A & A case reports
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A patient with an endobronchial tumor and critical airway obstruction developed hypoxia and hypercarbia and, subsequently, cardiac arrest during a palliative laser core-out excision. The differential diagnosis included tension pneumothorax, as well as airway obstruction due to swelling of residual tumor or to blood clots. ⋯ Immediate bedside lung ultrasonography provided real-time information leading to the stabilization of the patient. This case provides compelling motivation for anesthesiologists to acquire this easily learned skill.
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We present the case of a 62-year-old woman with an advanced metastatic lung tumor that required palliative debulking. Perioperative placement of a surgical clip in the dura of the thoracic spinal cord caused a dural breach, which ultimately caused a pneumocephalus. An awareness of this association is important, especially in patients undergoing thoracic resections. We also describe our approach to the management of this condition.
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A 56-year-old man with a history of coronary artery disease, 4 months of cough and shortness of breath, a new lung mass, and increasing hypoxemia presented to the operating room emergently for a subxiphoid pericardial window for cardiac tamponade. After 1200 mL of pericardial fluid was drained, the patient immediately went into acutely decompensated right heart failure as seen on a transesophageal echocardiogram. The patient had cardiovascular collapse refractory to high-dose vasopressors, necessitating emergent venous-arterial extracorporeal membrane oxygenation for successful resuscitation.
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Case Reports
Superimposed cocaine-induced rhabdomyolysis in a patient with aortic dissection rhabdomyolysis.
A 52-year-old man presented with acute, sharp chest pain radiating to the back and abdomen after using cocaine 18 hours previously. Computed tomographic angiography revealed a type B aortic dissection that extended to the iliac arteries. ⋯ The combination of aortic dissection and creatine kinase toxicity was extensive enough to cause permanent renal failure and paraplegia below T6. The severity of the patient's symptoms was attributed to concomitant cocaine-induced rhabdomyolysis and aortic dissection rhabdomyolysis.