A&A practice
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A 49-year-old man with cirrhosis and portal hypertension was admitted for acute respiratory distress syndrome secondary to coronavirus disease 2019 (COVID-19) pneumonia. His course was complicated by postprandial hypotension (PPH)-episodic hemodynamic collapse that occurred minutes after enteral administration of medications or fluids. ⋯ Portal hypertension is a likely additional risk factor that has not been previously described. Octreotide is the mainstay of PPH prophylaxis.
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Elevated peak inspiratory pressures (PIPs) cause harm via hypoventilation, barotrauma, and hemodynamic instability. Heat and moisture exchangers (HMEs) are used during mechanical ventilation to prevent heat loss, dehydration of airway mucosa, and accumulation of dried secretions. ⋯ HME obstruction should be considered when PIPs are elevated. Alternative heat and moisture preservation strategies should be contemplated, as HMEs increase airflow resistance and add another point of possible malfunction.
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Case Reports
Prevention of Perioperative Abdominal Migraine in a Patient Undergoing Spinal Fusion: A Case Report.
Abdominal migraine is a variant of migraine headaches characterized by episodic attacks of severe abdominal pain with migrainous features, including anorexia, nausea, vomiting, and pallor. It is more commonly diagnosed in children rather than adults. ⋯ As a precautionary measure, a perioperative opioid-sparing treatment plan was devised to prevent abdominal migraine while the patient underwent elective lumbar fusion surgery. Opioid-sparing treatment plans may enable similar patients to undergo surgery without experiencing perioperative abdominal migraines.