Subject(s)
Pulmonary Edema , Vasotocin , Humans , Tocolytic Agents , Vasotocin/analogs & derivativesSubject(s)
Pulmonary Edema , Tattooing , Tocolytic Agents , Adrenal Cortex Hormones , Female , Humans , Pregnancy , Risk Factors , TocolysisABSTRACT
Methemoglobinemia is a rare pathology that results from the oxidation of iron in the hemoglobin molecule. Oxidation of iron switches it from the ferrous to the ferric state, and impedes the ability of hemoglobin to carry oxygen. Hence, methemoglobinemia often results in hypoxemia. The disease can be hereditary or acquired, and its diagnosis can be challenging. This rare condition may often be missed by clinicians, since information on oxygen saturation provided by standard pulse oximeters is unreliable. We here present two cases of acquired methemoglobinemia. The first one is a 24-year old woman, who received dapsone as an alternative antibiotic therapy because of known allergies to a series of other antibiotics and who could not get weaned from mechanical ventilation despite minimal ventilator support. The second case describes a 49-year old man who developed respiratory insufficiency following the use of 'poppers' containing alkyl nitrites. Following treatment of both patients using the antidote methylene blue, they could be successfully weaned from mechanical ventilation.
Subject(s)
Methemoglobinemia/therapy , Anti-Infective Agents/adverse effects , Anti-Infective Agents/therapeutic use , Antidotes/therapeutic use , Dapsone/adverse effects , Dapsone/therapeutic use , Female , HIV Infections/complications , HIV-1 , Humans , Male , Methemoglobinemia/chemically induced , Methylene Blue/therapeutic use , Middle Aged , Nitrates , Oxygen/blood , Oxygen Inhalation Therapy , Pneumocystis carinii , Pneumonia, Pneumocystis/drug therapy , Respiration, Artificial , Respiratory Insufficiency/chemically induced , Respiratory Insufficiency/complications , Substance-Related Disorders/complications , Ventilator Weaning , Young AdultABSTRACT
Anticoagulation medications are frequently used for primary and secondary treatment of several thrombo-embolic disorders. An important side effect of all anticoagulants is hemorrhagic diathesis which necessitates acute treatment, ideally using medicinal therapy with an antidote. Much experience has been gained in treating bleeding while on traditional anticoagulants, such as heparins and vitamin K antagonists by the use of antagonists. A multitude of factor-specific anticoagulants have recently been introduced or will soon receive approval. With this new generation of anticoagulants no valid laboratory parameters or effective antagonists are presently available. Due to a lack of adequate studies regarding acute treatment this can at present only be carried out on a symptomatic basis.
Subject(s)
Anticoagulants/antagonists & inhibitors , Anticoagulants/therapeutic use , Antidotes/therapeutic use , Hemorrhage/chemically induced , Hemorrhage/therapy , Acute Disease , Anticoagulants/classification , Factor Xa Inhibitors , Heparin/adverse effects , Heparin/therapeutic use , Heparin Antagonists/therapeutic use , Humans , Polysaccharides/therapeutic use , Prothrombin/antagonists & inhibitors , Vitamin K/antagonists & inhibitorsABSTRACT
The difficult airway is the single most important cause of anaesthesia-related morbidity and mortality and most catastrophes are due to unexpected difficulty, which are more likely in emergencies. We report a difficult airway scenario in a patient with a high energetic trauma and used several techniques for the "can't intubate, can't ventilate scenario". Eventually, successful intubation was obtained with the video-assisted laryngoscope.
