scholarly journals October 2021 Critical Care Case of the Month: Unexpected Post-Operative Shock

2021 ◽  
Vol 23 (4) ◽  
pp. 93-97
Author(s):  
Sharanyah Srinivasan ◽  
◽  
Sooraj Kumar ◽  
Benjamin Jarrett ◽  
Janet Campion
Keyword(s):  
Lower Extremity ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Intravenous Drug Use ◽  
Past Medical History ◽  
Incision And Drainage ◽  
Lower Extremity Wound ◽  
History Of ◽  
The Right ◽  
Operative Assessment

No abstract available. Article truncated after 150 words. History of Present Illness: A 55-year-old man with a past medical history significant for endocarditis secondary to intravenous drug use, osteomyelitis of the right lower extremity was admitted for ankle debridement. Pre-operative assessment revealed no acute illness complaints and no significant findings on physical examination except for the ongoing right lower extremity wound. He did well during the approximate one-hour “incision and drainage of the right lower extremity wound”, but became severely hypotensive just after the removal of the tourniquet placed on his right lower extremity. Soon thereafter he experienced pulseless electrical activity (PEA) cardiac arrest and was intubated with return of spontaneous circulation being achieved rapidly after the addition of vasopressors. He remained intubated and on pressors when transferred to the intensive care unit for further management. PMH, PSH, SH, and FH: • S/P Right lower extremity incision and drainage for suspected osteomyelitis as above • Distant history of endocarditis related …

scholarly journals A Case of Sudden Death: Subarachnoid Hemorrhage, Pheochromocytoma, Berry Aneurysm

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Ana B. Arevalo ◽  
Jacxelyn Moran ◽  
Stephen Zink ◽  
Binny Khandakar
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Pulseless Electrical Activity ◽  
Young Female ◽  
Aneurysm Rupture ◽  
Medical Emergency ◽  
Uncontrolled Hypertension ◽  
Past Medical History ◽  
Common Cause ◽  
History Of ◽  
The Right

Subarachnoid hemorrhage is a medical emergency. Berry aneurysm rupture is the second most common cause following trauma. Diagnosis is often challenging. Neurogenic heart syndrome often complicates subarachnoid hemorrhage. A concomitant pheochromocytoma can be deadly causing sudden cardiac arrhythmia. Here, we describe a case of subarachnoid hemorrhage with concomitant incidental pheochromocytoma in a relatively young female who died suddenly, diagnosed during autopsy. A 57-year-old Hispanic woman with past medical history of asthma, prediabetes, and uncontrolled hypertension collapsed unexpectedly. She initially had ventricular tachycardia, followed by pulseless electrical activity and finally asystole without response to resuscitation. In the emergency department she was on epinephrine, calcium, naloxone, and tPA with suspected thrombotic stroke. Despite measures, she was pronounced dead. Autopsy revealed subarachnoid hemorrhage due to a ruptured berry aneurysm. Additionally, pheochromocytoma was detected in the right adrenal gland. Subarachnoid hemorrhage has a grave prognosis by itself. This case describes the uncommon detection of pheochromocytoma in the setting of subarachnoid hemorrhage.

WED 142 ‘anti-hu syndrome’ – a case of paraneoplastic sensory neuropathy with encephalitis

2018 ◽  
Vol 89 (10) ◽  
pp. A16.3-A16
Author(s):  
Gupta Srishti ◽  
Jaiswal Amit ◽  
Knopp Michael
Keyword(s):  
Sensory Neuropathy ◽  
Middle Lobe ◽  
Past Medical History ◽  
Small Cell Lung ◽  
Mri Brain ◽  
Brain Scan ◽  
History Of ◽  
Right Middle Lobe ◽  
T2 Hyperintensity ◽  
The Right

A 75-year-old female was referred to the neurology outpatients department with a 6 month history of progressive amnesia and cognitive decline as well as symptoms/signs suggestive of a sensory neuropathy. Past medical history included TIA, cervical spondylosis and recent investigation for hyponatraemia which had been attributed to SIADH. She had been a smoker with a 50+pack year history and consumed minimal alcohol. An MRI brain scan demonstrated bilateral hippocampal T2 hyperintensity. A lumbar puncture demonstrated normal CSF constituents and negative viral PCRs. Full autoimmune and paraneoplastic screening was undertaken which was all normal except for a positive anti-Hu antibody. A CT-TAP highlighted a mass lesion in the right middle lobe of the lung and biopsy confirmed small cell lung cancer (T1aN2M0). A diagnosis of anti-Hu antibody related paraneoplastic syndrome was made and an initial treatment course of IV Methylprednisolone was administered. The patient’s cancer was treated with chemotherapy and adjuvant radiotherapy. Despite a good response with regard to her tumour and hyponatraemia, the patient did not improve significantly cognitively. This case highlights the need for awareness of the combination of symptoms/signs of the described ‘anti-Hu syndrome’ with paraneoplastic sensory neuropathy and/or encephalomyelitis.

Salbutamol misuse or abuse with fatal outcome: A case-report

2010 ◽  
Vol 30 (11) ◽  
pp. 1869-1871 ◽  
Author(s):  
Alexandra Boucher ◽  
Christine Payen ◽  
Christelle Garayt ◽  
Hervé Ibanez ◽  
Anne Dieny ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Adrenergic Receptors ◽  
Fatal Outcome ◽  
Lung Edema ◽  
Acute Dyspnea ◽  
Past Medical History ◽  
History Of ◽  
The Right ◽  
Acting Agonist ◽  
Sudden Collapse

Salbutamol is a short-acting agonist of the β2 adrenergic receptors sometimes misused or abused, which can result in various cardiovascular adverse effects. We report one case of fatal salbutamol misuse or abuse in a 36-year-old poorly controlled female asthmatic patient with a past medical history of alcoholism and a recent smoking cessation. She died shortly after hospital admission following acute dyspnea and sudden collapse at home. Toxicological analyses evidenced salbutamol overdose, and necropsy showed acute lung edema and marked dysplasia of the right ventricle and revealed the patient was pregnant. The involvement of an initial disorder of the ventricular rhythm leading to cardiac failure is suggested by the presence of several combined pro-arrhythmogenic factors, such as arrhythmogenic right ventricle dysplasia, hypoxemia related to bronchospasm and salbutamol overdose.

scholarly journals Heavy Eye Syndrome Mimicking Abducens Nerve Palsies

2020 ◽  
Vol 47 (5) ◽  
pp. 683-684
Author(s):  
Caberry W. Yu ◽  
Jonathan A. Micieli
Keyword(s):  
Medical History ◽  
Abducens Nerve ◽  
Double Vision ◽  
Spherical Equivalent ◽  
Past Medical History ◽  
Pathological Myopia ◽  
Bilateral Cataract ◽  
Retinal Tears ◽  
History Of ◽  
The Right

A 70-year-old woman was seen in neuro-ophthalmology consultation for a progressive right esotropia. She had a past medical history of asthma and osteoporosis, and her ocular history was significant for pathological myopia (spherical equivalent of −23.00 D OD and −21.00 D OS), bilateral cataract surgeries, and laser retinopexy for retinal tears. Twenty-five years prior to presentation, she developed binocular horizontal diplopia and was found to have a limitation of abduction to 60% and 80% of normal in the right and left eyes, respectively, by a previous neuro-ophthalmologist. She developed a progressive maculopathy in the right eye secondary to myopia, resulting in the resolution of double vision. The resolution occurred because the double vision was binocular in nature and the loss of vision in her right eye functioned similar to monocular occlusion. However, she noticed that her right eye continued to turn in toward her nose.

A Man with Simultaneous Occurrence of Acute Lower Extremity Arterial Embolization and Acute Myocardial Infarction: A Case Report

2020 ◽  
Author(s):  
Liangyuan Lu ◽  
Yanyan Xue ◽  
Yalei Han ◽  
Tongxin Bao ◽  
Jing Xue ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lower Extremity ◽  
Arterial Embolization ◽  
Lower Limbs ◽  
Simultaneous Occurrence ◽  
Arterial Embolism ◽  
Multiple Organs ◽  
History Of ◽  
The Right

Abstract Background: Spontaneous co-occurrence of acute myocardial infarction (AMI) and acute lower extremity arterial embolism (ALEAE) has rarely been reported.Case presentation: A 44-year-old male with a history of 4 years of type1 diabetes was admitted to hospital when he suddenly experienced severe pain in his right lower limb and felt tightness in the left anterior chest area. Ultrasonography revealed distal occlusion of the right superficial femoral artery. ECG showed acute anterior interstitial myocardial infarction. After conservative treatment for 2 days, the patient had severe necrosis of lower limbs and secondary injury of multiple organs. Hemodialysis and heparin anticoagulant therapy were performed before amputation. Twelve days after the operation, the patient's condition was stable and he was transferred out of ICU.Conclusions: Emergency amputation and multidisciplinary approaches may offer a chance for survival if patents lost the opportunity for early treatment.

scholarly journals Perinephric abscess secondary to a staghorn calculus presenting as a subcutaneous abscess

CJEM ◽  
2006 ◽  
Vol 8 (04) ◽  
pp. 285-288 ◽  
Author(s):  
Dylan Tsukagoshi ◽  
Bozanka Dinkovski ◽  
Sunil Dasan ◽  
Jalpesh Jethwa
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Rare Complication ◽  
Flank Pain ◽  
Perinephric Abscess ◽  
Incision And Drainage ◽  
Staghorn Calculus ◽  
History Of ◽  
The Right

ABSTRACTPerinephric abscesses often present with flank pain and signs of sepsis, and are known to discharge to the skin. We report a case of a young patient presenting with a 48-hour history of painful swelling in her right renal angle following a urinary tract infection and no overt signs or symptoms of sepsis. Plain abdominal films showed a perinephric abscess secondary to a staghorn calculus in the upper pole of the right kidney. On incision and drainage, 700 mL of pus was drained freely. The patient recovered well but required partial nephrectomy.Subcutaneous abscess as a result of intra-abdominal pathology is a recognized but rare complication. This case illustrates that subcutaneous abscesses may have underlying intra-abdominal pathology without overt signs of sepsis.

scholarly journals Tuberculous Pyomyositis: A Rare but Serious Diagnosis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Vikram Krishnasamy ◽  
Matthew Joseph
Keyword(s):  
Lower Extremity ◽  
Poor Prognosis ◽  
Multiorgan Failure ◽  
Laboratory Data ◽  
The United States ◽  
Past Medical History ◽  
Blood Cell Count ◽  
Large Area ◽  
Left Lower Extremity ◽  
History Of

Tuberculous pyomyositis is a rare clinical entity with serious consequences if a diagnosis is not established early. A 53-year-old female with a past medical history of sarcoidosis and pulmonary fibrosis presented from an outside hospital with persistent fevers and a rash. She had been hospitalized multiple times at an outside hospital without any improvement in her symptoms. On examination, she was noted to have a large area of left upper lower extremity (LUE) tenderness with superimposed erythema. Laboratory data revealed a white blood cell count of 22,300. Computed tomography (CT) scans of the LUE, chest, and left lower extremity (LLE) showed multiple intramuscular abscesses in those regions without evidence of osteomyelitis. Subsequent drainage of the abscesses and resulting cultures revealedMycobacterium tuberculosis. The patient was started on therapy with rifampin, isoniazid, pyrazinamide, and ethambutol. However, the patient developed hepatitis on these agents and subsequently went into septic shock with multiorgan failure. Care was eventually withdrawn as a result of a poor prognosis. This case illustrates the severe consequences of TB pyomyositis if not diagnosed promptly. While tuberculosis is uncommon in the United States, it should be an important consideration in the differential diagnosis of immunocompromised patients.

Ankle Dorsiflexion in Adolescent Athletes

2003 ◽  
Vol 93 (4) ◽  
pp. 312-314 ◽  
Author(s):  
Amol Saxena ◽  
Will Kim
Keyword(s):  
High School ◽  
Lower Extremity ◽  
Ankle Dorsiflexion ◽  
T Test ◽  
Ankle Injury ◽  
High School Athletes ◽  
Adolescent Athletes ◽  
Left Ankle ◽  
History Of ◽  
The Right

Ankle equinus has been proposed to be associated with lower-extremity pathology. Physiologically normal measurements have been quantified in various populations. Forty high-school athletes (16 girls and 24 boys) without a history of ankle injury had ankle dorsiflexion measured with the knee extended and flexed by an experienced evaluator using a goniometer with the subjects supine. The group mean ± SD dorsiflexion for the right ankle was 0.35° ± 2.2° with the knee extended and 4.88° ± 3.23° with the knee flexed. The values for the left ankle were –0.6° ± 2.09° and 4.68° ± 3.33°, respectively. There were no statistically significant differences between limbs using the Student t-test. In girls, values for right and left ankle dorsiflexion were 0.19° ± 2.1° and –0.7° ± 2.3°, respectively, with the knee extended and 4.88° ± 3.59° and 4.88° ± 3.07°, respectively, with the knee flexed. In boys, these values were 0.46° ± 2.3° and –0.5° ± 1.98° with the knee extended and 4.88° ± 3.04° and 4.54° ± 3.55° with the knee flexed. There were no statistically significant differences between boys and girls. Ankle dorsiflexion in asymptomatic adolescent athletes is approximately 0° with the knee extended and just less than 5° with the knee flexed. (J Am Podiatr Med Assoc 93(4): 312-314, 2003)

scholarly journals Simultaneous Supraclavicular Lymph Node Transfer and Lymphovenous Anastomosis for the Surgical Treatment of End-Stage Lymphedema

2021 ◽  
Author(s):  
Kyung-Chul Moon ◽  
In-Jae Yoon
Keyword(s):  
Lymph Node ◽  
Lower Extremity ◽  
Nonsurgical Management ◽  
Inguinal Area ◽  
History Of ◽  
Lymph Node Transfer ◽  
Lymphovenous Anastomosis ◽  
The Right ◽  
End Stage ◽  
Vascularized Lymph Node Transfer

Abstract BackgroundVarious surgical options are available to treat lymphedema, such as direct excisional debulking surgery, suction-assisted lipectomy debulking, lymphovenous anastomosis (LVA), and vascularized lymph node transplantation (VLNT). However, no studies have addressed simultaneous surgery with both LVA and VLNT for patients with advanced-stage lymphedema. Case Presentation A 72-year-old female with bilateral lower extremity lymphedema refractory to nonsurgical management was admitted to our lymphedema clinic. This patient had a history of lymphoma and treated with radiotherapy on right inguinal area 26 years ago. Interestingly, the patient developed lymphedema on both the right and left lower extremities although she had radiotherapy on her right inguinal area. The patient underwent simultaneous vascularized lymph node transfer and lymphovenous anastomosis for treatment of end-stage lymphedema. Significant reduction in circumference and volume of lower extremity was achieved following simultaneous vascularized lymph node transfer and lymphonvenous anastomosis Conclusion The authors recommend simultaneous VLNT and LVA surgeries as the first treatment option for patients with end-stage lymphedema.

scholarly journals TORSION OF RIGHT UN-DESCENDED TESTIS;

2011 ◽  
Vol 21 (02) ◽  
pp. 418-420
Author(s):  
Muhammad Khalid
Keyword(s):  
Blood Flow ◽  
Groin Pain ◽  
Ultrasound Examination ◽  
Inguinal Region ◽  
Incision And Drainage ◽  
Doppler Examination ◽  
Inguinal Area ◽  
History Of ◽  
The Right

A case of 14 months old child with history of uncorrected right cryptorchidism isreported here who presented with right inguinal abscess after 7 days of right groin pain.. Agenitourinary examination was performed, which revealed that his right inguinal region wasswollen and fluctuant, that was 5 cm in greatest dimension. No testicle was palpable in the rightipsilateral hemiscrotum. An ultrasound examination of the inguinal area revealed aheterogeneous testicle, with no blood flow on Doppler examination. Incision and drainageconfirmed torsion of the right undescended gangrenous testis. After. Incision and drainage andorchiectomy patient showed un-eventful recovery

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