Nasogastric Tube-Induced Catastrophic Airway Compromise Due to a Large Blood Clot.

Nasogastric and orogastric tube (NGT/OGT) insertion is a routine in-hospital procedure used in patients who need enteral feeding, medication administration, and gastric decompression in a patient unable to tolerate per oral administration. NGT insertion has a relatively low complication rate when performed adequately; however, previous studies demonstrate that associated complications range from delicate, simple nose bleeds to more severe conditions such as nasal mucosal bleeding, which can be easily aspirated in a patient with encephalopathy or other conditions associated with the inability to protect the airway. Here we present a case of traumatic NGT insertion causing nasal bleeding, leading to respiratory distress secondary to aspiration of blood clot obscuring the airway.

Systemic Lupus Erythematosus With Multi-System Involvement and Immunosuppression Presenting With a Rare Fungal Brain Abscess.

The fungal pathogen Scedosporium apiospermum is a ubiquitous opportunistic pathogen found in soil and water that can cause severe infection in hosts with impaired immunity. Patients with systemic autoimmune diseases such as systemic lupus erythematosus (SLE) are already at risk for infections given their altered immunity. This can be exacerbated further in patients taking immune-suppressing medications to control their disease status. Here, we present a case of a rare and challenging clinical scenario of a woman with refractory multi-organ SLE on steroids who developed neurologic deficits found to have a brain abscess caused by a unique fungal etiology.

A prospective study on the precision of height data from electronic medical records in tidal volume calculation for lung-protective ventilation.

Lung-protective ventilation is now the norm for all patients, regardless of the presence of acute respiratory distress syndrome (ARDS), owing to the mortality associated with higher tidal volumes (TV). Clinicians calculate TV using recorded height from medical records and predicted body weight (PBW); however, the accuracy remains uncertain. Our study aimed to validate accurate TV settings for lung-protective ventilation by examining the correlation between the charted height and bedside measurements. In a single-center study, we compared PBW-based TV calculated from recorded height to PBW-based TV from measured height and identified factors causing height overestimation during charting. Our team measured patient height within 24 hours of admission using metal tape. TV calculated from recorded height (6-8 mL/kg PBW) was significantly larger (391.55 ±â€…65.98 to 522.07 ±â€…87.97) than measured height-based TV (162.62 ±â€…12.62 to 470.28 ±â€…89.64) (P < .01). In the height overestimated group, 57.7% were prescribed TV by healthcare provider, which was more than TV of 8 mL/kg of PBW, as determined by measured height. Negative predictors for height overestimation were male sex (OR: 0.45 [95% CI: 0.25-0.82]; P = .008) and presence of driver's license information (OR: 0.45 [95% CI: 0.25-0.80]; P = .007), whereas Asian ethnicity was a positive predictor (OR: 4.34 [95% CI: 1.09-17.27]; P = .04). The height overestimation group had a higher in-patient mortality rate (38.5%) than the matched/underestimation group (20%) (P < .01). In stadiometer-limited hospitals, the PBW-based TV is overestimated using the recorded height instead of the measured height. In the group where heights were overestimated, over half of the patients received TV prescriptions from healthcare providers that surpassed the TV of calculated 8 mL/kg PBW based on their measured height. The risk factors for height overestimation include female sex, Asian ethnicity, and missing driver's license data. Alternative height measurement methods should be explored to ensure precise ventilation settings and patient safety.

Neutropenic Fever in a Patient With SARS-CoV-2-Induced Hemophagocytic Lymphohistiocytosis (HLH).

Hemophagocytic lymphohistiocytosis (HLH) is a severe systemic inflammatory syndrome that is often fatal. In the adult population, it is believed to develop secondary to immune dysregulation due to rheumatologic, infectious, malignant, and recently, immunomodulatory drugs. It has been well documented that infectious etiologies can lead to HLH however to date there is a paucity of case reports of HLH stemming from the 2019 novel coronavirus (SARS-CoV-2). Furthermore, it is well established that overlap exists between the extensive hyper-inflammatory syndromes produced from both HLH and severe COVID-19 infection. Here, we present a case of COVID-19-associated HLH with recurrent neutropenic fever in a patient with controlled follicular non-Hodgkin lymphoma who received treatment with etoposide after continued hospital admissions with refractory medical treatment.

Lenalidomide-Associated Hemophagocytic Lymphohistiocytosis With Plasma Cell Phagocytosis.

Hemophagocytic lymphohistiocytosis (HLH) is a severe systemic inflammatory syndrome that is often fatal. In the adult population, it is believed to develop secondary to immune dysregulation due to rheumatologic, infectious, malignant, and recently, immunomodulatory drugs. It's co-occurrence with phagocytosis by non-macrophage cells has not been previously well defined. We present a case of lenalidomide-associated HLH with concurrent plasma cell hemophagocytosis in a patient with controlled multiple myeloma (MM).