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 It’s never too late- spontaneous rupture of spleen and life-threatening hypovolemic shock in a patient recuperating from legionnaire’s disease

2021 ◽  
Vol 7 (2) ◽  
Keyword(s):  
Splenic Rupture ◽  
Hypovolemic Shock ◽  
Traumatic Rupture ◽  
Quadrant Pain ◽  
Legionella Pneumonia ◽  
Threatening Condition ◽  
Life Threatening ◽  
Legionnaires Disease ◽  
Low Threshold ◽  
Rupture Of The Spleen

Spontaneous non-traumatic rupture of the spleen in the setting of Legionnaires’ disease is very uncommon but a life-threatening condition. The splenic rupture can present within a few days after symptom onset with significant hypotension with drop in haemoglobin along with left side upper quadrant pain. Most of the cases described in the previous literature have presented within 0-11 (mean 4) days of the pneumonia but this case we are reporting presented after 3 weeks after being treated with Legionella pneumonia. The case also highlights an atypical presentation and emphasises the need to maintain a low threshold for diagnosis especially in resource constrained setting so that patient can be transferred at the earliest to a centre where appropriate corrective measures including surgery can be safely undertaken. Keywords: splenic rupture, pneumonia, hypovolemic shock

scholarly journals Sudden cardiac arrest associated with myxedema coma due to undiagnosed hypothyroidism: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Asami Yoshinaka ◽  
Masayuki Akatsuka ◽  
Shuji Yamamoto ◽  
Michiaki Yamakage
Keyword(s):  
Cardiac Arrest ◽  
Differential Diagnosis ◽  
Physical Examination ◽  
Sudden Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Clinical Findings ◽  
Neurological Dysfunction ◽  
Myxedema Coma ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background Myxedema coma, which occurs due to hypothyroidism, is a rare and life-threatening condition. Some patients have hemodynamic dysfunction, which consequently leads to cardiac arrest. The rarity of this condition makes it difficult to determine the cause of cardiac arrest. It is important to diagnose myxedema coma based on clinical findings, including physical examination and laboratory parameters. We present a case of undiagnosed and untreated hypothyroidism that initially caused myxedema coma and then led to cardiac arrest. Case presentation A 56-year-old woman who had no medical history was transferred to our hospital for the management of return of spontaneous circulation due to sudden cardiac arrest. Findings of laboratory tests revealed that she had hypothyroidism. On physical examination, she was found to have a puffy face, thin eyebrows, and severe systemic non-pitting edema. Therefore, the patient was clinically diagnosed with myxedema coma, which was the cause of cardiac arrest. She was treated with thyroid hormone and hydrocortisone, resulting in improvement in her general condition, except for the neurological dysfunction. Conclusions This case suggests that myxedema coma is caused by undiagnosed and untreated hypothyroidism, leading to sudden cardiac arrest. Our findings are useful in the differential diagnosis of hypothyroidism based on characteristic physical examination findings. Clinicians should be aware of the differential diagnosis of myxedema coma based on findings from physical examination and laboratory testing of thyroid function, and the treatment should be started immediately.

scholarly journals Clinical Report of Probable Catastrophic Antiphospholipid Syndrome in Pregnancy

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Eryk Hakman ◽  
Sasha Mikhael
Keyword(s):  
Early Recognition ◽  
Vital Signs ◽  
Adverse Outcomes ◽  
Laboratory Evaluation ◽  
Clinical Report ◽  
Elevated Liver Enzymes ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
In Pregnancy

Background. Catastrophic APS (CAPS) is a rare but life-threatening form of APS defined as multiorgan thrombosis affecting a minimum of three organs with confirmation by histopathology of small vessel occlusions in at least one organ or tissue. The development of CAPS in pregnancy poses many diagnostic challenges as a result of its broad range of clinical presentations and its overlap with other obstetric complications and microangiopathic diseases. Because of the high associated mortality rate, prompt recognition and treatment are paramount. Case. A twenty-five-year-old G3P0111 with a history of multiple thromboembolisms presented at 21 weeks and 3 days of gestation with complaints of right upper quadrant pain, visual disturbances, headache, and syncopal episodes. Laboratory evaluation demonstrated microangiopathic disease with hemolysis (confirmed on peripheral smear), elevated liver enzymes, and abnormal 24-hour urine protein with vital signs within the normal range. Presence of significantly elevated antiphospholipid antibodies was noted, facilitating the diagnosis of probable CAPS. Proper workup was achieved based on clinical suspicion, allowing immediate and appropriate management. Conclusion. CAPS is a life-threatening condition rarely seen in pregnancy making early recognition difficult. A low threshold to initiate urgent and aggressive treatment should be maintained to minimize the risk of adverse outcomes.

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 Neonatal Hypernatremic Dehydration Associated with Lactation Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Zemichael Ogbe ◽  
Amanuel Kidane Andegiorgish ◽  
Aradom Habteab Zeray ◽  
Lingxia Zeng
Keyword(s):  
Vital Signs ◽  
Free Water ◽  
Laboratory Facilities ◽  
Neurologic Sequelae ◽  
Threatening Condition ◽  
Life Threatening ◽  
Laboratory Investigations ◽  
Term Baby ◽  
Initial Bolus ◽  
Hypernatremic Dehydration

Hypernatremic dehydration secondary to lactation failure remains a potentially life-threatening condition in countries where advanced laboratory investigations are scarce. An 11-day term baby with excessive weight loss (33.6%), reduced urine output, fever, jaundice, doughy skin, opisthotonus posturing, and tachycardia with poor perfusion was presented to our neonatal care. The baby was diagnosed with shock with hypernatremic dehydration. An initial bolus of 20 ml/kg of N/S was repeated 3 times (each over 20 minutes), i.e., a total of 204 ml was given over 1 hr, until the vital signs were normalized to PR-145, RR-45, T-37.2°C, SPO2-100%, and CRT < 3 seconds, and the baby began to void urine. Free water deficit and sodium excess was managed by gradual and slow correction over 72 hours to prevent cerebral oedema and neurologic sequelae. The baby required reconstituted solutions of 5% D/W + 1/2 N/S at a rate of 27 ml/hr for 72 hrs. Sepsis and hyperbilirubinemia were treated with antibiotics and phototherapy. Management of symptomatic hypernatremic dehydration must be considered in settings with inadequate laboratory facilities.

scholarly journals Tele-EMS physicians improve life-threatening conditions during prehospital emergency missions

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hanna Schröder ◽  
Stefan K. Beckers ◽  
Klaudia Ogrodzki ◽  
Christina Borgs ◽  
Sebastian Ziemann ◽  
...  
Keyword(s):  
Vital Signs ◽  
Improve Patient Care ◽  
Secondary Outcome ◽  
Telemedicine System ◽  
Threatening Condition ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Drug Doses ◽  
The City

AbstractAlmost seven years ago, a telemedicine system was established as an additional component of the city of Aachen’s emergency medical service (EMS). It allows paramedics to engage in an immediate consultation with an EMS physician at any time. The system is not meant to replace the EMS physician on the scene during life-threatening emergencies. The aim of this study was to analyze teleconsultations during life-threatening missions and evaluate whether they improve patient care. Telemedical EMS (tele-EMS) physician consultations that occurred over the course of four years were evaluated. Missions were classified as involving potentially life-threatening conditions based on at least one of the following criteria: documented patient severity score, life-threatening vital signs, the judgement of the onsite EMS physician involved in the mission, or definite life-threatening diagnoses. The proportion of vital signs indicating that the patient was in a life-threatening condition was analyzed as the primary outcome at the start and end of the tele-EMS consultation. The secondary outcome parameters were the administered drug doses, tracer diagnoses made by the onsite EMS physicians during the missions, and quality of the documentation of the missions. From January 2015 to December 2018, a total of 10,362 tele-EMS consultations occurred; in 4,293 (41.4%) of the missions, the patient was initially in a potentially life-threatening condition. Out of those, a total of 3,441 (80.2%) missions were performed without an EMS physician at the scene. Records of 2,007 patients revealed 2,234 life-threatening vital signs of which 1,465 (65.6%) were remedied during the teleconsultation. Significant improvement was detected for oxygen saturation, hypotonia, tachy- and bradycardia, vigilance states, and hypoglycemia. Teleconsultation during missions involving patients with life-threatening conditions can significantly improve those patients' vital signs. Many potentially life-threatening cases could be handled by a tele-EMS physician as they did not require any invasive interventions that needed to be performed by an onsite EMS physician. Diagnoses of myocardial infarction, cardiac pulmonary edema, or malignant dysrhythmias necessitate the presence of onsite EMS physicians. Even during missions involving patients with life-threatening conditions, teleconsultation was feasible and often accessed by the paramedics.

scholarly journals The Double Gut Point: A Novel Sonographic Sign of Pneumoperitoneum

2022 ◽  
Author(s):  
Yale Tung Chen ◽  
Tomas Villén Villegas ◽  
Elmo Pereira
Keyword(s):  
Point Of Care ◽  
Critically Ill Patient ◽  
Point Of Care Ultrasound ◽  
Sudden Increase ◽  
Urgent Surgery ◽  
Free Air ◽  
Linear Probe ◽  
Threatening Condition ◽  
Life Threatening ◽  
Upper Abdominal

Abstract Pneumoperitoneum is a life-threatening condition, caused by hollow organ perforation. The diagnosis is often difficult, and Point-of-care ultrasound can be useful to distinguish from different conditions, and early set the indication of urgent surgery. We report a critically ill patient presented to the Emergency Department with sudden increase in upper abdominal pain and distension with a diagnosis of small bowel obstruction on ultrasound using a curvilinear probe. After repeating the ultrasound using a linear probe, two dynamic points at mesogastrium very similar to the “double lung point” seen in thoracic ultrasound was detected. This “double gut point” due to bowel ischemia and perforation was confirmed on a computed tomography scan. In this case, the finding of an abdominal “double gut point” allowed us to diagnose pneumoperitoneum, being a novel sign not previously described, that could aid to diagnose small amounts of free air in the peritoneal cavity.

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.

Clinical Course

2020 ◽  
pp. 99-125
Keyword(s):  
Clinical Course ◽  
Cell Damage ◽  
Post Partum ◽  
Thyroid Cell ◽  
Myxedema Coma ◽  
Silent Thyroiditis ◽  
Clinical Presentations ◽  
Threatening Condition ◽  
Life Threatening ◽  
Painless Thyroiditis

The various clinical presentations of Hashimoto's thyroiditis (HT) include euthyroidism and goiter, subclinical hypothyroidism and goiter, primary thyroid failure, hypothyroidism, adolescent goiter, painless thyroiditis or silent thyroiditis, post-partum painless thyrotoxicosis, and alternating hypo- and hyper-thyroidism. Generally, the progress from euthyroidism to hypothyroidism is considered “irreversible” due to thyroid cell damage and loss of thyroidal iodine stores. Myxedema psychosis is a relatively uncommon consequence of hypothyroidism. Myxedema coma, a rare, life-threatening condition, occurs late in the progression of hypothyroidism when the body's compensatory responses to hypothyroidism are overwhelmed by a precipitating factor such as infection, medication, environmental exposure, or other metabolic-related stresses. Several unusual syndromes that are believed to be associated with HT include amyloidosis, interstitial pneumonitis, Vitiligo, hives, and alopecia. Hashimoto's encephalopathy and Hashimoto's ophthalmopathy are rare complications of HT. This chapter explores the clinical course of Hashimoto's disease.

scholarly journals Nurses’ Knowledge Regarding Food-Drug Interaction in the Intensive Care and Emergency Hospitals

2019 ◽  
Vol 4 (2) ◽  
pp. 61-68
Author(s):  
Samir Y Lafi ◽  
Aram Salih Mohammed Amin Kamali ◽  
Bayan Omar Sharif
Keyword(s):  
Intensive Care ◽  
Drug Interaction ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Ethical Point ◽  
Threatening Condition ◽  
Life Threatening ◽  
Level Of Knowledge ◽  
High Level ◽  
Nurses Knowledge

Usually supplement is essential and fundamental components for ensure and creating the human body, also drugs seem to survey the life of each individual and ensure the wellbeing for a long life aimed most of illness, but in case nourishment sedate interaction ignored since of information shortage almost it or any reason maybe lead to futile of medicine for the patients or cause life threatening condition because of that, one of the most significant ethical point in every health care setting in the world is patient's safety;  and  the care for patients must be improved in every country to prevent complication of interaction between food and drug. The main objective of this cross-sectional study has been conducted to assess the nurses' knowledge regarding food-drug interaction (FDI) at the intensive care in both of Shar and emergency hospitals in the Slemani city, the data were collected during the period of October up to the end of December. Non-probability, (purposive sample) of 78 nurses at both hospitals, a questionnaire was designed according to literatures and books regarding FDI which contained 25 items, 8 items for demographic characteristics, and 17 items concerning FDI. The validity of the questionnaire was given to a panel of 7 experts, a pilot study was carried out to check the reliability of the questionnaire which determined through the use of stability reliability (test-retest) approach which was estimated as r = 0.81.  The data were collected through the interviewing of the study sample and analyzed through the using of the Statistical Package for Social Sciences SPSS, version 23, and analyzed through the application of descriptive and inferential statistical analysis. The findings of the present study conclude that more than half of nurses had low knowledge and none of them had high level of knowledge, also there is no significant association between the levels of knowledge with age, gender, educational level, years of experience and working place. The study suggested extends the knowledge of nurses regarding the FDI, by training courses from clinical pharmacologists.

Sign in / Sign up

Export Citation Format

Share Document