scholarly journals Reversal of Ketamine Induced Acute Delirium with Continuous Midazolam Infusion in a Post Extubation Child with Refractory Bronchospasm: A Case Report

2020 ◽  
Vol 26 (2) ◽  
pp. 56-59
Author(s):  
Fahisham Taib ◽  
Laila Ab Mukmin
Keyword(s):  
Low Dose ◽  
Care Setting ◽  
Tertiary Hospital ◽  
Emergence Delirium ◽  
The Past ◽  
First Case ◽  
Midazolam Infusion ◽  
Standardized Treatment ◽  
Life Threatening ◽  
The Common

Continuous ketamine infusion has been used successfully to treat severe refractory bronchospasm in children requiring mechanical ventilation in the intensive care setting. One of the common side effects known is emergence delirium. There is no standardized treatment for the ketamine-induced emergence delirium although benzodiazepine, haloperidol and dexmedetomidine have been reported to be effective in the past. A 7-year-old girl admitted to a tertiary hospital for life-threatening asthma requiring immediate intubation and ventilation. Ketamine was used as sedative and bronchodilator in anticipation of her challenging ventilation strategy. She was successfully extubated on day 8 of admission, however, she developed symptoms associated with the delirium. Successful reversal of the symptoms was achieved after 48-hour use of low dose intravenous midazolam. This was the first case reported on the reversal of ketamine-induced emergence phenomenon using low dose intravenous midazolam infusion.

scholarly journals B.05 Hemi-laryngopharyngeal spasm (HELPS) syndrome: The discovery, cure, and characterization of a new neurological condition

2017 ◽  
Vol 44 (S2) ◽  
pp. S11-S11
Author(s):  
C Honey ◽  
M Morrison
Keyword(s):  
Surgical Care ◽  
Review Of The Literature ◽  
The Past ◽  
First Case ◽  
Patient Reported ◽  
Operative Outcome ◽  
Small Cohort ◽  
The Common ◽  
Similar Motor

Background: We published the world’s first case of hemi-laryngpharyngeal spasm (HELPS) syndrome cured by microvascular decompression (MVD) of the Xth cranial nerve in 2016. We now present a small cohort of patients (n=3) successfully treated with surgery in order to better delineate the common characteristics of this syndrome, diagnostic tests of choice, nuances of their surgical care and outcomes of their treatment. Methods: The history and physical examination of three patients with HELPS syndrome are presented. Pre-operative laryngoscopy, neuroimaging, response to botox and intra-operative videos are detailed. Post-operative outcome and complications are presented. Results: Each patient reported similar motor (choking) and sensory (coughing) features in their history. Episodic choking relentlessly progressed over the years until it occurred while sleeping and with frightening severity prompting tracheostomy in one patient and intubation in another. A “tickling” sensation deep in the throat triggered episodic coughing that worsened over the years until it occurred while sleeping and with frightening severity (syncope and incontinence). Conclusions: A review of the literature suggests that patients with similar symptoms, often called episodic laryngospasm in the past, have been treated with psychotherapy or antacids. With the recognition that a clearly defined subset of these patients have HELPS syndrome, we can offer them the potential of a neurosurgical cure.

Management of meningitis and encephalitis in the critically ill

2016 ◽  
Author(s):  
Simon Nadel ◽  
Johnny Canlas
Keyword(s):  
Bacterial Meningitis ◽  
Care Setting ◽  
Antimicrobial Agents ◽  
Acute Bacterial Meningitis ◽  
Supportive Treatment ◽  
Intensive Care Setting ◽  
Vaccine Research ◽  
Common Causes ◽  
Life Threatening ◽  
The Common

Management of CNS infections requires specific antimicrobial agents, as well as specific supportive treatment targeted at reducing raised intracranial pressure and other life-threatening complications. It is important that the need for management in an intensive care setting is considered early in the illness. Antibiotic resistance amongst the most common organisms causing bacterial meningitis is becoming more common and antibiotic therapy should be adjusted accordingly. Anti-inflammatory treatment such as steroids should be started as soon as possible in patients with proven acute bacterial meningitis. Optimally, this should be before or with the first dose of antibiotics. Vaccine research is progressing so that effective vaccines should be available in the future against all the common causes of bacterial meningitis and encephalitis, including Neisseria meningitidis serogroup b.

scholarly journals COVID-19: An Emerging Rapidly Evolving Situation

2020 ◽  
Vol 6 (2) ◽  
pp. 82-89
Author(s):  
Bhairav Prasad ◽  
Neha Prasad
Keyword(s):  
Respiratory Tract Infections ◽  
Genetic Material ◽  
The Novel ◽  
Enveloped Viruses ◽  
The Past ◽  
Life Threatening ◽  
The Common ◽  
Tract Infections ◽  
Corona Viruses ◽  
Asymptomatic Disease

Coronaviruses are large group of enveloped viruses with unsegmented, single-stranded, positive-sense RNA as genetic material. These are collection related RNA viruses that cause diseases of economically important vertebrate viz. mammals and birds. In humans, these viruses cause respiratory tract infections that can range from asymptomatic to life threatening. The asymptomatic disease include very similar to some cases of the common cold, while other deadly varieties can cause SARS, MERS, and COVID-19. The SARS-CoV (severe acute respiratory syndrome coronavirus) and MERS-CoV (Middle East respiratory syndrome coronavirus) are zoonotic origin and extremely pathogenic coronaviruses that can cause localized and worldwide outbreak. The novel Coronaviruses, COVID-19 posses a unique morphology.  The outer surface of the virus bearing surface spike and reveled like crown hence being named corona virus. The mode of replication of the virus is very unique as it replicate through the generation of nested set of viral mRNA. The HCoV (Human coronavirus) cause respiratory complication with asymptomatic to life threatening outcomes. From the past 15 years we have witnessed appearance of two zoonotic, extremely pathogenic human corona viruses the:  SARS-CoV and MERS-CoV.

Understanding and managing cardiac side-effects of second-generation antipsychotics in the treatment of schizophrenia

2019 ◽  
Vol 26 (1) ◽  
pp. 26-40 ◽  
Author(s):  
Mark Sweeney ◽  
Eromona Whiskey ◽  
Rishi K. Patel ◽  
Derek K. Tracy ◽  
Sukhi S. Shergill ◽  
...  
Keyword(s):  
Side Effects ◽  
Second Generation ◽  
List Type ◽  
Cardiac Side Effects ◽  
The Past ◽  
Second Generation Antipsychotics ◽  
Evidence Based Treatments ◽  
Life Threatening ◽  
The Common

SUMMARYSecond-generation antipsychotic medications (SGAs) have advanced the treatment of schizophrenia over the past 30 years. However, a number of potentially life-threatening cardiac side-effects associated with these treatments concern and can discourage prescribers from administering these evidence-based treatments. This review provides a practical, psychiatrist-oriented understanding of the relative frequencies, mechanisms, investigations and treatments associated with these cardiac toxicities. We aim to highlight that these are relatively rare complications of an effective class of drug and to promote the advantages of early involvement of cardiologists in the psychiatric multidisciplinary team to guide the investigation and management of these conditions.LEARNING OBJECTIVESAfter reading this article you will be able to: •understand the relative incidence of cardiotoxic side-effects of the various SGAs•perform preliminary investigations to diagnose the common cardiotoxic side-effects of SGAs•understand the treatments for these cardiac side-effects and the role of cardiologists involved the care of these patients.

scholarly journals Typical errors pulmonary artery verification on the example of a clinical case

2020 ◽  
Vol 92 (4) ◽  
pp. 80-83
Author(s):  
O. Ya. Vasiltseva ◽  
I. N. Vorozhtsova ◽  
I. L. Bukhovets ◽  
V. M. Gulyaev ◽  
K. N. Vitt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Low Dose ◽  
Protein S ◽  
Fibrinogen Concentration ◽  
Active Protein ◽  
The Past ◽  
Dose Oral ◽  
Life Threatening ◽  
Thrombotic Complications ◽  
Concentration Factors

The difficulties of verification of pulmonary embolism (PE) are well known and have not been overcome to date, despite significant progress in approaches to managing patients with this pathology over the past 1015 years. Due to the nonspecific clinical picture, cases of a long and difficult journey to this diagnosis are not exclusive. In large studies have shown that the most frequent symptom of pulmonary embolism shortness of breath. However, it is not always associated with doctors of different specialties with the need to exclude this diagnosis, purposefully collect anamnesis, identify risk factors. Modern low-dose oral contraceptives are considered quite prosperous in terms of the development of thrombotic complications and cause a slight (1020%) increase in fibrinogen concentration, factors VII, VIII and X, as well as a decrease in the content of active protein S by 1020%. But in the case of the presence of diseases and conditions that increase the risk of venous embolism, this effect may be sufficient for the realization of life-threatening pulmonary embolism. In this regard, it is important to provide a combined effect on the prognosis of the pathology of the patients and the chosen method of contraception.

Three case reports of the use of haemodiafiltration in the treatment of salicylate overdose

2001 ◽  
Vol 20 (9) ◽  
pp. 491-495 ◽  
Author(s):  
G Wrathall ◽  
R Sinclair ◽  
A Moore ◽  
D Pogson
Keyword(s):  
Intensive Care ◽  
Acetylsalicylic Acid ◽  
Care Setting ◽  
Case Reports ◽  
Intensive Care Setting ◽  
Small Reduction ◽  
First Case ◽  
Salicylate Poisoning ◽  
Life Threatening

Aspirin (acetylsalicylic acid) is widely available without prescription. Although self-poisoning is rare, if severe it may be life threatening. Haemodialysis has been recommended in severe cases when salicylate levels exceed 7.3 mmol l-1. We describe three cases of severe salicylate poisoning, which were treated with continuous veno-venous haemodiafiltration (CVVHDF). All patients survived. The first case had already undergone haemodialysis before transfer to the ICU, where CVVHDF was commenced because salicylism persisted at 3 mmol l-1. A small reduction in serum salicylate was noted. In the second case, serum salicylate decreased from 8.5 to 3.5 mmol l-1 after 3 h of CVVHDF even though only minimal urine was produced. Our third case is a chronic overdose in whom serum salicylate decreased from 6.2 to 4 mmol l-1 after 4 h and to 1.4 mmol l-1 after a further 7 h. No bicarbonate was administered to this patient and elimination can only be attributed to CVVHDF and urinary clearance, which is known to be slow. We discuss the pathogenesis of severe salicylate toxicity and postulate that CVVHDF, which is widely used in the intensive care setting, may be a useful therapy in severely poisoned patients who are unstable and cannot undergo haemodialysis or in situations where haemodialysis is unavailable.

Lacosamide-Induced Recurrent Ventricular Tachycardia in the Acute Care Setting

2017 ◽  
Vol 31 (2) ◽  
pp. 222-226 ◽  
Author(s):  
Theodore J. Berei ◽  
Matthew P. Lillyblad ◽  
Adrian K. Almquist
Keyword(s):  
Ventricular Tachycardia ◽  
Care Setting ◽  
Sustained Ventricular Tachycardia ◽  
Acute Care Setting ◽  
Acute Setting ◽  
First Case ◽  
Life Threatening ◽  
Clonic Seizures ◽  
New Generation ◽  
Electrocardiogram Ecg

Lacosamide is a new-generation antiepileptic drug (AED) most commonly used adjunctively in the setting of partial-onset seizures refractory to traditional therapy. We describe the first case report, to our knowledge, of a patient who developed recurrent, sustained ventricular tachycardia with multiple administrations of lacosamide in an acute setting. A 70-year-old woman with a history significant for valvular heart disease was admitted to the inpatient cardiology service for worsening heart failure. On hospital day 7, she received a bioprosthetic aortic valve. Prior to surgery and immediately after, the patient’s electrocardiogram (ECG) was normal. After developing multiple generalized tonic–clonic seizures refractory to levetiracetam, fosphenytoin, and valproic acid, the decision was made to initiate lacosamide. Two hours following the second lacosamide dose, the patient developed a wide complex QRS that transitioned into sustained ventricular tachycardia requiring electrical cardioversion. Sustained ventricular tachycardia occurred again, just hours after the third dose of lacosamide was given. Following cessation of lacosamide, the patient’s QRS interval normalized and has since had no documented episodes of ventricular tachycardia. Clinicians should be aware of the potential for life-threatening rhythmic disturbances in patients initiated on lacosamide and the need for vigilant ECG, electrolyte, and drug–drug monitoring.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

The Evolution of Lead Extraction

2009 ◽  
Vol 5 (1) ◽  
pp. 32
Author(s):  
Melanie Maytin ◽  
Laurence M Epstein ◽  
◽  
Keyword(s):  
Natural Selection ◽  
Lead Extraction ◽  
Significant Morbidity ◽  
Extraction Techniques ◽  
Extraction Technology ◽  
Device Management ◽  
Future Developments ◽  
The Past ◽  
New Methods ◽  
Life Threatening

Prior to the introduction of successful intravascular countertraction techniques, options for lead extraction were limited and dedicated tools were non-existent. The significant morbidity and mortality associated with these early extraction techniques limited their application to life-threatening situations such as infection and sepsis. The past 30 years have witnessed significant advances in lead extraction technology, resulting in safer and more efficacious techniques and tools. This evolution occurred out of necessity, similar to the pressure of natural selection weeding out the ineffective and highly morbid techniques while fostering the development of safe, successful and more simple methods. Future developments in lead extraction are likely to focus on new tools that will allow us to provide comprehensive device management and the design of new leads conceived to facilitate future extraction. With the development of these new methods and novel tools, the technique of lead extraction will continue to require operators that are well versed in several methods of extraction. Garnering new skills while remembering the lessons of the past will enable extraction technologies to advance without repeating previous mistakes.

Brain-eating Amoebae Infection: Challenges and Opportunities in Chemotherapy

2019 ◽  
Vol 19 (12) ◽  
pp. 980-987 ◽  
Author(s):  
Mohammad Ridwane Mungroo ◽  
Ayaz Anwar ◽  
Naveed Ahmed Khan ◽  
Ruqaiyyah Siddiqui
Keyword(s):  
Mortality Rate ◽  
Free Living ◽  
Outdoor Activities ◽  
The Past ◽  
Free Living Amoeba ◽  
Challenges And Opportunities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Living Nature ◽  
Treatment And Diagnosis

Pathogenic free-living amoeba are known to cause a devastating infection of the central nervous system and are often referred to as “brain-eating amoebae”. The mortality rate of more than 90% and free-living nature of these amoebae is a cause for concern. It is distressing that the mortality rate has remained the same over the past few decades, highlighting the lack of interest by the pharmaceutical industry. With the threat of global warming and increased outdoor activities of public, there is a need for renewed interest in identifying potential anti-amoebic compounds for successful prognosis. Here, we discuss the available chemotherapeutic options and opportunities for potential strategies in the treatment and diagnosis of these life-threatening infections.

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