Crit Care Resusc
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Dissection of the internal carotid artery is often caused by trauma to the face or neck. It usually has a delayed onset neurological presentation, a partial middle cerebral artery territory syndrome, 'normal' early CT scan, MRI evidence of middle cerebral artery occlusion, progressive partial or complete neurological recovery, and duplex scan evidence of a reestablished lumen in the internal carotid artery after 10 weeks. A case is reported of a dissection of the right internal carotid artery in a patient with severe facial trauma. ⋯ The patient was anticoagulated and over the next two weeks made a slow recovery, using her left hand effectively and walking unaided. Four months after the accident a duplex scan revealed that the right carotid artery lumen was patent with normal arterial flows. Five months after the accident the patient had returned to work.
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To report Palmerston North Hospital's (PNH) recent experiences with paediatric admissions to the general Intensive Care Unit (ICU), and to identify any aspects relevant to regionalisation of paediatric intensive care. ⋯ If the PNH experience reflects that of other similar institutions, then non-tertiary ICUs admit small numbers of critically ill paediatric patients who tend to be of low to moderate severity, but who cover the full spectrum of severity. Most cases can be well managed locally, but appropriate referral and transfer is an important component in the delivery of a rational and integrated paediatric intensive care service.
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A case is described of subarachnoid haemorrhage caused by vertebral artery dissection following general anaesthesia for laparoscopic cholecystectomy. It is postulated that the dissection may have been a result of neck manipulation during intubation or other movements whilst paralysed, or alternatively, due to intra-operative blood pressure changes occurring in a patient with a predisposition to arterial disruption. The case highlights the important symptom of neck pain in a patient with an intracranial catastrophe. Fortunately, despite a dramatic clinical presentation her recovery has been good.