Value of Echocardiography in the Treatment of Patients With Acute Heart Failure

Heart failure (HF) is a burden in pandemic medicine resulting in high mortality and morbidity. Because acute HF is a life-threatening event, its diagnosis and choice of optimal treatment are important to improve outcomes. Furthermore, understanding the cause and hemodynamics of acute HF is important in selecting the optimal treatment for these patients. Echocardiography is widely used in daily clinical practice because of its non-invasive nature and excellent portability to understand cardiac function and hemodynamics. Echocardiography is highly recommended by guidelines in the practice of HF, but evidence is limited. In this review, I would like to share clinical value of echocardiography in the treatment of patients with acute HF and discuss the usefulness of echocardiography.

Consenso sobre el manejo de eventos de aparente amenaza a la vida del lactante (ALTE)

Un Evento de Aparente Amenaza de la Vida o ALTE (del inglés: Apparent Life Threatening Event) corresponde a un episodio agudo que ante los ojos del observador pone en riesgo la vida de un lactante menor de 1 año. Debe presentar la combinación de 2 o más de los criterios siguientes: apnea, cambio de color, alteración del tono, atoro e implicar la necesidad de algún tipo de maniobras para reanimar. En el presente consenso sobre el manejo de un ALTE se revisaron la evidencia internacional y nacional respecto al enfoque diagnóstico, estudio etiológico, criterios y duración de hospitalización y las indicaciones de monitorización domiciliaria.

An unusual case of neck hematoma and hypercalcemia

One of the most frequent cause of hypercalcemia is primary hyperparathyroidism, which can lead to systemic involvement and life-threatening conditions. We described a rare case of a parathyroid adenoma rupture with consequent bleeding and respiratory airway compression. An 84-year-old man presented to the emergency department complaining neck swelling and related dysphagia. A computer tomography of the neck revealed an extensive left lateral hematoma, and a neck ultrasonography evidenced a hemorrhagic parathyroid adenoma, later confirmed by a 99 mTc-MIBI scintigraphy. To date only 40 cases of ruptured parathyroid adenomas have been described in literature, however due to the possibility of massive bleeding and compression of the airways this diagnosis should always be ruled out. The rupture of a parathyroid adenoma is a rare, but possibly life-threatening event due to airways compression and hemodynamic instability. Testing for hypercalcemia and hyperparathyroidism is mandatory to obtain a correct diagnosis.

Securing Endotracheal Tube in Pediatric Neurosurgical Patients Operated in Prone Position–A Novel Technique

Introduction The purpose of the present study relates to prevention of accidental extubation (AE) of pediatric patients in prone position. The control of endotracheal tube (ETT) in prone position becomes very difficult and an AE often occurs. This is more so deleterious in this age group because of the shallow respiratory reserves in children as well as the common use of noncuffed endotracheal tubes. The accidental tube exit may be a life-threatening event and its prevention is extremely important. Case Description Using the used plastic bottle of intravenous fluids, a rectangular piece is cut, foam pasted and wrapped on itself and stout threads are attached. This attachment is used for securing the ETT by wrapping it. The technical details are described in the text. The AE is a potentially disastrous event and its occurrence in pediatric patients is even more dangerous. Many techniques have been developed over the years for prevention of such an event. Conclusions The present technique uses all the principles of ETT fixation without leading to adding any significant technical difficulties. The method is safe, cost-effective and easily reproducible way of securement of ETT in pediatric neurosurgical patients operated in the prone position.

Type IV Laryngeal Cleft: A Therapeutic Challenge

Type IV laryngeal cleft (LC) is a rare congenital malformation often associated with poorer prognosis compared to lower grades LC. The difficulty in managing LC lies in the ventilation prior to cleft repair, intraoperative anesthesia, technical difficulties to repair a longer cleft and higher rates of post-operative complications. We report a case of a premature neonate with type IV LC who underwent early gastrostomy at birth and survived with optimal medical management despite suffering bouts of pneumonia and life-threatening event. After a late cleft repair at 4-month old, she survived for 3 months post-operatively without complication of relapse fistula. Despite our cleft repair, she was unable to be weaned off from ventilator attributed to her poor neurological recovery and subsequently succumbed to death at 7 months. We would like to discuss the management challenges with regards to ventilation, approach of surgery as well as post-operative complication to improve the management of such complicated disease.