Management of acute-onset and life-threatening respiratory distress of unusual aetiology

Students presenting with varying degrees of respiratory symptoms and distress occur commonly in the school setting. It is important to develop a differential diagnosis for respiratory distress, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary health care provider’s office, or directly to the closest emergency department via Emergency Medical Services). This article describes the initial assessment and management of a student presenting with respiratory distress.

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Acute Onset Peripartum Cardiomyopathy in a Woman with Severe Pre-eclamptia: A Diagnostic Dilemma

Obstetric Medicine ◽

10.1258/om.2012.120032 ◽

2013 ◽

Vol 6 (1) ◽

pp. 33-34 ◽

Cited By ~ 1

Author(s):

Sonela Basak ◽

Pallab Rudra

Keyword(s):

Late Pregnancy ◽

Acute Onset ◽

Peripartum Cardiomyopathy ◽

Lifestyle Modifications ◽

Diagnostic Dilemma ◽

Life Threatening ◽

Physiological Reserve ◽

Proper Diagnosis ◽

Future Pregnancy ◽

Lateral Thinking

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that can present as acute life-threatening pulmonary oedema in late pregnancy or early puerperium, its diagnosis is mainly by exclusion of other causes. Morbidity is high due to the reduced physiological reserve in pregnancy. PPCM and severe pre-eclampsia can co-exist and their clinical presentation may overlap, making the diagnosis more difficult and often delayed, with potentially devastating consequences. Here, we would like to share our experience of such a case and present to the readers how we dealt with the challenge. As obstetricians we often do not resort to transthoracic echocardiography, which in our case prompted the diagnosis timely. Lateral thinking and a heightened suspicion does help. Proper diagnosis is extremely important not only for the immediate appropriate management but also for advising long-term lifestyle modifications to minimize risk and counselling for future pregnancy.

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Mediastinal teratoma presenting with respiratory distress and cardiogenic shock in a neonate

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz328 ◽

2020 ◽

Vol 30 (5) ◽

pp. 788-789

Author(s):

Mila Stajevic ◽

Ivan Dizdarevic ◽

Igor Krunic ◽

Vesna Topic

Keyword(s):

Respiratory Failure ◽

Cardiogenic Shock ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Emergency Operation ◽

Fast Growing ◽

Mediastinal Teratoma ◽

Venous Compression ◽

Life Threatening

Abstract Mediastinal teratomas are uncommon, fast-growing thoracic tumours, which are usually diagnosed in childhood or adolescence. Neonatal forms are the rarest and often present with life-threatening respiratory distress syndrome. In our case, respiratory failure in a neonate was aggravated by severe cardiogenic shock due to aortic and systemic venous compression, extreme heart displacement and rotation, necessitating an emergency operation on the first day of life.

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Treatment of COVID-19 pneumonia and acute respiratory distress with ramatroban, a thromboxane A2 and prostaglandin D2 receptor antagonist: A 4-Patient Case Series Report

10.21203/rs.3.rs-474882/v3 ◽

2021 ◽

Author(s):

Martin L. Ogletree ◽

Kate Chander Chiang ◽

Rashmi Kulshreshta ◽

Aditya Agarwal ◽

Ashutosh Agarwal ◽

...

Keyword(s):

Respiratory Distress ◽

Organ Failure ◽

Viral Infections ◽

Pulmonary Veins ◽

D2 Receptor ◽

Case Series ◽

Acute Onset ◽

Lipid Mediator ◽

Prostaglandin D2 ◽

Th2 Immune Response

Abstract COVID-19 associated pneumonia and acute respiratory distress syndrome are characterized by a lipid mediator storm with massive increases in lung and systemic thromboxane A2 >> prostaglandin D2. Thromboxane A2 is a potent vasoconstrictor of pulmonary veins >> arteries, and thereby promotes an increase in pulmonary capillary pressures, transudation of fluid into the alveolar space, pulmonary edema and ARDS. Thromboxane A2 also increases vascular permeability, contracts bronchial smooth muscle, triggers and amplifies platelet activation, and promotes a prothrombotic state. PGD2 promotes a Th2 immune response that is atypical for viral infections and inhibits antiviral defense by suppressing interferon λ expression. D-dimers, urinary 11-dehydro-TxB2, and IL-13, a Th2 cytokine, have emerged as key biomarkers of severity and organ failure in COVID-19. Ramatroban is an orally bioavailable, potent, dual antagonist of the thromboxane A2 (TPr) and PGD2 (DPr2) receptors. We report use of ramatroban in 4 COVID-19 outpatients, 22 to 87 years of age, with acute onset / worsening of respiratory distress and hypoxemia. All four patients experienced decrease in respiratory distress and increase in SpO2, within hours of the first dose and thereby avoided hospitalization. By the 5th day all 4 patients had complete resolution of respiratory distress and hypoxemia. Ramatroban (Baynas®, Bayer Yakuhin Ltd., Japan) has an established safety profile, having been indicated in Japan for the treatment of allergic rhinitis for over 20 years. As a broncho-relaxant, anti-vasospastic, anti-thrombotic and immunomodulator, ramatroban addresses the fundamental pathophysiologic mechanisms underlying respiratory and critical organ failure in COVID-19, and therefore merits urgent clinical trials that might impact the ongoing pandemic.

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Suspected botulism outbreak after the consumption of vegetarian pâté in the south of Viet Nam

Wellcome Open Research ◽

10.12688/wellcomeopenres.16372.4 ◽

2021 ◽

Vol 5 ◽

pp. 257

Author(s):

Le Quoc Hung ◽

Vo Ngoc Anh Tho ◽

Do Thi Ngoc Khanh ◽

Vo Thi Thanh Hien ◽

Jeremy N. Day ◽

...

Keyword(s):

Early Recognition ◽

Specific Treatment ◽

Case Series ◽

Acute Onset ◽

Viet Nam ◽

Food Hygiene ◽

High Clinical Suspicion ◽

Cranial Nerve Palsies ◽

Life Threatening ◽

Botulinum Neurotoxins

Botulism and other botulinum neurotoxins-producing clostridia are potentially life-threatening diseases caused by toxins produced by Clostridium botulinum. Here we reported a case series of six patients who presented with botulism following ingestion of commercially made pâté. The key features of presentation were acute onset of bilateral cranial nerve palsies and symmetrical descending weakness in the absence of fever resulting in the need for mechanical ventilation in all six patients. The clinical diagnosis of botulism was confirmed through the identification of C. botulinum from the suspected food source. Given that botulinum antitoxin was not available in Vietnam at the time, and their severe status, all patients received a trial of plasma exchange therapy, but no clear benefit was seen. Due to its rarity, diagnosing botulism is a challenge, demanding high clinical suspicion. Successful outcomes depend upon early recognition and rapid initiation of specific treatment with botulinum antitoxin. There is a need to improve global access to antitoxin. These cases, the first in Viet Nam, serve as a reminder of the need to maintain the highest possible food hygiene and preservation practices.

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Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.798198 ◽

2021 ◽

Vol 8 ◽

Author(s):

Amanda M. Spillane ◽

Jenica L. Haraschak ◽

Maureen A. McMichael

Keyword(s):

Hepatic Encephalopathy ◽

Lipid Emulsion ◽

Reference Interval ◽

Ammonia Concentration ◽

Acute Onset ◽

Portosystemic Shunt ◽

Dramatic Improvement ◽

Intravenous Lipid Emulsion ◽

Life Threatening ◽

Patient’S History

A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.

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Acute respiratory distress syndrome in a case of diabetic ketoacidosis requiring ECMO support

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0192 ◽

2021 ◽

Vol 2021 ◽

Author(s):

Milad Darrat ◽

Brian Gilmartin ◽

Carmel Kennedy ◽

Diarmuid Smith

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Diabetic Ketoacidosis ◽

Distress Syndrome ◽

Early Recognition ◽

Ecmo Support ◽

List Type ◽

Life Threatening ◽

Life Threatening Complication

Summary Acute respiratory distress syndrome (ARDS) is a rare but life-threatening complication of diabetic ketoacidosis (DKA). We present the case of a young female, with no previous diagnosis of diabetes, presenting in DKA complicated by ARDS requiring extra corporeal membrane oxygenation (ECMO) ventilator support. This case report highlights the importance of early recognition of respiratory complications of severe DKA and their appropriate management. Learning points ARDS is a very rare but life-threatening complication in DKA. The incidence of ARDS remains unknown but less frequent than cerebral oedema in DKA. The mechanism of ARDS in DKA has multifactorial aetiology, including genetic predisposition. Early recognition and consideration of rare pulmonary complication of DKA can increase survival rate and provide very satisfactory outcomes. DKA patients who present with refractory ARDS can be successfully rescued by ECMO support.

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The Role of Omega-3 Polyunsaturated Fatty Acids in the Treatment of Patients with Acute Respiratory Distress Syndrome: A Clinical Review

BioMed Research International ◽

10.1155/2015/653750 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

M. García de Acilu ◽

S. Leal ◽

B. Caralt ◽

O. Roca ◽

J. Sabater ◽

...

Keyword(s):

Fatty Acids ◽

Acute Respiratory Distress Syndrome ◽

Fatty Acid ◽

Polyunsaturated Fatty Acids ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Acute Onset ◽

Omega 3

Acute respiratory distress syndrome (ARDS) is defined as the acute onset of noncardiogenic edema and subsequent gas-exchange impairment due to a severe inflammatory process. Recent report on the prognostic value of eicosanoids in patients with ARDS suggests that modulating the inflammatory response through the use of polyunsaturated fatty acids may be a useful strategy for ARDS treatment. The use of enteral diets enriched with eicosapentaenoic acid (EPA) and gamma-linolenic acid (GLA) has reported promising results, showing an improvement in respiratory variables and haemodynamics. However, the interpretation of the studies is limited by their heterogeneity and methodology and the effect ofω-3 fatty acid-enriched lipid emulsion or enteral diets on patients with ARDS remains unclear. Therefore, the routine use ofω-3 fatty acid-enriched nutrition cannot be recommended and further large, homogeneous, and high-quality clinical trials need to be conducted to clarify the effectiveness ofω-3 polyunsaturated fatty acids.

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