A&A practice
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Amniotic fluid embolism is a rare but dreaded complication of pregnancy, with an incidence between 2 and 7/100,000 deliveries. We report an amniotic fluid embolism after urgent cesarean delivery diagnosed on a cardiac arrest, complicated by cardiogenic shock and acute respiratory distress syndrome. This report describes the indication, efficacy, and success of venoarterial extracorporeal membrane oxygenation in the early management of cardiac arrest, cardiac failure driven by amniotic fluid embolism, and acute respiratory distress syndrome. The use of venoarterial extracorporeal membrane oxygenation support after recovery from cardiac arrest after amniotic fluid embolism should be considered early during the management of these cases.
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Case Reports
Awake Intubation via an Ambu AuraGain in a Patient With Extreme Obesity: A Case Report.
Severe obesity is associated with increased morbidity and mortality. Airway management is challenging due to difficulties in positioning and airway management and altered pulmonary physiology. ⋯ The procedure was well tolerated and easily performed in the full sitting position for optimal airway and ventilation and cardiovascular stability during intubation. To our knowledge, this is the first published report of awake flexible bronchoscopic intubation via an AuraGain, and we discuss our rationale for using this technique.
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Case Reports
Titration of Bivalirudin Infusion in the Pediatric Cardiac Catheterization Laboratory: A Case Report.
Bivalirudin is a direct thrombin inhibitor that is used as a procedural anticoagulant during percutaneous coronary interventions and cardiac surgery for patients with heparin-resistant thrombosis or heparin-induced thrombocytopenia. There is a robust literature describing its safety and efficacy in adults; however, its use in the pediatric population is relatively rare, with dosing extrapolated from adult data. In this case report, we describe a 4-year-old with complex congenital heart disease and history of heparin-induced thrombocytopenia who required bivalirudin dose uptitration during cardiac catheterization.
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Case Reports
Diagnosis of an Additional Ventricular Septal Defect by Observing Dark Blood in Aortic Root Vent: A Case Report.
Diagnosis and management of multiple ventricular septal defects still remain a challenging task. Although many new diagnostic modalities have been used for the perioperative diagnosis of ventricular septal defects, the discovery of residual or additional shunts in the postoperative period is not uncommon. We report a case where we observed an undiagnosed additional ventricular septal defect shunting deoxygenated dark blood into the aortic root vent during deairing of the heart, which was confirmed on transesophageal echocardiography and addressed with reinstitution of cardiopulmonary bypass.