RESUMEN
Ventilation in the prone position is a valid choice in the treatment of trauma patients with acute respiratory distress syndrome (ARDS). Two cases of trauma patients with ARDS treated in the prone position are described. The technique was very easy to use and safe. The prone position technique proved very useful in the treatment of post-traumatic ARDS in these 2 cases.
Asunto(s)
Postura/fisiología , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/terapia , Heridas y Lesiones/complicaciones , Adulto , Humanos , Masculino , Posición Prona , Respiración Artificial , Síndrome de Dificultad Respiratoria/fisiopatologíaRESUMEN
Scombroid fish poisoning (scombrotoxism, scombroid ichthyotoxicosis) is a food-related illness typically associated with the consumption of dark and white meat fish. Two patients presented to the emergency department. Metilprednisone 1000 mg and ranitidine 150 mg were administered initially. A large amount of crystalloids and colloids in in combination with vasoactive drugs were required to maintain normopressure. Levels of histamine and N-methylhistamine were far above the normal mean. Carboxyhemoglobin levels were also tested to exclude a superimposition of carbon monoxide intoxication. In both cases, major symptoms occurred and were treated aggressively. Early goal directed fluid therapy corrected the DO2/VO2 unbalance, due to a distributive pattern of hypovolemic impending shock, and permitted a rapid stabilisation of both patients. It is important to recognize the syndrome as an intoxication (rather than an allergic reaction) so that the source of the toxin can be identified and further cases prevented. It is also important to investigate where the fish was cooked (i.e. in an open space vs. closed space), to exclude the possibility of a concomitant carbon monoxide intoxication, which would require transfer the patient to a hospital facility equipped with a hyperbaric chamber.
Asunto(s)
Fluidoterapia , Alimentos Marinos/envenenamiento , Adolescente , Animales , Antiinflamatorios/uso terapéutico , Servicios Médicos de Urgencia , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Masculino , Metilprednisolona/uso terapéutico , Ranitidina/uso terapéutico , AtúnRESUMEN
BACKGROUND: Our aim was to check out the advantages of temporary caval filtration in pregnancy with a retrievable filter: Tempofilter (tCF). METHODS: During a period of 2 years we implanted tCF in four patients at the third pregnancy trimester with serious acute deep venous thrombosis (DVT) of the lower limbs for prophylaxis of pulmonary thromboembolic disease (TED) in the pre-partum, during Caesarian section (CS), and in the post-partum period. tCF has been placed percutaneously in local anaesthesia using the Seldinger technique and under image intensifier control. All procedures were performed in a polyvalent ICU. RESULTS: tCF positioning was always easy. No complications linked to the adopted technique occurred. No incidence of pulmonary embolism was reported (PE). The permanence period of tCF in situ was 14 to 29 days (mean+/-SD: 21+/-6). The CS always took place without complications either for the patient or for the foetus. CONCLUSIONS: The combined use of tCF and an anti-coagulating therapy resulted in an effective prophylaxis of TED for the pregnant woman without any interferences with CS and with no consequence as for permanent endovascular prosthesis for the young patient herself.
Asunto(s)
Complicaciones Hematológicas del Embarazo/prevención & control , Tromboembolia/prevención & control , Filtros de Vena Cava , Adulto , Femenino , Filtración , Humanos , Embarazo , Embolia Pulmonar/prevención & control , Trombosis de la Vena/complicacionesRESUMEN
BACKGROUND: Subclavian vein catheterism, a commonly used methodology in ICU, is not devoid of complications, even some serious ones (Pneumothorax 0.5%). METHODS: The authors propose an alternative technique based on the use of an introducer needle bent on its own axis to form an arch with its concavity turned towards the Quincke point. On searching the blood vessel, once the subclavian plane has been reached, the needle advancement towards the jugular fosse happens by following the needle curvature. In this way the operator can keep the needle on a plane parallel to the cutaneous one, and all the complications due to involuntary exceeding of the costal plane are avoided. The response of this new technique in 110 patients (study group) is compared through a retrospective study, to 100 patients with whom the standard technique has been used (control group). RESULTS: The study group has presented a significant reduction both of total complications (p<0.05) and of total failures (p< 0.01). CONCLUSIONS: Such results, although pertinent to a still limited study, testify to an improvement in terms of security and efficacy, with the new alternative technique without an increase in costs.