A&A practice
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We describe a case of a complete endotracheal tube (ETT) transection due to patient bite. The patient was intubated for postoperative pneumonia; during weaning of sedation, the patient was unable to tolerate pressure support ventilation (PSV) due to agitation. ⋯ Utilizing a multidisciplinary approach, we provided respiratory support and performed nasopharyngolaryngoscopy (NPL) to identify and extract the foreign body. An algorithm for management of ETT fragment extraction is provided.
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Case Reports
Management of a Fragmented Angiocatheter During Central Venous Cannulation: A Case Report and Important Lessons.
Complications during central venous catheter (CVC) insertion are infrequent with an incidence of 0.1%-1%. We experienced a rare CVC complication with fragmentation of the angiocatheter at its hub during central venous cannulation while utilizing the modified Seldinger technique (ie, wire through the catheter technique). ⋯ Prompt recognition and appropriate management included leaving the guidewire in place (to stabilize the distal fragmented segment) and promptly consulting vascular surgery for removal before potential vascular embolization of the angiocatheter fragment. We further recommend that all components of the insertion kit be inspected before and after patient use.
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There is an increasing impetus to perform primary total hip arthroplasty and total knee arthroplasty on an outpatient basis and in the outpatient setting. However, with recent federal regulatory changes, orthopedic surgeons must now evaluate patients on a case-by-case basis to determine whether an inpatient admission will be medically necessary and appropriate. We thus created our prototype Lower Extremity Inpatient-Outpatient (LET-IN-OUT) total joint replacement tool as a simple, consistent way for other clinicians to identify specific major preoperative patient comorbidities and thus to recommend independently and objectively to the orthopedic surgeon postoperative inpatient or outpatient status for a given patient.
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Case Reports
Peripartum Management in Myelodysplastic Syndrome Guided by Serial Thromboelastography: A Case Report.
Myelodysplastic syndrome with severe thrombocytopenia is a rare disease in women of child-bearing age. The challenging aspect in management of such a patient is maintaining optimal coagulation with minimum platelet transfusion during the peripartum period. Multiple transfusions can result in allo-sensitization which can affect lifesaving bone marrow transplantation in future. Thromboelastography is a useful tool to assess and guide appropriate transfusion requirements.
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Case Reports
Severe Acute Lung Injury After H2O2 Irrigation of an Aneurysmal Bone Cyst in an 8-Year-Old Girl: A Case Report.
An 8-year-old girl developed severe acute lung injury after irrigation of a pelvic aneurysmal bone cyst with H2O2 and filling with bone cement. Sudden profound oxygen desaturation occurred on the operating table when the patient was turned from the prone to the supine position. ⋯ The patient started to improve after 24 hours and eventually made a full recovery. We hypothesize that the incident was caused by gas embolization and pulmonary endothelial damage by H2O2.