TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS最新文献

{"title":"Spontaneous Heparin Induced Thrombocytopenia Post Knee Replacement Surgery","authors":"J. Burgei, B. French, A. Simeone, A. Basit","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2918","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2918","url":null,"abstract":"","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124577284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory Lactic Acidosis Due to Thiamine Deficiency from Metformin Toxicity","authors":"T. Uchel, U. Sofi","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2939","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2939","url":null,"abstract":"","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122407134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Flaccid Quadriparesis Due to Hyperkalemia; A Case Report","authors":"M. Saeed, A. Gohar, A. Shahzadi, Z. Khan, M. Siuba, N. Chaisson","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2930","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2930","url":null,"abstract":"","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"166 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115768202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Where Temperature Matters: Persistent Hemodynamic Shock from Cold Agglutinin Disease","authors":"J. Doran, J. Hua, I. Douglas","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2902","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2902","url":null,"abstract":"","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130915904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome in the Setting of Amiodarone Use","authors":"S. Dumond, S. Sirajee, M. Bonk, F. Bowden","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2920","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2920","url":null,"abstract":"Introduction Bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) is a syndrome resulting from the synergistic effect of profound hyperkalemia and AV nodal blockade, resulting in a cyclic pattern of bradycardia, and worsening renal function, in turn exacerbating hyperkalemia. This syndrome is classically defined with beta-blockers (BB) and calcium channel blockers (CCB). We present a case of BRASH syndrome in the setting of amiodarone - class III antiarrhythmic with alpha- and beta-blocking properties. Case Presentation 58-year-old obese male presents with dyspnea, and lower extremity swelling. Medical history is notable for hypothyroidism, atrial fibrillation, and recent hospitalization for novel coronavirus-2019 (COVID-19) complicated by acute renal failure requiring temporary hemodialysis. Active medications include levothyroxine, amiodarone, and apixaban. Patient is afebrile, with pulse 49 beats per minute (bpm), blood pressure 85/54mmHg, and respiratory rate 32 breaths per minute. On exam, respirations are non-labored, with bibasilar rales, jugular venous distention, and anasarca. Electrocardiogram shows sinus bradycardia (pulse 53bpm), with first-degree AV block and PR interval of 240ms. Basic metabolic panel: blood urea nitrogen 73 mmol/L, creatinine 2.3 mg/dL, sodium 125 mmol/L, chloride 93 mmol/L, and potassium 5.9 mEq/L. TSH is elevated (7.34 mIU/L) with normal free T4 level (1.2 ng/dL). A formal transthoracic echocardiography suggests normal systolic and diastolic function. Baseline cortisol level could not be ascertained;nevertheless, 60-minutes post-cosyntropin administration, cortisol level is 71.8 ug/dL. Repeat testing 96-hours later was not suggestive of adrenal insufficiency. Discussion The diagnosis of BRASH syndrome requires bradycardia in the setting of synergistic effect of hyperkalemia and AV nodal blockade with underlying renal insufficiency, in turn exacerbating hyperkalemia. There is a paucity of literature delineating the pathophysiology of BRASH. Unlike most reported cases classically involving BB or CCB, in our patient, the AV nodal blocking medication implicated is amiodarone. Amiodarone is a class III antiarrhythmic with alpha- and beta-blocking properties which prolongs the action potential and refractory period in myocardial tissue, thereby decreasing AV conduction and sinus node function. The anti-sympathetic action, calcium, and potassium channel blockade are responsible for the negative chronotropic effects as seen in BB and CCB. There has been one reported case linking BRASH and amiodarone. However, multiple doses of diltiazem and metoprolol were also cited. Our patient received no additional AV nodal blocking agents. Conclusion Patients taking amiodarone can present in renal failure as part of BRASH syndrome. With the wide use of amiodarone, this case deserves attention from clinicians.","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131396489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pill a Day to Keep the Doctor Away","authors":"J. Zoglman, D. Mikhalkova, A. Hussein","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2907","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2907","url":null,"abstract":"","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115620038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ring of Disaster: Complication in Percutaneous Dilatational Tracheostomy on ECMO","authors":"S.S. Wu, R. Silverman","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2922","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2922","url":null,"abstract":"Introduction: Venous-venous extracorporeal membrane oxygenation (VV-ECMO) is becoming more utilized especially during the SARS-COV-2 pandemic. Although percutaneous dilatational tracheostomy (PDT) can be done and used safely to facilitate mechanical ventilation weaning, the procedure is associated with a higher complication rate when done in VV-ECMO patients. Case: 28-year-old male with past medical history significant for seizure disorder was transferred from outside hospital after getting treated for aspiration induced acute respiratory distress syndrome (ARDS). Decision was made to place the patient on VV-ECMO given refractory hypoxemia and hypercapnia with persistently high peak airway pressures. He was also placed on inhaled nitricoxide. Over the next 10 days, the patient was able to wean down to minimal ECMO settings. The decision was made to proceed with PDT to facilitate long term ventilation weaning. The tracheostomy was placed with minimal bleeding. Coagulopathy was optimized at that time. 24 hours after the procedure, the patient developed significant bleeding around the nasopharynx and the tracheostomy site. Patient's tidal volumes significantly decreased on pressure support ventilation leading to urgent inspection bronchoscopy. New clot burden was noted within the right bronchus intermedius. In addition, while entering the airway through the tracheostomy lumen, there was a valve-like ring of mucosal tissue that was semi-obstructing the lumen with each ventilation. The tissue was unable to be removed at the time. Unfortunately, the patient had a respiratory acidosis associated PEA arrest. He was able to regain pulse after 2 rounds of CPR and adjustment of sweep on ECMO. Second look bronchoscopy was done. Previously noted mucosal tissue appeared to be dislodged into the right main stem along with fibrous clot burden. Patient regained the previous tidal volume on the ventilator after the mucosal tissue and fibrous clot burden was removed. The bleeding was eventually controlled with supportive care. Eventually, the patient was able to be successfully decannulated from the ECMO and transferred back to the prior institution for further ventilation weaning. Discussion: ECMO patients often have increased hemorrhagic risk and post procedural complications given the circuit-blood interaction that affects coagulation and platelet function. Our case demonstrated rare potential severe complication peri-procedure. Insertion of a tracheostomy in an edematous airway can sheer mucosa and create the flap that can potentially lead to cardiac arrest. Early bronchoscopy surveillance may be warranted after PDT on patients with VV-ECMO to avoid unexpected complication. VV-ECMO setting should be adjusted when ventilation issues occur.","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"49 407 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116503421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Fatal Toxicity Due to Recreational PDCB Ingestion","authors":"S. C. Tompkins, I. Kang, D. Suárez, M. Reddy, M. Kaul, J. Mbae, Y. Htwe, S. Dudek, T. F. Ferrer Marrero","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2912","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2912","url":null,"abstract":"","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125718415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Spontaneous Fungal Peritonitis in a Patient with Alcoholic Liver Cirrhosis","authors":"A. Israni, C. Shah, U. Patel","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2934","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2934","url":null,"abstract":"","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128037269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metformin Toxicity Successfully Treated with Intermittent Hemodialysis Despite Shock State","authors":"J. Dugan, J.R. Walker, L. Kartha, R. T. Marino, C. Teba","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2928","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2928","url":null,"abstract":"","PeriodicalId":342007,"journal":{"name":"TP57. TP057 NON-PULMONARY CRITICAL CARE CASE REPORTS","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133766390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}