology, pathophysiology, clinical presentation, and management of MSR were briefly discussed in this report.

scholarly journals Asymptomatic Presacral Paraganglioma: Management of an Unpredictable Intraoperative Finding

2020 ◽  
Vol 06 (02) ◽  
pp. e131-e134
Author(s):  
Athina A. Samara ◽  
Alexandros Diamantis ◽  
Dimitrios Symeonidis ◽  
Athanasios Anagnostou ◽  
Andreas Marios Diamantis ◽  
...  
Keyword(s):  
Neural Crest ◽  
Neuroendocrine Tumors ◽  
Rare Case ◽  
Intraoperative Complications ◽  
Hypertensive Crisis ◽  
Clinical Suspicion ◽  
Anatomical Location ◽  
Presacral Mass ◽  
Life Threatening ◽  
High Level

AbstractParagangliomas are rare neuroendocrine tumors originating from the embryological neural crest. We report a rare case of a patient with an asymptomatic presacral mass (incidentaloma) who experienced an unpredictable intraoperative hypertensive crisis after manipulation of the tumor. Presacral neoplasms pose a diagnostic and therapeutic challenge due to their obscure anatomical location and the difficulty in performing an R0 excision. Furthermore, the management of asymptomatic paragangliomas requires a high level of clinical suspicion and expertise due to potential life-threatening intraoperative complications.

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