A&A practice
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Although rare, cannot intubate and cannot oxygenate situations are challenging acute events. The development of management algorithms, standardized equipment provisions, and appropriate clinical training in the application of front-of-neck access techniques are necessary to optimize procedural success to ensure adequate oxygenation. ⋯ With proper implementation, this unique process aligning the cannula cricothyroidotomy and scalpel bougie as primary and secondary techniques, respectively, can potentially optimize procedural success. This algorithmic approach is trained routinely among our anesthesia providers, while the equipment is standardized throughout our anesthetizing locations.
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We present a case of a 41-year-old man who suffered cardiac arrest after induction of general anesthesia for an ambulatory ophthalmologic procedure. In this report, we highlight the use of focused transthoracic echocardiography by the anesthesia team to guide a prolonged resuscitation. Emergency room and critical care physicians have described the use of focused echocardiography to aid in diagnosing correctible causes of cardiac arrest, predicting outcomes, and in decision making regarding termination of resuscitation. We discuss benefits and barriers to anesthesiologists incorporating focused cardiac ultrasound into the perioperative arena.
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Case Reports
Idiopathic Cluneal Neuralgia Successfully Treated With Radiofrequency Nerve Ablation: A Case Report.
Middle cluneal nerve entrapment neuropathy/neuralgia (MCN-EN) is a rare and potentially underdiagnosed etiology for chronic low back pain. Symptoms include pain in the buttock and posterior superior iliac spine area that is increased by activity and direct pressure over the area, and is "neuropathic" in nature. Previous case reports describe successful treatment of MCN-EN with nerve block and/or surgical decompression of the MCN. We present a case report detailing the first successful use of radiofrequency nerve ablation in treating MCN-EN.
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A patient presented with a stab injury caused by a knife penetrating the orbital floor and maxillary sinus along the skull base with the tip situated adjacent to the left internal carotid artery. A flexible fiberoptic bronchoscope loaded with an endotracheal tube was initially positioned superior to the vocal cords and advanced into the trachea immediately following induction. The blade was removed after occluding endovascular balloons were positioned distal and proximal to the potential internal carotid artery injury site. Therefore, contralateral nasal fiberoptic intubation might be safely performed in patients with unilateral maxillofacial trauma, no intracranial penetration, and minimal bleeding.
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ε-Aminocaproic acid is routinely used in cardiac surgery to prevent excess bleeding. It is rarely associated with thrombotic events. This case report illustrates the formation of intracardiac thrombi leading to massive pulmonary embolism during a coronary artery bypass graft surgery, secondary to the administration of ε-aminocaproic acid as confirmed by intraoperative transesophageal echocardiogram. After a failure of resolution with high-dose heparin, tissue plasminogen activator was used to successfully reverse the patient's hypercoagulable state.