scholarly journals Unnecessary Chest Tube for a Hemodialytic Patient with Multiple Trauma: A Case Report

2021 ◽  
Author(s):  
Vahid Reisi-Vanani ◽  
Hooman Esfahani
Keyword(s):  
Multiple Trauma ◽  
Chest Tube ◽  
Vital Signs ◽  
Physical Exam ◽  
Respiratory Sounds ◽  
Mortality And Morbidity ◽  
Radiologic Findings ◽  
Skin Fold ◽  
Chest Deformity ◽  
Threatening Condition

Abstract Background Pneumothorax (PTX) is a life-threatening condition that overdiagnosis could result in increases in mortality and morbidity of patients, this overdiagnosis would be increased if physicians do not manage the patient classically and do not pay attention to the physical exam and history of the patient. Case presentation: A-71-year old man was admitted to the emergency department due to multiple trauma. His vital signs were stable and in examination, there were two lacerations on his scalp with venous bleeding source and galea transaction; there were also some abrasions all over his body including his thorax. In the physical exam, there was no sucking lesion, decreases in respiratory sounds in auscultation or chest deformity but he had little right hemithorax rib tenderness. In more evaluations, there was a suspected visceral line of pleura in his CXR and no plural sliding movement was seen in E-FAST by the operator. Due to the inconsistency in physical exam and radiologic findings we decided to take a chest CT-scan before the insertion of the chest tube that indicated no PTX for him and the suspected visceral line in CXR was skin fold of a permacath for hemodialysis. Conclusions Several conditions could mimic findings of PTX in CXR that every physician should know and pay attention to them besides special attention to the history taking and physical examination to reduce the mortality and morbidity of patients.

scholarly journals Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre

2021 ◽  
Vol 8 (11) ◽  
pp. 3359
Author(s):  
Lokesh M. G. ◽  
S. Chandrashekar ◽  
Arundathi Raikar ◽  
Abhishek S. S.
Keyword(s):  
Perioperative Complications ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Threatening Condition ◽  
Hollow Viscus Perforation

Background: High mortality and morbidity is associated with peritonitis secondary to hollow viscus perforation, proving it a most common life threatening condition which needs emergency surgical care. Hence a proper evaluation was needed regarding appropriate management to have a better outcome, which was a challenge to operating surgeon.Methods: A serial study of 96 cases of peritonitis secondary to hollow viscus perforation was conducted at tertiary care centre, department of general surgery, Mysore medical college and research institute, Mysore, Karnataka from the period of August 2020 to July 2021. Data related to aetiology, surgical intervention and its peri-operative complications were noted. Appropriate statistical analyses were done to draw the inference.Results: Out of 96 cases studied, 74 were male, 22 were female with mean age of 45.53 years. Most common cause of peritonitis was GU perforation, followed by idiopathic, infective, malignancy, appendicular perforation and Trauma.Conclusions: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co-morbidities and aetiologies.

Life-threatening complications of Ludwig’s angina: a series of cases in a developed country

2021 ◽  
Vol 14 (4) ◽  
pp. e240429
Author(s):  
Catarina Mendes Silva ◽  
Joana Paixão ◽  
Pedro Neves Tavares ◽  
João Pedro Baptista
Keyword(s):  
Developed Countries ◽  
Developed Country ◽  
Mortality And Morbidity ◽  
Space Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ludwig’S Angina ◽  
Reduction Of Mortality ◽  
Modern Era ◽  
Ludwig's Angina

Ludwig’s angina is a deep neck space infection defined as a rapidly progressive bilateral cellulitis of the submandibular space. In spite of being an uncommon entity in developed countries and the reduction of mortality and morbidity due to modern era of antibiotics, improved imaging and airway management, it is still an important and potentially life-threatening condition. The authors present 3 cases of Ludwig’s angina that occurred in a developed country, and that required admission in intensive care unit and extensive surgical and medical treatment.

scholarly journals Aortic Dissection in a Pregnant Patient without Other Risk Factors

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Priya V. Patel ◽  
Raanan Alter ◽  
Recia Frenn ◽  
Thaddeus P. Waters
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Aortic Rupture ◽  
Treatment Options ◽  
Pregnant Patient ◽  
Physical Exam ◽  
Vascular Events ◽  
Increased Risk ◽  
Threatening Condition ◽  
Life Threatening

Background. An aortic dissection is a life-threatening condition in which the intima of the artery tears causing separation of the intima and media. Pregnancy places women at a significantly increased risk of common vascular events including venous thromboembolism, myocardial infarction, and stroke, while also increasing the risk of rarer vascular events such as aortic dissection and aortic rupture. Case. A 30-year-old previously healthy multiparous woman presenting at 36 weeks of pregnancy with a Type A aortic dissection. She underwent a combined emergent cesarean delivery followed by repair of her aortic root. Conclusions. Aortic dissection should be high on the differential for pregnant patients presenting with the characteristic complaints and physical exam findings given the high mortality rate associated with this vascular event. Teaching Points. (1) This report reviews the characteristic presentation, risk factors, and physical exam findings in a patient with an aortic dissection. (2) The report includes treatment options for pregnant patients based on the classification of the dissection.

scholarly journals OUTCOMES OF PENETRATING CARDIAC INJURIES – A CARDIAC SURGEON APPROACH TO 22 CASES

2021 ◽  
Vol 8 (4) ◽  
pp. 213-218
Author(s):  
Ali Cemal Duzgun ◽  
Ekin Ilkeli
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Injury ◽  
Vital Signs ◽  
Trauma Patients ◽  
Cardiac Trauma ◽  
Mortality And Morbidity ◽  
Initial Intervention ◽  
Gun Shot ◽  
Cardiac Surgeon ◽  
Time Of Admission

Aim: Cardiac traumas are of great danger as they have life threatening potential. Although the patient may have normal vital signs at the time of admission the rate of mortality rate has been reported up to 69%. We believe that conducting the initial evaluation and early intervention by a cardiac surgeon may have an impact on decreased mortality. Material and methods: This study has been conducted with 22 patients that have been admitted with cardiac trauma history. The subjects who were operated after applying to emergency service have been enrolled in this retrospective analysis. İndividuals died due to cardiac arrest at admission have been excluded from the study. The subjects with penetrating cardiac injury who have undergone sternotomy or thoracotomy has been included in the analysis. Results: At the time of admission 4 patients has been presented with shock and 2 patients had been administered resuscitation due to cardiac arrest. The gun shot wound cases were 27% (n=6) and of these cases 3 of them were alive while the remaining 3 died. The stab wound cases were 73% (n=16) withh a higher survival rate of 75% (n=4/16). Thoracotomy has been conducted less than sternotomy as the rate was 13.6% (n=3) versus 86.4% (n=19). The overall rate of mortality has been found as 32% (n=7). Conclusıon: According to the results of this study one can say that conducting initial intervention to cardiac trauma patients by a cardiac surgeon reduced the rate of mortality and morbidity.

scholarly journals An Algorithm for Treatment of Cervical Pregnancy: Report of a Series of Eight Patients

2020 ◽  
Author(s):  
Azam Tarafdari ◽  
Sedigheh Borna ◽  
Sheida Janatrostami ◽  
Fatemeh Farajzadeh Vajari
Keyword(s):  
Fetal Heart ◽  
Case Series ◽  
Expectant Management ◽  
Mortality And Morbidity ◽  
Cervical Pregnancy ◽  
Case Series Study ◽  
Future Fertility ◽  
Threatening Condition ◽  
Endocervical Canal ◽  
Treat All

Being considered as an important life-threatening condition, Cervical Pregnancy (CP) is defined as the implantation and growth of the gestational sac in the endocervical canal. Due to high maternal mortality and morbidity expectant management is not recommended. There is no definite treatment for this complication. During this case series study, we usedan algorithm for CP treatment according to gestational age, presence of fetal heart activity, hemodynamic stability, and patients desire for future fertility in 8 patients. We used a combination of several modalities such as fetal heart reduction, systemic methotrexate, and uterine artery embolization to successfully treat all of them. Reproductivity ability of all patients has been reserved and 3 pregnancies including 2 terms and 1 preterm occurred during the follow-up period.

scholarly journals Maternal and foetal outcome of eclampsia in a referral hospital

2017 ◽  
Vol 6 (3) ◽  
pp. 1021
Author(s):  
Mousumi Das Ghosh ◽  
Vinita Singh ◽  
Alokananda Ray
Keyword(s):  
Antenatal Care ◽  
Early Recognition ◽  
Mode Of Delivery ◽  
Ventilatory Support ◽  
Adequate Treatment ◽  
Mortality And Morbidity ◽  
Foetal Mortality ◽  
Threatening Condition ◽  
Life Threatening ◽  
Foetal Outcome

Background: Eclampsia is a life-threatening condition, common in developing countries with high fatality rate. It is a cause of maternal and foetal mortality and morbidity. The aim of the study is to determine the maternal and foetal outcome in Tata Main Hospital, Jamshedpur, Jharkhand, India.Methods: All cases of eclampsia were analysed from January 2012 to December 2014 from admission to discharge or death of the patient.  Age, parity, antenatal care, interval between attack and admission, blood pressure on admission, gestational age and mode of delivery were  taken into account. There were 135 cases of eclampsia out of 14572 deliveries. Only singleton pregnancies were analysed.Results: The incidence of antepartum eclampsia was 84.4%, intrapartum 3% and postpartum 12.5 %. 83% patients were primigravida, 33% less than 20 yrs,42% had no antenatal checkup and 45% had < 4 visits. Only 15% patients received magnesium sulphate before referral to the hospital. There were four maternal deaths and twenty-one perinatal deaths. Eleven patients needed ventilatory support, four developed pulmonary oedema,  two patients had respiratory depression and three patients had renal failure.Conclusions: Hypertensive disease in pregnancy requires proper antenatal care, early recognition and referral, adequate treatment and timely delivery.

Surgical management of esophageal perforation: role of primary closure

2019 ◽  
Vol 27 (3) ◽  
pp. 192-198 ◽  
Author(s):  
Vu Huu Vinh ◽  
Nguyen Viet Dang Quang ◽  
Nguyen Van Khoi
Keyword(s):  
Hospital Admission ◽  
Esophageal Perforation ◽  
Primary Closure ◽  
Primary Repair ◽  
Time Interval ◽  
Mortality And Morbidity ◽  
Thoracic Level ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening

Objective Esophageal perforation is a life-threatening condition associated with high mortality and morbidity. Ambiguous clinical presentation is one of the most common causes of delayed and difficult diagnosis of esophageal perforation. In this retrospective single-center study, we reviewed the outcome of primary closure in patients with esophageal perforation between 2009 and 2017. Methods The data of 65 patients attending our department of thoracic surgery (from 2009 to 2017) for esophageal perforation were reviewed. Primary repair was attempted in 63 patients irrespective of the site of perforation and time interval between injury and hospital admission. In intrathoracic lesions, continuous mediastinal and pleural irrigation was undertaken, whereas in cervical perforations, gauze packing and local irrigation were performed. Jejunotomy was carried out in patients with inadequate healing. Results Of the 65 patients, 63 underwent primary closure and 2 were left to heal spontaneously. The majority of patients ( n = 44) had an esophageal perforation at the thoracic level, and only one was admitted early (<24 h after injury). Among the 63 patients managed with primary closure, 55 had satisfactory healing with one surgery. Healing was delayed in the other 10 patients. No mortality was reported. Conclusions Esophageal perforation can be well managed by primary closure, irrespective of the time interval between injury and hospital admission and the site of perforation. Conservative management might lead to an increased rate of complications such as empyema or necrotizing mediastinitis, and increased morbidity and mortality.

Personalized Medicine

2016 ◽  
Author(s):  
Michael Snyder
Keyword(s):  
Family History ◽  
Personalized Medicine ◽  
Medical History ◽  
Personal Information ◽  
Vital Signs ◽  
Physical Exam ◽  
Practice Of Medicine ◽  
Laboratory Measures

What is personalized medicine? The practice of medicine has always been personal. Doctors use extensive personal information about a patient—including medical history, physical exam, vital signs, family history, laboratory measures, and imaging tests—to determine a patient’s risk for certain diseases and to make diagnoses....

Therapeutic Pneumoperitoneum: Relevant or Obsolete in 2015?

2016 ◽  
Vol 65 (05) ◽  
pp. 375-381 ◽  
Author(s):  
Jonathan Berger ◽  
Joe Small ◽  
Rafael Garza ◽  
Rafael Andrade ◽  
Eitan Podgaetz
Keyword(s):  
Chest Tube ◽  
Pulmonary Function Tests ◽  
Vital Signs ◽  
Pleural Space ◽  
Abdominal Incision ◽  
Intraperitoneal Pressure ◽  
Proper Patient Selection ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal

Background Therapeutic pneumoperitoneum (TP) is one alternative to manage pleural space problems. We describe our technique and experience. Materials and Methods Medical records of all patients who underwent TP from January 1, 2007, to January 1, 2015, were reviewed after Institutional Review Board approval. We report indication, preprocedure pulmonary function tests, volume of insufflated air, time to chest tube removal, and complications. We place a red rubber catheter into the peritoneal space through the diaphragm or a small abdominal incision, insufflate with room air, record volume (liters), intraperitoneal pressure (goal 9–10 mm Hg), and monitor vital signs, airway pressures, and urine output. Results We performed TP in 32 patients. Follow-up was available for 31 patients. Indications were prevention of pleural space problems in bilobectomy patients (n = 11), following decortication for empyema (n = 11), prevention of prolonged air leak (n = 3), prevention of postresection space (n = 4), and spontaneous chylothorax (n = 2). TP was done postoperatively in three patients. Median air volume used was 3.5 L (3–6 L). Time to chest tube removal overall was 7.8 days (3–20 days) and to discharge 10.2 days (4–32 days). No patient developed respiratory failure, renal failure, or required evacuation of TP. Conclusion TP is a simple, safe, and effective technique to manage pleural space problems. Proper patient selection and meticulous technique are imperative for the successful clinical application of TP. We believe that TP is an underutilized tool for the management of pleural space problems and merits wider application in thoracic surgical practice.

scholarly journals Diabetic ketoacidosis in pregnancy

2018 ◽  
Vol 7 (7) ◽  
pp. 2945
Author(s):  
Rosália S. Coutada ◽  
Soraia S. Cunha ◽  
Elisabete S. Gonçalves ◽  
Ana P. Gama ◽  
João P. Silva ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Pregnant Woman ◽  
Diabetic Ketoacidosis ◽  
Perinatal Mortality ◽  
Aggressive Treatment ◽  
Mortality And Morbidity ◽  
Threatening Condition ◽  
Life Threatening ◽  
In Pregnancy

Diabetic ketoacidosis in pregnancy is a rare but potential life-threatening condition for the mother and the fetus. It tends to occur latter in pregnancy and is more common in patients with pregestational diabetes. Obstetricians should be aware of the events that can trigger diabetic ketoacidosis in pregnancy. Prompt recognition and aggressive treatment of this condition are essential in order to reduce perinatal mortality and morbidity. The authors present a case of a pregnant woman with type 1 diabetes with a poor surveillance of pregnancy and noncompliance to treatment that develops severe diabetic ketoacidosis at 34 weeks of gestation.

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