scholarly journals Lobektomi Life Saving pada Hemoptisis Berulang Pada Tuberkulosis Paru

2020 ◽  
Vol 5 (3) ◽  
pp. 79
Author(s):  
Soedarsono Soedarsono ◽  
Tri Puji Astuti
Keyword(s):  
Conservative Therapy ◽  
Alternative Therapy ◽  
Massive Hemoptysis ◽  
Common Complication ◽  
Case Patient ◽  
Lung Lobe ◽  
Lung Tuberculosis ◽  
Life Saving ◽  
Definitive Therapy ◽  
Life Threatening

Background. Hemoptysis is the most common complication of lung tuberculosis (TB). Its can occur repeated and massive. Reccurent massive hemoptysis resolved with conservative therapy but if conservative therapy fails, definitive therapies such as lobectomy surgery are used as alternative treatments especially life-threatening. Case. A 38-year-old man with chief complaint hemoptysis since 4 months pior to admission hospital. Hemoptysis 4-5 times daily with volume 200-600 cc per day and make him shortness of breath and anemia. Initial AFB (Acid Fast Bacilli) was positive and GeneXpert MTB (+) sensitive rifampisin. He got Anti Tuberculosis Drug (ATD) therapy 1st category since 3 months ago. He has been given conservative therapy for hemoptysis but failed. Discussion. Surgery is one of alternative therapy for reccurent massive hemoptysis. Surgery only if source of bleeding already known certainty. In this case patient were suggest for lobectomy superior right lung lobe, not a segmentectomy because there was adhesions on intrathoracic. After lobectomy he getting better and hemoptysis stops. He has continued ATD until 6 months without hemoptysis. Conclusion. Reccurent massive hemoptysis and life-threatening with failure of conservative therapy may given definitive therapy such as lobectomy

Life-Threatening Hemoptysis

2020 ◽  
Author(s):  
Himanshu Deshwal ◽  
Ankur Sinha ◽  
Atul C. Mehta
Keyword(s):  
Bronchial Artery ◽  
Vascular Anatomy ◽  
Massive Hemoptysis ◽  
Evidence Based ◽  
Airway Protection ◽  
Artery Embolization ◽  
Life Saving ◽  
Advanced Therapies ◽  
Life Threatening ◽  
And Control

AbstractLife-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.

scholarly journals Rasmussen’s Aneurysm, Rare yet Acknowledged Cause of Massive Hemoptysis: Retrospective Review of 16 Cases

2021 ◽  
Vol 36 (2) ◽  
pp. 136-143
Author(s):  
Seungwoo Chung ◽  
I Re Heo ◽  
Tae Hoon Kim ◽  
Sun Mi Ju ◽  
Jung-Wan Yoo ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Conservative Therapy ◽  
Bronchial Artery ◽  
Chest Ct ◽  
Massive Hemoptysis ◽  
Bronchial Artery Embolization ◽  
Artery Embolization ◽  
Chest Computed Tomography ◽  
Life Threatening ◽  
History Of

Objectives: Rasmussen’s aneurysm may cause life-threatening hemoptysis. We investigated the clinical characteristics and outcomes of patients with hemoptysis and Rasmussen’s aneurysm.Methods: We retrospectively investigated patients who clinically presented with hemoptysis and were diagnosed with a Rasmussen’s aneurysm on spiral chest computed tomography (CT).Results: Our study included 16 patients (men:women, 12:4; mean age, 65.25 ± 13.0 years). Massive hemoptysis was observed in nine patients (56%) and blood-tinged sputum in four patients (25%). Ten patients (62.5%) had a history of pulmonary tuberculosis, and three patients (18.7%) had underlying lung cancer. Chest CT revealed coexisting fungal balls in seven patients (43.7%). Bronchial artery embolization (BAE) was performed in 12 patients (75%). One patient died of uncontrolled massive hemoptysis.Conclusions: Patients with Rasmussen’s aneurysm showed hemoptysis during the course of the disease; however, bleeding can be controlled with conservative therapy and radiological interventions, such as BAE.

scholarly journals Impact of Positive Vancomycin-Resistant Enterococcus (VRE) Screen Result on Appropriateness of Definitive Antibiotic Therapy

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s263
Author(s):  
Jenna Reynolds ◽  
Lynn Chan ◽  
Raelene Trudeau ◽  
Maria Teresa Seville
Keyword(s):  
Antibiotic Therapy ◽  
Predictive Value ◽  
Hematologic Malignancy ◽  
Tertiary Care ◽  
Alternative Therapy ◽  
Care Hospital ◽  
Positive Screen ◽  
Screen Result ◽  
Definitive Therapy ◽  
Vancomycin Resistant

Background: Vancomycin-resistant Enterococcus (VRE) screening has been utilized to identify colonized patients to prevent transmission. However, little is known about the utility of screening to guide antibiotic therapy. We assessed the appropriateness of definitive therapy in patients with a VRE screen and evaluate the predictive value of screening for the development of a VRE infection. Methods: In this retrospective study, we evaluated VRE screening of patients aged 18 years admitted between June 1, 2015, and May 31, 2018, to a 280-bed, academic, tertiary-care hospital. Rectal swabs were tested using Cepheid Xpert. Screening was performed routinely on admission for hematologic malignancy and liver transplantation patients. Only the first screen result was included for patients who had multiple VRE screens. The patient was classified as having a VRE infection if any Enterococcus isolates were vancomycin resistant. The primary outcome was appropriateness of antibiotic therapy in patients who had a VRE screen. Appropriateness of VRE-directed therapy was defined as therapy with linezolid or daptomycin for patients who had a positive VRE culture and an identifiable source of infection, or who had no clinical improvement on alternative therapy, or who had a documented β-lactam allergy. If appropriateness was unclear, 2 infectious diseases specialists determined appropriateness. Results: In total, 1,374 patients who had a rectal VRE screen met inclusion criteria. Of these, 1,053 (88%) had a negative screen. We detected no difference in the appropriateness of VRE-directed therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE screen had a sensitivity of 60% (95% CI, 43%–74%), specificity of 90% (95% CI, 88%–92%), positive predictive value of 18% (95% CI, 12%–25%), and negative predictive value of 98% (95% CI, 97%–99%) for VRE infection. Conclusions: Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for VRE-directed therapy. Patients with a negative VRE screen have a low likelihood of developing a VRE infection, and a negative screen could be used to identify patients who may not require empiric coverage for VRE. Further research is needed to determine optimal utilization of VRE screening for prediction and treatment of VRE infections.Funding: NoneDisclosures: None

scholarly journals Myelodysplastic Syndrome Clinically Presenting with the “Classic TTP Pentad”

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Santiago Fabián Moscoso Martínez ◽  
Evelyn Carolina Polanco Jácome ◽  
Elizabeth Guevara ◽  
Vijay Mattoo
Keyword(s):  
Myelodysplastic Syndrome ◽  
Clinical Presentation ◽  
Renal Involvement ◽  
Medical Emergency ◽  
Complete Blood Cell Count ◽  
Blood Cell Count ◽  
Thrombocytopenic Purpura ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening

The clinical presentation of myelodysplastic syndrome (MDS) is not specific. Many patients can be asymptomatic and can be detected only due to an abnormal complete blood cell count (CBC) on routine exam or for other reasons while others can be symptomatic as a consequence of underlying cytopenias. Thrombotic thrombocytopenic purpura (TTP) usually is suspected under the evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia and because it is a life-threatening condition (medical emergency) immediate initiation of plasmapheresis could be life-saving. The following case illustrates an unusual presentation of MDS in a patient who came in to the emergency room with the classic TTP “pentad” of fever, renal involvement, MAHA, mental status changes, and thrombocytopenia. We will focus our discussion in the clinical presentation of this case.

Cardiac Arrhythmia Detection using Dual Tree Wavelet Transform and Convolutional Neural Network

2021 ◽  
Author(s):  
K Reddy Madhavi ◽  
Padmavathi kora ◽  
L Venkateswara Reddy ◽  
J Avanija ◽  
KLS Soujanya ◽  
...  
Keyword(s):  
Neural Network ◽  
Wavelet Transform ◽  
Cardiac Cells ◽  
P Wave ◽  
Computer Assisted ◽  
Ecg Signals ◽  
Coronary Diseases ◽  
Life Saving ◽  
Life Threatening ◽  
Assisted Diagnosis

Abstract The non-stationary ECG signals are used as a key tools in screening coronary diseases. ECG recording is collected from millions of cardiac cells’ and depolarization and re-polarization conducted in a synchronized manner as: The P-wave occurs first, followed by the QRScomplex and the T-wave, which will repeat in each beat. The signal is altered in a cardiac beat period for different heart conditions. This change can be observed in order to diagnose the patient’s heart status. There are life-threatening (critical) and non-life - threatening (noncritical) arrhythmia (abnormal Heart). Critical arrhythmia gives little time for surgery, whereas non-critical needs additional life-saving care. Simple naked eye diagnosis can mislead the detection. At that point, Computer Assisted Diagnosis (CAD) is therefore required. In this paper Dual Tree Wavelet Transform (DTWT) used as a feature extraction technique along with Convolution Neural Network (CNN) to detect abnormal Heart. The findings of this research and associated studies are without any cumbersome artificial environments. The CAD method proposed has high generalizability; it can help doctors efficiently identify diseases and decrease misdiagnosis.

Extracorporeal membrane oxygenation in pheochromocytoma-induced cardiogenic shock

2017 ◽  
Vol 26 (4) ◽  
pp. 314-316 ◽  
Author(s):  
Nadia Bouabdallaoui ◽  
Denis Bouchard ◽  
E. Marc Jolicoeur ◽  
Alexandra Chronopoulos ◽  
Pierre Y Garneau ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Clinical Value ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Life Saving ◽  
Adrenal Pheochromocytoma ◽  
Life Threatening

Extracorporeal membrane oxygenation has been extensively used for cardiopulmonary support in cardiogenic shock. However, its clinical value in the management of pheochromocytoma crisis remains unclear. We report a rare case of life-threatening cardiogenic shock managed with peripheral venoarterial extracorporeal membrane oxygenation combined with endovascular left ventricular venting, in a 40-year-old female patient, in the setting of unknown adrenal pheochromocytoma. We highlight the life-saving role of extracorporeal membrane oxygenation in undiagnosed endocrine emergencies, allowing cardiac and end-organ recovery, and giving time for accurate diagnosis and specific treatment in such unusual situations.

scholarly journals Adrenal Insufficiency - Aetiology, Diagnosis and Treatment

2015 ◽  
Vol 3 (1) ◽  
pp. 36-47
Author(s):  
Nazma Akter ◽  
Nazmul Kabir Qureshi
Keyword(s):  
Quality Of Life ◽  
Adrenal Insufficiency ◽  
Presenting Symptoms ◽  
Life Saving ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Term Management

Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 ?g ACTH (adrenocorticotropic hormone) stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist. DOI: http://dx.doi.org/10.3329/dmcj.v3i1.22238 Delta Med Col J. Jan 2015; 3(1): 36-47

History and experience of a volunteer ambulance first responder scheme in London

2021 ◽  
Vol 13 (8) ◽  
pp. 344-348
Author(s):  
Saman Al-Sahab ◽  
Aditi Nijhawan ◽  
Tim Kirkby ◽  
Shadman Aziz
Keyword(s):  
Cardiac Arrest ◽  
Blue Light ◽  
Response Times ◽  
Ambulance Service ◽  
First Responder ◽  
Emergency Responders ◽  
Life Saving ◽  
Wide Range ◽  
Life Threatening ◽  
Set Up

Emergency responders (ERs) are volunteers who attend category 1 (immediately life-threatening) and category 2 (emergency) 999 calls on behalf of the London Ambulance Service NHS Trust (LAS). ERs aim to arrive first on scene to these incidents to provide essential life-saving interventions prior to the arrival of further ambulance resources. ERs come from a wide range of backgrounds and undergo a thorough selection, training and mentorship process before advancing to working in a two-person ER crew. Compared to most traditional volunteer first responder schemes, the LAS ER scheme, which was set up in 2008, involves an enhanced skillset, dispatch to medical and traumatic emergencies in addition to cardiac arrest, and the use of blue-light vehicles to reduce response times. Over a period of 13 years, the scheme has grown in scope and size, and now operates with more than 120 volunteers based at seven ambulance stations across London.

Fab Fragments of Digoxin-Specific Antibodies Used to Reverse Ventricular Fibrillation Induced by Digoxin Ingestion in a Child

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 468-471
Author(s):  
Aaron R. Zucker ◽  
Samuel J. Lacina ◽  
D. S. DasGupta ◽  
H. A. Fozzard ◽  
David Mehlman ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Digoxin Level ◽  
Bundle Branch Block ◽  
Specific Antibodies ◽  
Fab Fragments ◽  
Intellectual Function ◽  
Digitalis Poisoning ◽  
Life Saving ◽  
Life Threatening ◽  
Massive Overdose

Digitalis poisoning is a rare problem in children, but it may be life threatening. A case of massive overdose of digoxin in a 2½-year-old boy that produced prolonged ventricular fibrillation refractory to conventional therapy is reported. After two hours the boy was given digoxin-specific Fab fragments of antibody in sufficient quantity to bind his estimated dose of 10 mg. By completion of the treatment minutes later, normal rhythm and circulation were restored. The serum free digoxin level before antibody administration was > 100 ng/ml, and it rapidly fell to undetectable levels after antibody was given. Digoxin bound to the antibody had a clearance half-life of approximately 48 hours. The child had no apparent neurologic damage and his intellectual function was normal on discharge. He had a transient hematuria and a residual incomplete right bundle branch block. Administration of purified Fab fragments of digoxin-specific antibodies can be life saving in children with digitalis poisoning, and prolonged cardiopulmonary resuscitation in children is justified when the cause of cardiac arrest is potentially reversible.

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