Curēus
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Cricothyroidotomy is a life-saving medical procedure that allows for tracheal intubation. Most current cricothyroidotomy simulation models are either expensive or not anatomically accurate and provide the learner with an unrealistic simulation experience. The goal of this project is to improve current simulation techniques by utilizing rapid prototyping using 3D printing technology and expert opinions to develop inexpensive and anatomically accurate trachea simulators. ⋯ Skin has been simulated as well to enhance the realism of the model. The result is an accurate simulation that will provide users with an anatomically correct model to practice important skills used in emergency airway surgery, specifically landmarking, incision and intubation. This design is a novel and easy to manufacture and reproduce, high fidelity trachea model that can be used by educators with limited resources.
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Background Awareness during general anesthesia is undesired and unanticipated patient wakefulness during surgery or recall of intraoperative events. Incidence of awareness in patients undergoing cardiac surgery is significantly higher than the overall incidence of 1% during general surgery. Awareness during cardiac surgery can be prevented by a number of methods. ⋯ None of the patients in either group had recall of intraoperative events. Conclusion Administration of dexmedetomidine was as effective in reducing awareness and recall in cardiac surgery compared to propofol. Thus, dexmedetomidine can be used as an alternative sedative agent to prevent awareness and recall in cardiac surgery.
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Bony hyperostosis is commonly associated with meningioma growth and is considered one of the characteristic signs on imaging; however, recurrence of meningiomas in the sphenoorbital area, including associated hyperostosis, is typically precluded by gross total resection of the lesion. This 63-year-old man presented with progressive double vision and proptosis in the right eye. He underwent frontotemporal craniotomy and partial removal after magnetic resonance imaging demonstrated a right sphenoorbital meningioma extending to the orbit and middle fossa. ⋯ Although the postoperative computed tomography scan revealed a gross total resection, the five-year follow-up scan demonstrated a recurrent hyperostosis in the region of the lesser and greater sphenoid wings, the middle cranial fossa floor with inferior extension toward the infratemporal fossa, and the sphenoid sinus wall. After another redo surgery, the patient continues to be monitored with yearly imaging. The extent of surgical resection is one of the most important predictors of meningioma recurrence postoperatively, and cases of recurrence after gross total resection are rare.
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Case Reports
The Effervescent Gallbladder: An Emergency Medicine Bedside Ultrasound Diagnosis of Emphysematous Cholecystitis.
Emphysematous cholecystitis (EC) is a distinct clinical disease that carries a high rate of morbidity and mortality. Maintaining a high index of suspicion, especially in the right patient population, combined with emergency bedside ultrasound can lead to rapid diagnosis and initiation of treatment for this life threatening condition.
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Case Reports
Microvascular Decompression for a Patient with a Glossopharyngeal Neuralgia: A Technical Note.
The glossopharyngeal neuralgia (GPN) constitutes approximately 0.2-1.3% of all facial pain syndromes. The GPN is a syndrome of neuropathic pain characterized by paroxysmal pain episodes localized in the posterior tongue, tonsil, throat, or external ear canal. The first-line treatment is pharmacological. Patients who are refractory to medical therapy can be treated surgically with microvascular decompression (MVD) or sectioning the IX nerve and the upper rootlets of the X nerve. We aim to describe the technical nuances of MVD of the IX cranial nerve with a targeted inferior mini-craniotomy in a patient with a neurovascular compression.