A & A case reports
-
Residency programs are charged with teaching, assessing, and documenting resident competency for a multitude of skills. Documentation of competency requires demonstrating specific milestones mandated by the Accreditation Council for Graduate Medical Education. ⋯ A simulation format was chosen to allow standardized objective assessment of the resident's skill level at an early stage of training, with possible identification of and intervention for skills needing improvement. Our experience may serve as a template for other programs and specialties developing processes for assessing and documenting improvement in skill and competency over the course of residency training.
-
Arrhythmia and palpitation are common during pregnancy. Right ventricular outflow tract tachycardia, a rare cause of palpitations occurring even in the absence of structural heart disease, is uncommon during pregnancy. Nevertheless, the presence of right ventricular outflow tract tachycardia in pregnancy requires careful cardiac evaluation with a focus on managing arrhythmogenic activity while maintaining patient comfort and safety. We report a case of right ventricular outflow tract tachycardia in a pregnant 32-year-old woman, whose arrhythmia was detected 2 weeks before labor and persisted through the peripartum period.
-
The Statlock(™) is an IV stabilization device developed by Bard Access Systems, Inc. We describe the use of a modified Statlock with tracheostomy ties to provide a secure anchor for an endotracheal tube in a child with toxic epidermal necrolysis. We review the benefits and drawbacks of previously described devices in patients with similar conditions (burns, epidermolysis bullosa, Stevens Johnson syndrome). We demonstrate creation of this system with readily available supplies to provide an accessible and stable airway in patients with facial injury precluding adhesive use.
-
We describe a patient who presented with a bilateral pulmonary artery sarcoma, initially treated as pulmonary embolism, that necessitated concomitant pulmonary endarterectomy and pneumonectomy. We reviewed the anesthetic management used for this procedure, which bears many similarities to the management of patients undergoing pulmonary thromboendarterectomy. Right ventricular failure, pulmonary hemorrhage, and cerebral ischemia due to circulatory arrest are life-threatening perioperative complications. The anesthesiologist can play a key role in the prevention (or timely recognition and treatment) of these perioperative complications by establishing adequate hemodynamic, echocardiographic, and neurologic monitoring and by optimizing cardiopulmonary function and coagulation.
-
Postoperative blindness is an unpredictable, devastating, and yet not-uncommon complication of anesthesia. We present the case of a patient who suffered bilateral loss of eyesight after surgery. The diagnostic evidence led us to believe that it was bilateral posterior ischemic optic neuropathy; however, the true mechanisms of damage remain a matter of speculation.