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2.
Pediatrics ; 145(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31862732

RESUMO

BACKGROUND: The belief that late-preterm infants have similar cardiorespiratory maturity to term infants has led many institutions to limit car seat tolerance screens (CSTSs) to those born early preterm. The objective of this study was to evaluate the incidence and predictors of CSTS failure, focusing on late-preterm infants. METHODS: We performed a retrospective review of late-preterm infants born from 2013 to 2017 to identify the incidence and predictors of CSTS failure, focusing on location of admission. We performed multivariable linear regression to assess the effect of CSTS results on length of stay (LOS). RESULTS: We identified 918 subjects who underwent CSTSs, of whom 4.6% failed. Those infants who were admitted to both the NICU and nursery before discharge had the highest failure rate (8.5%). Of those who failed, 24% failed ≥2 CSTSs. Of these, 20% (all from the nursery) were found to have obstructive apnea and desaturations, and a total of 40% required supplemental oxygen for safe discharge from the hospital. Although crude LOS was longer for those who failed an initial CSTS, when accounting for location of admission, level of prematurity, and respiratory support requirements, the CSTS result was not a significant predictor of longer LOS. CONCLUSIONS: A concerning number of late-preterm infants demonstrated unstable respiratory status when placed in their car seat. Those who failed repeat CSTSs frequently had underlying respiratory morbidities that required escalation of care. Although further study is warranted, LOS was not associated with CSTS results but rather with the cardiorespiratory immaturity noted or discovered by performing a CSTS.


Assuntos
Sistemas de Proteção para Crianças/efeitos adversos , Recém-Nascido Prematuro , Monitorização Fisiológica , Apneia/etiologia , Bradicardia/etiologia , Segurança de Equipamentos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/fisiopatologia , Masculino , Programas de Rastreamento/métodos , Oxigênio/sangue , Alta do Paciente , Doenças Respiratórias/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
3.
J Vet Emerg Crit Care (San Antonio) ; 30(1): 74-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31883205

RESUMO

OBJECTIVE: To describe the treatment and clinical course of a dog accidentally prescribed 10 times the recommended dose of colchicine (0.3 mg/kg/d instead of 0.03 mg/kg/d). CASE SUMMARY: After glaucoma surgery, a 1-year-old male neutered Pomeranian weighing 6.8 kg was prescribed 1,000 µg colchicine twice a day per os. The dog presented to the emergency department after the first dose with vomiting and was treated as an outpatient. Two colchicine doses later, the dog represented with vomiting, ocular pain, and increased intraocular pressure. The dog's vital signs were normal, and the dog was admitted for rehydration, analgesia, and revision glaucoma surgery the next day. Two hours after revision surgery, the dog developed vomiting and diarrhea. Postoperatively, the dog was hypothermic (36.3°C), persistently hypertensive (227 mm Hg), and bradycardic (60/min). Biochemistry revealed metabolic acidosis and increased hepatic enzyme activities. Mannitol was administered for presumed cerebral edema. Later, the dog developed bradycardia due to second-degree atrioventricular heart block, which responded to atropine. Total hospitalization was 9 days. Treatment included IV fluids, IV lipid emulsion, N-acetylcysteine, activated charcoal, gastroprotectants, antiemetics, opioids, antimicrobials, and barrier nursing due to transient neutropenia. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report to describe the successful treatment of a dog with colchicine overdose. The systemic effects were presumed to be secondary to colchicine toxicosis rather than diet, infection, or other drug reaction, and may have been compounded by a second anesthetic episode. Gastrointestinal signs, symptoms of cerebral edema, cardiac arrhythmias, and neutropenia were documented. One other report of colchicine overdose in a dog exists, and that patient was euthanized. This report demonstrates that complete recovery with intensive care is possible; however, the prognosis remains guarded.


Assuntos
Colchicina/envenenamento , Doenças do Cão/diagnóstico , Animais , Bradicardia/etiologia , Bradicardia/veterinária , Carvão Vegetal/uso terapêutico , Cuidados Críticos , Diarreia/etiologia , Diarreia/veterinária , Doenças do Cão/sangue , Doenças do Cão/terapia , Cães , Overdose de Drogas/complicações , Overdose de Drogas/veterinária , Hidratação/veterinária , Glaucoma/cirurgia , Glaucoma/veterinária , Masculino , Complicações Pós-Operatórias/veterinária , Vômito/etiologia , Vômito/veterinária
5.
Int Heart J ; 60(5): 1222-1225, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484879

RESUMO

Bradycardia is a common complication at the early postoperative period after heart transplantation (HT). The heart rate (HR) usually recovers within a few weeks; however, several patients need a temporary pacemaker or chronotropic agents to stabilize their hemodynamics. Here, we report the first case of transient bradycardia associated with hemodynamic deterioration following HT, which was successfully treated with cilostazol, a phosphodiesterase-3-inhibiting agent. A 59-year-old man received HT for advanced heart failure due to ischemic cardiomyopathy. General fatigue persisted even after the HT. His HR was around 60 beats per minute (bpm) with sinus rhythm. Echocardiography showed no abnormal findings. Right heart catheterization showed that the cardiac index (CI) was 1.9 L/minute/m2. Continuous intravenous infusion of isoproterenol (0.003 µg/kg/minute) increased the HR to 80 bpm and CI to 2.7 L/minute/m2 and improved his symptoms. Isoproterenol was switched to oral administration of cilostazol (100 mg, twice a day), which maintained the HR at around 80 bpm and CI of 2.5 L/minute/m2. The patient's HR gradually recovered and cilostazol could be discontinued three months after the HT. Oral administration of cilostazol can be a therapeutic option for patients with sinus bradycardia following HT, who need positive chronotropic support.


Assuntos
Bradicardia/tratamento farmacológico , Cilostazol/uso terapêutico , Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Bradicardia/diagnóstico por imagem , Bradicardia/etiologia , Débito Cardíaco/efeitos dos fármacos , Eletrocardiografia/métodos , Seguimentos , Insuficiência Cardíaca/diagnóstico , Transplante de Coração/métodos , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Radiografia Torácica/métodos , Fatores de Tempo , Resultado do Tratamento
7.
Am J Case Rep ; 20: 1356-1359, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31515465

RESUMO

BACKGROUND It is still challenging to remove an epidural catheter in a postoperative patient receiving urgent antiplatelet and anticoagulation therapy for acute coronary syndrome. CASE REPORT While under general anesthesia combined with thoracic epidural anesthesia, a 72-year-old male patient underwent right radical nephrectomy for renal cell carcinoma. On postoperative day 1 (POD1), the patient experienced bradycardia and a decrease in blood pressure, and he was diagnosed acute myocardial infarction. Intra-aortic balloon pumping (IABP) was induced for cardiogenic shock, and urgent thrombus aspiration and coronary balloon angioplasty were performed. On POD3, the surgeon removed the epidural catheter under both antiplatelet and anticoagulation therapy. At that time, the platelet count was 45×109/L and the activated partial thromboplastin time (APTT) was 72.2 seconds. Four hours after the epidural catheter was removed, the patient complained of bilateral fatigue in legs and developed a loss of sensation. Six hours after the epidural catheter was removed, he developed motor paralysis and became completely paralyzed in both limbs after 9 hours. At 19 hours after the epidural catheter was removed, emergency magnetic resonance imaging detected a spinal epidural hematoma at the level of Th9-11 with compression of the spinal cord. Emergency laminectomy was performed to decompress and remove the spinal epidural hematoma at 18 hours after the onset of sensorimotor symptoms. After surgery and rehabilitation, these symptoms had only slightly improved. CONCLUSIONS In patients with urgent antithrombotic therapy for urgent percutaneous coronary intervention (PCI) with an IABP for acute coronary syndrome, the epidural catheter should not be removed until the IABP and heparin are discontinued, and platelet counts have recovered.


Assuntos
Anestesia Epidural/efeitos adversos , Angioplastia Coronária com Balão , Anticoagulantes/efeitos adversos , Hematoma Epidural Espinal/etiologia , Balão Intra-Aórtico , Infarto do Miocárdio/terapia , Idoso , Anestesia Geral , Anticoagulantes/administração & dosagem , Bradicardia/etiologia , Bradicardia/terapia , Trombose Coronária/terapia , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/terapia , Humanos , Laminectomia , Imagem por Ressonância Magnética , Masculino , Infarto do Miocárdio/etiologia , Paralisia/etiologia , Paralisia/terapia , Complicações Pós-Operatórias , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Trombectomia
8.
J Stroke Cerebrovasc Dis ; 28(11): 104308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416760

RESUMO

Stroke involving some areas of the cerebral hemisphere, such as insula, amygdala, and lateral hypothalamus, may cause changes in autonomic control of cardiac function. A 58-year-old woman presented to the emergency department for acute onset of left facial-brachial-crural hemiparesis and dysarthria. A brain CT scan showed subacute ischemic lesion with hemorrhagic infarction in right insular-rolandic cortex. Over the next few days ECG showed severe bradycardia with elongation of QTc, significative pauses (5 seconds), runs of nonsustained ventricular tachycardia and torsades de pointes. Drug induced and other several possible causes of elongation of QT and bradycardia such as hypokalemia, a history of heart failure, and structural heart disease were ruled out. The case confirms that insular cortex plays a major role in stroke-induced cardiovascular changes.


Assuntos
Córtex Cerebral/irrigação sanguínea , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Síndrome do QT Longo/etiologia , Acidente Vascular Cerebral/complicações , Torsades de Pointes/etiologia , Potenciais de Ação , Bradicardia/etiologia , Bradicardia/fisiopatologia , Estimulação Cardíaca Artificial , Córtex Cerebral/diagnóstico por imagem , Feminino , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Síndrome do QT Longo/terapia , Pessoa de Meia-Idade , Marca-Passo Artificial , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia , Torsades de Pointes/terapia , Resultado do Tratamento
9.
A A Pract ; 13(7): 281-283, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31385818

RESUMO

Postsurgical trigeminal neuralgia (TN), although rare, can lead to significant hemodynamic perturbations by triggering the trigeminocardiac reflex (TCR). The combination can lead to diagnostic as well as management challenges for clinicians. We present the case of a patient with a parotid abscess, which developed as a complication of his otolaryngologic surgery, and which led to repeated episodes of symptomatic bradycardia associated with cardiovascular collapse. This case highlights the importance of heightened awareness, early diagnosis, and timely treatment of postsurgical neuropathic pain syndromes to avoid life-threatening complications.


Assuntos
Bradicardia/etiologia , Neuralgia do Trigêmeo/diagnóstico , Abscesso/cirurgia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Parotídeas/cirurgia , Complicações Pós-Operatórias , Reflexo Trigêmino-Cardíaco , Neuralgia do Trigêmeo/etiologia
10.
Am J Case Rep ; 20: 1279-1283, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31467262

RESUMO

BACKGROUND Flecainide is a class Ic antiarrhythmic agent used in the treatment of supraventricular and ventricular arrhythmias. It is associated with a potent adverse effect profile; however, the effects of flecainide toxicity in the setting of a pacemaker have not been well described. We describe a unique case of flecainide toxicity secondary to acute kidney injury in the setting of a dual-chamber pacemaker, resulting in ventricular capture latency and intermittent failure to capture. CASE REPORT The patient was a 91-year-old female with a history of atrial fibrillation maintained in sinus rhythm on flecainide, who presented complaining of purple visual disturbances and syncope. She was found to be hypotensive and bradycardic, with a heart rate between 30 to 40 beats per minute. Lab work was notable for creatinine at 2.12 mg/dL. A 12-lead ECG demonstrated atrial and ventricular pacing with severely widened QRS complex and a significant latency between the pacemaker ventricular spike and the ventricular capture. The pacemaker was interrogated, revealing a significant increase in ventricular threshold from 0.75 V at 0.5 ms at baseline to 5.0 V at 1 ms to obtain consistent capture. After multiple boluses of IV sodium bicarbonate, the QRS acutely narrowed, latency interval improved, and consistent pacing capture was achieved. The flecainide level drawn on arrival was 3.09 mcg/mL. CONCLUSIONS Flecainide increases the ventricular capture threshold for pacemakers. Toxicity in these patients may present with pacemaker ventricular capture latency or failure to capture.


Assuntos
Antiarrítmicos/efeitos adversos , Bradicardia/etiologia , Flecainida/efeitos adversos , Marca-Passo Artificial , Lesão Renal Aguda/complicações , Idoso de 80 Anos ou mais , Fibrilação Atrial/tratamento farmacológico , Eletrocardiografia , Feminino , Humanos , Hipotensão/etiologia
11.
Med Hypotheses ; 131: 109296, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443773

RESUMO

BACKGROUND: Among the most common autonomic signs visible in preterm neonates, apnea can represent the first sign of several neurologic and non-neurologic disorders, and seizure is a relatively infrequent cause. Herein authors present a case of neonatal autonomic apnea, discussing the polygraphic video-EEG features of this pathological entity and the differential diagnosis with central apnea and autonomic apnea. CASE REPORT: A female preterm Caucasian infant (29 + 4 weeks' gestational age (GA)), first twin of a twin pregnancy, at birth was intubated and surfactant administration was performed. She was ventilated via invasive ventilation for three days, with subsequent weaning with non-invasive ventilation for other two days, when she stopped requiring any ventilator support. After one week the ventilation weaning, the child presented episodes of cyanosis associated with sudden oxygen desaturation, skin pallor, apnea, and bradycardia. Therefore, the child underwent a continuous video-eeg recording with polygraphic study. The exam showed the presence of apneic episodes with an abrupt and clear start, associated with oxygen desaturation at 70%, with minimal thoracic effort at onset, and then evolving into central apnea. Central apnea lasted about 16 s and presented clear start- and end-points. These episodes were also associated with suppression of the EEG trace in frequency and amplitude, and after about 10 s of central apnea an abrupt decrease of the child's heart rate (more than 50% variation, from 160 bpm to 65 bpm) was recorded. In the suspect of epileptic apneas of autonomic origin, a therapy with oral Levetiracetam, at a starting dose of 10 mg/Kg/day, then increased up to 40 mg/Kg/day, was initiated, and after about 48 h the first administration of the anticonvulsant therapy, no new episodes of cyanosis or electrical apneas were recorded. HYPOTHESIS: Herein the authors suggest to consider the diagnosis of autonomic seizures in those neonates with apneic events associated with EEG suppression. Considering that apnea events are not only present in preterm infants but also in term neonates, it is mandatory to diagnose in this context neonatal seizures for a correct diagnosis and a proper therapeutic choice.


Assuntos
Apneia/diagnóstico , Doenças do Sistema Nervoso Autônomo/diagnóstico , Eletroencefalografia , Hipóxia/etiologia , Doenças do Prematuro/diagnóstico , Anticonvulsivantes/uso terapêutico , Apneia/classificação , Apneia/complicações , Apneia/fisiopatologia , Doenças do Sistema Nervoso Autônomo/complicações , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Bradicardia/etiologia , Bradicardia/fisiopatologia , Cianose , Diagnóstico Diferencial , Doenças em Gêmeos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Levetiracetam/uso terapêutico , Convulsões/diagnóstico , Apneia do Sono Tipo Central/diagnóstico , Apneia do Sono Tipo Central/etiologia , Apneia do Sono Tipo Central/fisiopatologia , Gravação em Vídeo
12.
Am J Case Rep ; 20: 1071-1074, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31327866

RESUMO

BACKGROUND Empty sella syndrome (ESS) occurs when the pituitary gland becomes flattened or shrinks, which leads to filling of the sella turcica with cerebrospinal fluid. This causes the appearance of empty sella on imaging. ESS is often diagnosed after the workup of pituitary disorders, or as an incidental finding after brain imaging. To the best of our knowledge, this is the first case report in which ESS was diagnosed after an incidental finding of bradycardia pre-operatively. CASE REPORT We present the case of a 66-year-old man who was admitted electively to undergo a transforaminal lumbar interbody fusion at the level of L5-S1. He was found to be bradycardic pre-operatively. Upon further workup, he was found to have a thyroid-stimulating hormone (TSH) level of 0.358 uIU/ML (normal range, 0.465-4.680 uIU/ML) and a free thyroxine (FT4) level of 0.8 ng/dL (normal range, 0.8-2.2ng/dL). He also had a history of hypotestosteronemia. He was diagnosed with central hypothyroidism at the time of admission. Subsequently, a magnetic resonance imaging (MRI) scan of the brain was performed, and partial empty sella syndrome was diagnosed. CONCLUSIONS Bradycardia in the setting of empty sella syndrome is a rare condition. It is of utmost importance for clinicians to keep in mind a wide differential that includes other non-cardiac causes for common cardiac symptoms such as bradycardia.


Assuntos
Bradicardia/etiologia , Síndrome da Sela Vazia/complicações , Síndrome da Sela Vazia/diagnóstico , Idoso , Humanos , Masculino
13.
Emerg Med J ; 36(9): 520-528, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31320332

RESUMO

BACKGROUND: Intubation is an essential, life-saving skill but associated with a high risk for adverse outcomes. Intubation protocols have been implemented to increase success and reduce complications, but the impact of protocol conformance is not known. Our study aimed to determine association between conformance with an intubation process model and outcomes. METHODS: An interdisciplinary expert panel developed a process model of tasks and sequencing deemed necessary for successful intubation. The model was then retrospectively used to review videos of intubations from 1 February, 2014, to 31 January, 2016, in a paediatric emergency department at a time when no process model or protocol was in existence. RESULTS: We evaluated 113 patients, 77 (68%) were successfully intubated on first attempt. Model conformance was associated with a higher likelihood of first attempt success when using direct laryngoscopy (OR 1.09, 95% CI 1.01 to 1.18). The use of video laryngoscopy was associated with an overall higher likelihood of success on first attempt (OR 2.54, 95% CI 1.10 to 5.88). Thirty-seven patients (33%) experienced adverse events. Model conformance was the only factor associated with a lower odds of adverse events (OR 0.94, 95% CI 0.88 to 0.99). CONCLUSIONS: Conformance with a task-based expert-derived process model for emergency intubation was associated with a higher rate of success on first intubation attempt when using direct laryngoscopy and a lower odds of associated adverse events. Further evaluation of the impact of human factors, such as teamwork and decision-making, on intubation process conformance and success and outcomes is needed.


Assuntos
Protocolos Clínicos/normas , Estado Terminal/terapia , Intubação Intratraqueal/normas , Guias de Prática Clínica como Assunto , Ressuscitação/normas , Adolescente , Bradicardia/epidemiologia , Bradicardia/etiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Hipóxia/epidemiologia , Hipóxia/etiologia , Lactente , Recém-Nascido , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Laringoscópios/efeitos adversos , Masculino , Ressuscitação/efeitos adversos , Ressuscitação/instrumentação , Estudos Retrospectivos , Gravação em Vídeo , Adulto Jovem
14.
Medicine (Baltimore) ; 98(28): e16282, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305411

RESUMO

RATIONALE: Pain management is an essential part of good obstetrical care. The rapid onset of pain relief after combined spinal-epidural (CSE) analgesia may cause a transient imbalance in maternal catecholamine level, leading to uterine hyperactivity and fetal heart rate (FHR) abnormalities. How to manage the uterine basal tone and FHR abnormalities after labor analgesia still remains controversial. PATIENT CONCERNS: A 33-year-old nulliparous woman at 40 weeks' gestation underwent induction of labor after premature rupture of membranes. CSE analgesia was provided when the patient described her pain as the top on a scale of 10 during induction of labor with oxytocin infusion. DIAGNOSES: Uterine hypertonus and fetal bradycardia were diagnosed within 10 minutes after CSE analgesia. INTERVENTIONS: Oxytocin infusion and CSE analgesia were immediately suspended, and measures of staying in left lateral decubitus position and giving supplemental oxygen were attempted to resuscitating the baby. Because of suspicious fetal distress, the baby was rapidly delivered by emergency cesarean section. OUTCOMES: The Apgar score of the baby was 8 and 10 at 1 and 5 minutes after birth. Subsequent follow-up confirmed that both mother and baby were in good condition. LESSONS: The loss of the tocolytic effect of epinephrine after CSE analgesia and continuous oxytocin infusion may work together to form a totally synergistic function, finally leading to inevitable uterine hypertonus and fetal bradycardia. Both the obstetrical provider and anesthesiologist should carefully monitor all patients in the first 15 minutes after CES analgesia induction. Oxytocin administration in this critical period deserves attention. Additionally, intraprofessional collaboration is also necessary to ensure high quality and safe delivery for all childbearing women.


Assuntos
Analgesia Obstétrica , Bradicardia/etiologia , Doenças Fetais/etiologia , Trabalho de Parto Induzido , Hipertonia Muscular/etiologia , Doenças Uterinas/etiologia , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Feminino , Humanos , Recém-Nascido , Ocitócicos , Ocitocina
15.
Medicine (Baltimore) ; 98(24): e15904, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192924

RESUMO

RATIONALE: Classic laryngeal mask airway (LMA) has long been used for airway management. The LMA Supreme is a modified single-use version of the LMA Proseal, but it still remains some deficits such as the instable positioning that lead to easily sliding and the mask bowl full of air might lead to the reduced blood flow of the internal carotid artery. The carotid sinus is a baroreceptor that responds to the stretching of the arterial wall. Manual pressure of the carotid artery at the upper margin of the sternocleidomastoid muscle provoked bradycardia and hypotension. PATIENT CONCERNS: A previously fit and well 42-year-old woman presented with breast fibroma on the left side. No other disease history could be recorded. Her family history was negative for neuromuscular and autoimmune disease. DIAGNOSES: The patient suffered from a severe bradycardia and hypotension when the LMA showed a shift. We presented with a hypothetical that the dislocated LMA may cause carotid sinus syndrome (CSS). INTERVENTIONS: The patient's heart rate (HR) gradually rosed up as soon as the LMA adjusted back to the normal position. OUTCOMES: The patient was comfortable in the post anesthesia care unit (PACU) and had no adverse sequelae. LESSONS: The position of LMA Supreme should be confirmed throughout the surgery especially for the ones who has changed the position and the head was covered by surgical drapes.


Assuntos
Bradicardia/etiologia , Estenose das Carótidas/etiologia , Hipotensão/etiologia , Máscaras Laríngeas/efeitos adversos , Adulto , Feminino , Humanos
16.
BMJ Case Rep ; 12(5)2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31151977

RESUMO

Ciguatera is a common but underreported tropical disease caused by the consumption of coral reef fish contaminated by ciguatoxins. Gastrointestinal and neurological symptoms predominate, but may be accompanied by cardiovascular features such as hypotension and sinus bradycardia. Here, we report an unusual case of junctional bradycardia caused by ciguatera in the Caribbean; to our knowledge, the first such report from the region. An increase in global sea temperatures is predicted to lead to the spread of ciguatera beyond traditional endemic areas, and the globalisation of trade in coral reef fish has resulted in sporadic cases occurring in developed countries far away from endemic areas. This case serves as a reminder to consider environmental intoxications such as ciguatera within the differential diagnosis of bradycardias.


Assuntos
Bradicardia/etiologia , Intoxicação por Ciguatera/complicações , Animais , Bradicardia/terapia , Região do Caribe , Intoxicação por Ciguatera/terapia , Soluções Cristaloides/administração & dosagem , Diagnóstico Diferencial , Eletrocardiografia , Peixes , Humanos , Masculino , Pessoa de Meia-Idade , Potássio/administração & dosagem
17.
Am J Case Rep ; 20: 748-752, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31130721

RESUMO

BACKGROUND Acute pulmonary embolism (PE) is a common life-threatening cardiovascular emergency. The diagnosis of PE may be challenging, as there can be a wide range of atypical presentations. CASE REPORT A 92-year-old man with asymptomatic first-degree atrioventricular (AV) block, hypertension that was controlled on medication, and a past medical history of deep venous thrombosis (DVT), presented with dizziness, weakness, and collapse while getting dressed. On examination by the attending paramedics, he was noted to have sinus bradycardia at a rate of 18 bpm, which improved to 80 bpm after intravenous injection of atropine. An echocardiogram obtained in the emergency room (ER) showed a markedly dilated right ventricle (RV) with a hypokinetic RV free wall, preserved RV apical contractility, and septal wall motion abnormalities consistent with RV pressure overload. A ventilation/perfusion (V/Q) scan showed a massive PE involving more than 50% of the pulmonary vasculature. Urgent catheter-directed thrombolysis was performed, but the patient's condition deteriorated, and he died shortly afterward. CONCLUSIONS Sinus bradycardia is an unusual initial presentation of PE, but the diagnosis should be considered in patients with multiple risk factors for thromboembolism.


Assuntos
Bradicardia/etiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Doença Aguda , Idoso de 80 Anos ou mais , Bradicardia/diagnóstico , Bradicardia/terapia , Evolução Fatal , Humanos , Masculino , Embolia Pulmonar/terapia
18.
Am J Emerg Med ; 37(8): 1554-1561, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31060863

RESUMO

INTRODUCTION: Patients with acute myocardial infarction (AMI) may suffer several complications after the acute event, including dysrhythmias and heart failure (HF). These complications place patients at risk for morbidity and mortality. OBJECTIVE: This narrative review evaluates literature and guideline recommendations relevant to the acute emergency department (ED) management of AMI complicated by dysrhythmia or HF, with a focus on evidence-based considerations for ED interventions. DISCUSSION: Limited evidence exists for ED management of dysrhythmias in AMI due to relatively low prevalence and frequent exclusion of patients with active cardiac ischemia from clinical studies. Management decisions for bradycardia in the setting of AMI are determined by location of infarction, timing of the dysrhythmia, rhythm assessment, and hemodynamic status of the patient. Atrial fibrillation is common in the setting of AMI, and caution is warranted in acute rate control for rapid ventricular rate given the possibility of compensation for decreased ventricular function. Regular wide complex tachycardia in the setting of AMI should be managed as ventricular tachycardia with electrocardioversion in the majority of cases. Management directed towards HF from left ventricular dysfunction in AMI consists of noninvasive positive pressure ventilation, nitroglycerin therapy, and early cardiac catheterization. Norepinephrine is the first line vasopressor for patients with cardiogenic shock and hypoperfusion on clinical examination. Early involvement of a multi-disciplinary team is recommended when caring for patients in cardiogenic shock. CONCLUSIONS: This review discusses considerations of ED management of dysrhythmias and HF associated with AMI.


Assuntos
Fibrilação Atrial/terapia , Bradicardia/tratamento farmacológico , Bloqueio Cardíaco/terapia , Insuficiência Cardíaca/terapia , Infarto do Miocárdio/complicações , Taquicardia Ventricular/terapia , Fibrilação Atrial/etiologia , Bradicardia/etiologia , Medicina de Emergência , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/mortalidade , Insuficiência Cardíaca/etiologia , Humanos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Choque Cardiogênico/complicações , Taquicardia Ventricular/etiologia
19.
BMC Infect Dis ; 19(1): 428, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096922

RESUMO

BACKGROUND: Lyme disease (LD), is the most common vector-borne illness in the US and Europe, with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. LD affects all layers of the heart and every part of the conducting system. Carditis is a less common manifestation of LD. Heart block (HB) as the initial and sole manifestation of LD is rare. Inducible HB has never been reported in LD. We report a case of heart block (HB) inducible with exercise and reversible with rest. CASE PRESENTATION: A 37-year-old male presented to the emergency department after experiencing two episodes of syncope while at work. He presented, with a heart rate of 57 bpm, and the ECG showed sinus bradycardia with first degree AV block. The PR interval was 480 ms (NL 120-200 ms). Physical exam was unremarkable. The cardiologist's initial impression was vaso-vagal attack. He developed high degree AV block during a stress test for the initial work up, which resolved on cessation of exercise. A similar episode while walking in the hallway, resolved at rest. The high degree AV block appeared inducible with exercise and reversible with rest. His Lyme serology was strongly positive. He was treated with ceftriaxone and doxycycline. After completing treatment, the patient had a normal ECG and returned to work without limitations, doing manual labor. CONCLUSIONS: Manifestations of Lyme carditis (LC) vary from asymptomatic and symptomatic electrocardiographic changes and heart block (HB) reversible with treatment, to sudden death. HB as the sole and initial presentation of LC is rare. There have been no reports of inducible HB in LD. Here we present a case of inducible and reversible high degree HB in a case of LC and an update of literature. Exercise and stress testing should be avoided in suspected cases of LC until resolution of carditis. Lyme carditis should be suspected in individuals with cardiac manifestations in an endemic area, particularly in the younger patients with no other etiology evident.


Assuntos
Teste de Esforço/efeitos adversos , Bloqueio Cardíaco/etiologia , Doença de Lyme/complicações , Miocardite/etiologia , Adulto , Antibacterianos/uso terapêutico , Bradicardia/etiologia , Ceftriaxona/uso terapêutico , Morte Súbita , Doxiciclina/uso terapêutico , Exercício Físico/fisiologia , Frequência Cardíaca , Humanos , Doença de Lyme/tratamento farmacológico , Masculino
20.
J Int Med Res ; 47(5): 2309-2311, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30971152

RESUMO

Clinical doctors rarely associate hyperparathyroidism with significant bradyarrhythmia. We report a rare case of a patient initially misdiagnosed with primary sick sinus syndrome, which was eventually shown to be secondary to primary hyperparathyroidism.


Assuntos
Bradicardia/etiologia , Hiperparatireoidismo Primário/complicações , Bradicardia/sangue , Cálcio/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Pessoa de Meia-Idade , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/cirurgia
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