1/35. Massive gastrointestinal hemorrhage after transoesophageal echocardiography probe insertion.PURPOSE: To describe a case of a massive gastric bleeding following emergency coronary artery bypass surgery associated with transoesophageal echocardiographic (TEE) examination. CLINICAL FEATURES: A 50-yr-old man was referred for an acute myocardial infarction and pulmonary edema (Killip class 3). Twelve hours after his myocardial infarction, he was still having chest pain despite an i.v. heparin infusion. coronary angiography revealed severe three-vessel disease with multifocal stenosis of the left anterior descending, circumflex and total occlusion of the right coronary artery. The patient was transferred to the operating room for emergency coronary artery bypass graft surgery. After total systemic heparinization (3 mg.kg-1) was obtained for cardiopulmonary bypass, a multiplane TEE probe was inserted without difficulty to monitor myocardial contractility during weaning from CPB. During sternal closure, the TEE probe was removed and an orogastric tube was inserted with immediate drainage of 1,200 ml red blood. Endoscopic examination demonstrated a mucosal tear near the gastro-oesophageal junction and multiple erosions were seen in the oesophagus. These lesions were successfully treated with submucosal epinephrine injections and the patient was discharged from the hospital eight days after surgery. CONCLUSION: This is a report of severe gastrointestinal hemorrhage following TEE examination in a fully heparinized patient. This incident suggest that, if the use of TEE is expected, the probe should preferably be inserted before the administration of heparin and the beginning of CPB.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/35. Acute pulmonary edema associated with placement of waist-high, custom-fit compression stockings.Compression stockings are a safe, noninvasive treatment for patients with symptomatic orthostatic hypotension due to autonomic nervous system dysfunction. In this report, we describe a 75-year-old man who had development of pulmonary edema approximately 45 minutes after placement of compression stockings on the first postoperative day following a carotid endarterectomy. No sudden changes were noted on an electrocardiogram or echocardiogram or in the cardiac isoenzymes associated with the pulmonary edema. The patient had a history of coronary artery disease, diabetes mellitus-induced autonomic nervous system dysfunction, and recent surgery near the carotid baroreceptor. All these factors may have limited his ability to compensate for a rapid increase in central blood volume. The temporal relationship of the patient's respiratory distress to the placement of the compression stockings, in the absence of laboratory findings of primary cardiac dysfunction, make stocking-related fluid shift the likely precipitating event in the formation of acute pulmonary edema. This case suggests that compression stockings should be used with caution in patients with limited cardiac reserve.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/35. Drowning and near-drowning--some lessons learnt.Over a period of sixteen months, 17 cases of submersion injury (encompassing victims of drowning and near-drowning) were attended to at our Accident and Emergency Department at Changi General Hospital. Most of the victims were inexperienced recreational swimmers, and in 6 of them, early bystander cardiopulmonary resuscitation enabled them to recover without severe morbidity. Non-cardiogenic pulmonary oedema with resulting chest infection was the commonest complication in survivors. Most of the episodes occurred in an urban setting in swimming pools without supervision by lifeguards. About two-thirds of the cases were adults over the age of fifteen years. In addition, there were patients in whom submersion injury was associated with more sinister conditions (fits, traumatic cervical spine injury, dysbarism, intoxication from alcohol or drugs), some of which were unsuspected by the doctors initially. Apart from the immediate threats of hypoxia and pulmonary injury, active search for any possible precipitating causes and associated occult injury should be made. In this study, the determinants of survival from near-drowning were early institution of cardiopulmonary resuscitation, presence of pupil reactivity, and presence of a palpable pulse and cardiac sinus rhythm.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
4/35. Rapidly progressive pneumonia due to aeromonas hydrophila shortly after near-drowning.An 87-year-old woman died of rapidly progressive pneumonia due to aeromonas hydrophila shortly after a near-drowning event. autopsy showed necrotizing pneumonia and postmortem cultures of both blood and lung revealed the organism. Fulminant pneumonia should be considered in patients of a near-drowning event.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
5/35. Rapid and complete occlusion of a heat and moisture exchange filter by pulmonary edema (clinical report).PURPOSE: A case of near fatal obstruction of a breathing system is described, due to occlusion of a heat and moisture exchange filter in a patient with pulmonary edema. Previous reports have described cases of mechanical obstruction to fresh gas flow due to an accumulation of a bolus of fluid within the filter housing. However, in this case, the cause of occlusion was due to the protein and cell debris contained in a small amount of pulmonary edema fluid interacting with the filter membrane. CLINICAL FEATURES: Obstruction occurred rapidly and without warning, and was difficult to differentiate from the more common diagnoses of bronchospasm or tension pneumothorax. Outwardly the filter appeared normal, and routine protocol for emergency management of suspected breathing system obstruction initially failed to identify the site of occlusion. CONCLUSION: Minimal contamination by proteinaceous fluid may cause rapid and complete occlusion of a breathing system filter. Blockage of the breathing system filter and catheter mount should be considered in cases of unexplained breathing system occlusion. The use of a fresh breathing system without a filter for each patient, as recommended by The American Center for Disease Control and the American Society of Anesthesiologists, would have prevented this scenario from occurring.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/35. Acute presentation of undiagnosed end-stage renal disease in a young active duty male soldier.Chronic renal insufficiency is a condition involving the deterioration of renal function over a period of months to years. This differs from acute renal failure, which is a sudden decrease in renal function that occurs over a period of hours to days. patients with chronic renal insufficiency are often clinically asymptomatic until nearing end-stage renal disease, at which time their signs and symptoms reflect subtle changes in metabolic and volume control. In contrast, acute renal failure patients often present with overt symptoms caused by sudden metabolic abnormalities and volume overload. We describe a patient who's clinical presentation suggested acute renal failure but was actually caused by end-stage renal disease from a chronic renal process.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/35. Drowning: another plunge.Hypoxia, pulmonary edema, acidosis, and aspiration compose the syndrome of near drowning. A review of 20 cases of near drowning indicated that the initial chest roentgenogram bears little weight in assessing the present or future clinical status. In some cases a 24 to 48 hour delay occurred before roentgenographic evidence for pulmonary edema was noted. The composition of fluid aspirated does not affect the outcome. The results of this report suggest that patients with a history of near drowning should be followed closely for at least 48 hours despite an initial normal chest roentgenogram.- - - - - - - - - - ranking = 3keywords = near (Clic here for more details about this article) |
8/35. pulmonary edema associated with salt water near-drowning: new insights.In this case report we describe the clinical and laboratory findings of a man who nearly drowned after aspirating a large quantity of seawater. The aspiration of salt water, which is strongly hypertonic with respect to plasma, resulted in severe pulmonary edema, both from the quantity of aspirated seawater and the osmotically driven ultrafiltrate of plasma that accumulated in the air spaces. The initial concentration of protein in the edema fluid sample was very low, 0.7 g/dl, consistent with only a minimal increase in epithelial permeability. Approximately 4 h later, there was a marked increase in the concentration of protein in the residual alveolar fluid associated with improvement in several clinical indices, indicating that the excess alveolar fluid was reabsorbed very rapidly. In addition, the magnesium concentration was markedly elevated because of the aspiration of magnesium-containing seawater, which may have diagnostic importance for near-drowning in salt water. The data from this case provide evidence for well-preserved alveolar epithelial barrier function after aspiration of large quantities of hypertonic salt water.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
9/35. Reexpansion pulmonary edema after resolution of tension pneumothorax in the contralateral lung of a previously lung injured patient.We present the case of a 19-year-old woman who developed sudden severe left-sided tension pneumothorax in the recovery room after undergoing a 6-hour open reduction and internal fixation of an anterior and posterior pelvic fracture sustained in a motor vehicle accident 4 days prior to surgery. Additional preoperative injuries included a right-sided hemopneumothorax, right lung contusion, and liver laceration. The left lung was rapidly reexpanded using tube thoracostomy. The patient subsequently developed ipsilateral pulmonary edema and ultimately acute respiratory distress syndrome, which required vigorous treatment over the next several days. It is postulated that a variety of intraoperative and immediate postoperative maneuvers may have contributed to the development of this near fatal complication.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/35. Delayed resolution of negative pressure pulmonary edema associated with low-molecular-weight dextran after microsurgery--a case report.Negative pressure pulmonary edema (NPPE) is an uncommon perioperative complication after total or partial upper airway obstruction during anesthesia or respiratory distress. The cardinal event causative of the pathophysiology is believed to be the generation of a sudden and marked negative intrapleural pressure against a closed glottis, resulting in a disruption of the normal intravascular Starling mechanism. Ultimately, excessive intravascular fluid which transudes into the interstitial space eventuates in pulmonary edema. In most reports, patients suffering from NPPE could recover within 24 h after appropriate treatment. Here, we report a case of highly suspected NPPE with delayed resolution associated with the perioperative use of dextran, following microsurgery for digital anastomosis of the nearly amputated right thumb. We have reviewed the possible pathomechanisms of NPPE, and discuss herein the possible relationship between the delayed resolution of NPPE and perioperative use of dextran.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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