A & A case reports
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Case Reports
The Critical Importance of Hepatic Venous Blood Flow Doppler Assessment for Patients in Shock.
Hepatic venous blood flow can be easily obtained using bedside ultrasound with either transthoracic or transesophageal echocardiography. Six critically ill patients with shock associated with absent or significantly reduced hepatic venous blood flow in the presence of normal or increased pulmonary venous flow are presented. ⋯ These shock situations are secondary to increased resistance to venous return. Their treatment is highly specific and typically involves a surgical intervention.
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We describe a patient who received an unintentionally prolonged epidural infusion of phenylephrine. The patient experienced no major morbidity. However, this case highlights the continuing problem of wrong-route drug administration and the urgent need to adopt route-specific connections.
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Case Reports
Misconnections in the Critically Ill: Injection of High-Dose Gadolinium into an External Ventricular Drain.
We report an unfortunate case of accidental administration of intrathecal gadolinium through an external ventricular drain in a postcraniotomy patient during magnetic resonance imaging of the brain. The incident occurred after the venous contrast line was connected mistakenly to the ventricular drainage catheter. ⋯ Despite all interventions, the patient developed irreversible neurologic disability. We address the clinical sequelae, management strategies, and factors contributing to the catheter misconnection that led to this event.
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Case Reports
Blood-Conservation Strategies in a Blood-Refusal Parturient with Placenta Previa and Placenta Percreta.
Abnormal placentation can be associated with significant blood loss and massive blood transfusions. Caring for parturients with abnormal placentation who refuse blood transfusion is very challenging. ⋯ A multidisciplinary team developed a plan, including the use of perioperative erythropoietin and IV iron dextran, intraoperative acute normovolemic hemodilution, cell salvage, tranexamic acid, and uterine artery embolization. This strategy was successful in avoiding the need for allogeneic transfusion and ensuring an uneventful recovery after both surgical procedures.