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1.
Medicine (Baltimore) ; 98(45): e17940, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702683

RESUMO

Venous air embolism (VAE) can be observed in the right heart system on contrast-enhanced computed tomography (CT), following injection of contrast media with a power injector system. Although most VAEs are mostly asymptomatic, they may result in paradoxical air embolism (PAE).To evaluate whether the incidence of VAE on coronary CT angiography is associated with the process of preparation of the intravenous access route.We retrospectively evaluated 692 coronary CT examinations at 3 institutions. Trained CT nurses placed an intravenous cannula in the forearm. Tubes connected to the cannula were prepared in the following ways: A, using an interposed three-way cock and a 20-mL syringe filled with normal saline to collect air contamination in the tube; B, through direct connection to the power injector system without the interposed 3-way cock; and C, using an interposed three-way cock and a 100-mL normal saline drip infusion bottle system to keep the tube patent. The incidence and location of VAE and preparation of intravenous injection were assessed.The overall incidence of VAE was 55.3% (383/692), most frequently observed in the right atrium (81.5%, 312/383). Its incidence varied significantly across the 3 techniques (A: 21.6% (35/162), B: 63.2% (237/375) and C: 71.6% (111/155); P < .001). No patient demonstrated any symptom associated with VAE.Using a 3-way cock with syringe demonstrated the lowest incidence of VAE on coronary CT angiography. It is thus recommended to reduce potential complication risks related to intravenous contrast media injection.


Assuntos
Angiografia por Tomografia Computadorizada/efeitos adversos , Embolia Aérea/etiologia , Embolia Paradoxal/etiologia , Átrios do Coração/diagnóstico por imagem , Idoso , Meios de Contraste/administração & dosagem , Embolia Aérea/complicações , Embolia Aérea/epidemiologia , Embolia Paradoxal/epidemiologia , Humanos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
World Neurosurg ; 131: 38-42, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369880

RESUMO

BACKGROUND: Venous air embolism (VAE) is a rare but, frequently, fatal complication that can occur during surgery. Several reported studies have shown visible bubbling of air at the surgical site as the first clinical indication of VAE-induced cardiovascular collapse during prone-position spine surgery. However, to the best of our knowledge, video imaging of this phenomenon has not been previously reported. CASE DESCRIPTION: A 41-year-old man had undergone cervical laminoplasty for ossification of the posterior longitudinal ligament and thoracic laminectomy for ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum in the prone position. The entire surgery was recorded with video imaging. Before cardiac arrest due to the massive VAE, visible air bubbling had been observed at the operated site of the thoracic laminectomy, and this phenomenon had been incidentally recorded with the video. The patient recovered with cardiopulmonary resuscitation and intensive treatment against severe acute respiratory distress syndrome due to pulmonary damage. CONCLUSIONS: The present case report offers the first video imaging evidence of intraoperative visible air bubbling as a sign of a massive VAE during prone-position spine surgery. To the best of our knowledge, this is also the first report of intraoperative VAE in a patient with extensive ossification of the spinal ligaments.


Assuntos
Embolia Aérea/complicações , Parada Cardíaca/etiologia , Complicações Intraoperatórias , Ligamento Amarelo/cirurgia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Decúbito Ventral , Síndrome do Desconforto Respiratório do Adulto/etiologia , Adulto , Reanimação Cardiopulmonar , Vértebras Cervicais/cirurgia , Parada Cardíaca/terapia , Humanos , Masculino , Ossificação Heterotópica/cirurgia , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 97(39): e12639, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278587

RESUMO

RATIONALE: Although venous air embolism (VAE) during liver operation has been reported occasionally, fatal VAE in hepatic resection is uncommon. Prompt detection of VAE by transesophageal echocardiography (TEE) is crucial for effective therapy. We describe a case of fatal VAE that caused repeated cardiac arrest during hepatic resection and was confirmed by TEE. PATIENT CONCERNS: A 51-year-old woman with a body weight of 50 kg underwent partial liver resection due to intrahepatic duct calculus. She had a 1-year history of intrahepatic duct calculus without cardiopulmonary disease. The operation was performed under general anesthesia combined with epidural block. When the inferior vena cava was compressed, the PetCO2 level decreased abruptly from 30 to 10 mmHg, followed by a decrease in SpO2 and the development of hypotension. Her heart rate increased with ST interval elevation on electrocardiography monitoring. Ephedrine and phenylephrine were administered immediately but had little effect. Cardiac arrest occurred. DIAGNOSES: Air embolism was detected by TEE. INTERVENTIONS: Resuscitation was successful although cardiac arrest occurred repeatedly. OUTCOMES: The patient returned to consciousness 6 hours postoperatively but died of multiorgan dysfunction 10 days later. LESSONS: Fatal air embolism may happen during hepatic resection. Prompt detection of VAE by TEE is crucial for effective therapy and should always be available during hepatic resection.


Assuntos
Ductos Biliares Intra-Hepáticos/cirurgia , Colelitíase/cirurgia , Ecocardiografia Transesofagiana , Embolia Aérea/complicações , Embolia Aérea/diagnóstico por imagem , Parada Cardíaca/etiologia , Complicações Intraoperatórias , Fígado/cirurgia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva
8.
Ultrasound Q ; 34(4): 268-271, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30169490

RESUMO

Ultrasonography (US) is believed to be the most available method of detecting hepatic portal venous gas (HPVG) with real-time imaging capability. Hepatic portal venous gas has characteristic image appearances in various ultrasound modes such as bright mode, Doppler mode, and even motion (M) mode. In this article, we give a comprehensive review of the image appearances of HPVG among different modes of US with a special focus on the M mode US. Hepatic portal venous gas was recognized as linear echogenicities in various oblique directions (the meteor shower sign) on the M mode US. This specific sign may expand some potential of HPVG detection by US.


Assuntos
Embolia Aérea/diagnóstico por imagem , Isquemia/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Ultrassonografia/métodos , Embolia Aérea/complicações , Humanos , Isquemia/etiologia , Fatores de Risco
9.
Ther Hypothermia Temp Manag ; 8(3): 176-180, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30016198

RESUMO

Cerebral arterial gas embolism (CAGE) shows various manifestations according to the quantity of gas and the brain areas affected. The symptoms range from minor motor weakness, headache, and confusion to disorientation, convulsions, hemiparesis, unconsciousness, and coma. A 46-year-old man was transferred to our emergency department due to altered sensorium. Immediately after a controlled ascent from 33 m of seawater, he complained of shortness of breath and rigid extremities, lapsing into unconsciousness. He was intubated at another medical center, where a brain computerized axial tomography scan showed no definitive abnormal findings. Pneumothorax and obstructing lesions were apparent in the left thorax of the computed tomography scan. Following closed thoracostomy, we provided hyperbaric oxygen therapy (HBOT) using U.S. Navy Treatment Table (USN TT) 6A. A brain magnetic resonance imaging diffusion image taken after HBOT showed acute infarction in both middle and posterior cerebral arteries. We implemented targeted temperature management (TTM) to prevent worsening of cerebral function in the intensive care unit. After completing TTM, we repeated HBOT using USN TT5 and started rehabilitation therapy. He fully recovered from the neurological deficits. This is the first case of CAGE treated with TTM and consecutive HBOTs suggesting that TTM might facilitate salvage of the penumbra in severe CAGE.


Assuntos
Infarto Cerebral/terapia , Doença da Descompressão/complicações , Mergulho/efeitos adversos , Embolia Aérea/complicações , Hipotermia Induzida , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Doença da Descompressão/diagnóstico por imagem , Doença da Descompressão/terapia , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/terapia , Humanos , Oxigenação Hiperbárica , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Tomografia Computadorizada de Emissão de Fóton Único
11.
J Comput Assist Tomogr ; 42(5): 767-770, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29613995

RESUMO

Perforation of a peptic ulcer into the ventricle is uncommon, and the definitive diagnosis is difficult in living patients. We herein report a case of perforation of a peptic ulcer in a hiatal hernia into the left ventricle with systemic air and food embolism. This is the first case report of the perforation diagnosed by computed tomography and confirmed by autopsy. Computed tomography was useful for the diagnosis of perforation into the ventricle.


Assuntos
Embolia/complicações , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/lesões , Hérnia Hiatal/complicações , Úlcera Péptica/complicações , Perfuração Espontânea/complicações , Idoso , Autopsia , Embolia/diagnóstico por imagem , Embolia Aérea/complicações , Embolia Aérea/diagnóstico por imagem , Evolução Fatal , Feminino , Alimentos , Hérnia Hiatal/diagnóstico por imagem , Humanos , Úlcera Péptica/diagnóstico por imagem , Perfuração Espontânea/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
12.
J Vet Intern Med ; 32(2): 805-814, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29460300

RESUMO

BACKGROUND: Venous air embolism is a potentially life-threatening complication of IV catheter use in horses. Despite widespread anecdotal reports of their occurrence, few cases have been reported in the literature and the prognosis is currently unknown. HYPOTHESIS/OBJECTIVES: Our objective was to describe the surrounding circumstances, clinical signs, treatment, progression, and outcome of venous air embolism in hospitalized horses. ANIMALS: Thirty-two horses with acute onset of compatible clinical signs associated with IV catheter disconnection or damage. METHODS: Multicenter retrospective study. Data extracted from clinical records included signalment, presenting complaint, catheter details, clinical signs, treatments, and outcome. RESULTS: Most cases resulted from extension set disconnection occurring within approximately 24 hours after catheter placement. In fewer horses, extension set damage was cited as a cause. Common clinical signs included tachycardia, tachypnea, recumbency, muscle fasciculations and agitation, with abnormal behavior including kicking and flank biting. Less commonly, pathological arrhythmias or more severe neurologic signs, including blindness and seizures, were noted. Progression was unpredictable, with some affected horses developing delayed-onset neurologic signs. Mortality was 6/32 (19%), including 2 cases of sudden death and other horses euthanized because of persistent neurologic deficits. Negative outcomes were more common in horses with recorded blindness, sweating or recumbency, but blindness resolved in 5/8 affected horses. CONCLUSIONS AND CLINICAL IMPORTANCE: The prognosis for resolution of clinical signs after air embolism is fair, but permanent neurologic deficits or pathologic cardiac arrhythmias can arise. Unpredictable progression warrants close monitoring. Systematic clinic-based surveillance could provide additional useful information to aid prevention.


Assuntos
Embolia Aérea/veterinária , Doenças dos Cavalos/etiologia , Dispositivos de Acesso Vascular/veterinária , Animais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/veterinária , Cegueira/complicações , Cegueira/veterinária , Embolia Aérea/complicações , Embolia Aérea/etiologia , Embolia Aérea/mortalidade , Doenças dos Cavalos/mortalidade , Cavalos , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/veterinária , Estudos Retrospectivos , Convulsões/complicações , Convulsões/veterinária , Dispositivos de Acesso Vascular/efeitos adversos
13.
Br J Hosp Med (Lond) ; 79(2): 87-92, 2018 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-29431502

RESUMO

Mesenteric ischaemia is relatively uncommon, but is an important diagnosis to remember as it can lead to significant morbidity and mortality. Improvements in clinical imaging technology have made rapid diagnosis and treatment possible, but this relies on awareness of the condition. This article summarizes current best practice in diagnosis and management of mesenteric ischaemia to guide the clinician.


Assuntos
Isquemia Mesentérica/diagnóstico , Aterosclerose/complicações , Aterosclerose/diagnóstico , Colite/complicações , Colite/diagnóstico , Diagnóstico por Imagem , Embolia Aérea/complicações , Embolia Aérea/diagnóstico , Humanos , Anamnese/métodos , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/terapia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/diagnóstico , Exame Físico/métodos , Pneumatose Cistoide Intestinal/complicações , Pneumatose Cistoide Intestinal/diagnóstico , Padrões de Prática Médica , Trombose/diagnóstico , Trombose/etiologia , Trombose/terapia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Trombose Venosa/terapia
14.
J Neurosurg ; 128(5): 1553-1559, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28574314

RESUMO

OBJECTIVE Surgical simulation has the potential to supplement and enhance traditional resident training. However, the high cost of equipment and limited number of available scenarios have inhibited wider integration of simulation in neurosurgical education. In this study the authors provide initial validation of a novel, low-cost simulation platform that recreates the stress of surgery using a combination of hands-on, model-based, and computer elements. Trainee skill was quantified using multiple time and performance measures. The simulation was initially validated using trainees at the start of their intern year. METHODS The simulation recreates intraoperative superior sagittal sinus injury complicated by air embolism. The simulator model consists of 2 components: a reusable base and a disposable craniotomy pack. The simulator software is flexible and modular to allow adjustments in difficulty or the creation of entirely new clinical scenarios. The reusable simulator base incorporates a powerful microcomputer and multiple sensors and actuators to provide continuous feedback to the software controller, which in turn adjusts both the screen output and physical elements of the model. The disposable craniotomy pack incorporates 3D-printed sections of model skull and brain, as well as artificial dura that incorporates a model sagittal sinus. RESULTS Twelve participants at the 2015 Western Region Society of Neurological Surgeons postgraduate year 1 resident course ("boot camp") provided informed consent and enrolled in a study testing the prototype device. Each trainee was required to successfully create a bilateral parasagittal craniotomy, repair a dural sinus tear, and recognize and correct an air embolus. Participant stress was measured using a heart rate wrist monitor. After participation, each resident completed a 13-question categorical survey. CONCLUSIONS All trainee participants experienced tachycardia during the simulation, although the point in the simulation at which they experienced tachycardia varied. Survey results indicated that participants agreed the simulation was realistic, created stress, and was a useful tool in training neurosurgical residents. This simulator represents a novel, low-cost approach for hands-on training that effectively teaches and tests residents without risk of patient injury.


Assuntos
Simulação por Computador , Embolia Aérea/complicações , Modelos Anatômicos , Neurocirurgia/educação , Procedimentos Neurocirúrgicos/educação , Seio Sagital Superior/lesões , Perda Sanguínea Cirúrgica , Competência Clínica , Craniotomia/instrumentação , Embolia Aérea/cirurgia , Serviços Médicos de Emergência , Frequência Cardíaca , Humanos , Internato e Residência , Microcomputadores , Neurocirurgiões/economia , Neurocirurgiões/educação , Neurocirurgia/economia , Procedimentos Neurocirúrgicos/economia , Procedimentos Neurocirúrgicos/instrumentação , Estresse Ocupacional , Impressão Tridimensional , Software , Seio Sagital Superior/cirurgia
16.
MedEdPORTAL ; 14: 10788, 2018 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-30800988

RESUMO

Introduction: Arterial gas embolism (AGE) is a rare but severe complication of scuba diving. While AGE is most commonly encountered in coastal areas with high volumes of recreational divers, at-risk populations exist throughout the United States, making basic knowledge of the disease important for all emergency medicine (EM) physicians. Methods: We used a hypothetical simulation case to train EM residents on diagnosis and management of AGE. A 32-year-old male presented with shortness of breath and unilateral neurologic deficits immediately after scuba diving. Residents were challenged to emergently diagnose and treat tension pneumothorax followed by diagnosis and treatment of AGE. A resident, attending, and simulation technician ran the case for four separate simulation teams in the simulation center with the addition of chest tube supplies to the basic resuscitation bay setup. Teams were allowed to use the internet in real time as a reference tool. Results: Most teams arrived at the correct diagnosis using real-time internet searches, but none found the Divers Alert Network Emergency Hotline. Learners were debriefed both immediately and in a formal lecture. A follow-up survey showed good retention of knowledge. Discussion: This case fills a significant knowledge and training gap for many EM physicians. AGE is a rare but highly morbid complication of diving, and EM residents should have knowledge of the disease and available consultation resources. Most EM residents will not have the opportunity to treat a diver during training, and the simulation environment provides a means to teach and practice this skill set.


Assuntos
Barotrauma/complicações , Embolia Aérea/complicações , Adulto , Artérias/anormalidades , Barotrauma/diagnóstico , Mergulho/efeitos adversos , Embolia Aérea/diagnóstico , Medicina de Emergência/educação , Humanos , Oxigenação Hiperbárica/métodos , Internato e Residência/métodos , Masculino , Oxigênio/uso terapêutico , Fatores de Risco , Treinamento por Simulação/métodos , Inquéritos e Questionários
17.
BMC Res Notes ; 10(1): 599, 2017 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-29145881

RESUMO

BACKGROUND: Cerebral air embolism is a rare cause of cerebral infarction. In cerebral air embolism, T2 star-weighted imaging shows numerous spotty hypointense signals. Previous reports have suggested that these signals represent air in the brain and are gradually diminished and absorbed. We experienced two cases of cerebral air embolism, and in one of them, we conducted an autopsy. CASE PRESENTATION: Case 1 was a 76-year-old Japanese man with lung cancer and emphysema. A spasmodic cough induced massive cerebral and cardiac air embolisms and the patient died because of cerebral herniation. T2 star-weighted imaging of brain magnetic resonance imaging showed multiple spotty low signals. Brain autopsy showed numerous spotty hemorrhagic infarcts in the area of T2 star-weighted imaging signals. Case 2 was an 85-year-old Japanese man with emphysema who suffered from acute stroke. Similar spotty T2 star-weighted imaging signals were observed and remained unchanged 2 months after the onset. CONCLUSIONS: These findings indicate that T2 star-weighted imaging in cerebral air embolism partially represents micro-hemorrhagic infarction caused by air bubbles that have migrated into the brain.


Assuntos
Infarto Cerebral/etiologia , Embolia Aérea/complicações , Embolia Intracraniana/complicações , Hemorragias Intracranianas/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Autopsia , Encéfalo/patologia , Infarto Cerebral/patologia , Enfisema/complicações , Humanos , Hemorragias Intracranianas/patologia , Neoplasias Pulmonares/complicações , Imagem por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/patologia
19.
Diving Hyperb Med ; 47(2): 75-81, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28641319

RESUMO

INTRODUCTION: Important developments in the diagnosis of scuba diving fatalities have been made thanks to forensic imaging tool improvements. Multi-detector computed tomography (MDCT) permits reliable interpretation of the overall gaseous distribution in the cadaver. However, due to post-mortem delay, the radiological interpretation is often doubtful because the distinction between gas related to the dive and post-mortem decomposition artifactual gases becomes less obvious. METHODS: We present six cases of fatal scuba diving showing gas in the heart and other vasculature. Carbon dioxide (CO2) in cardiac gas measured by gas chromatography coupled to thermal conductivity detection were employed to distinguish decomposition from embolism based on the detection of decomposition gases (hydrogen, hydrogen sulfide and methane) and to confirm arterial gas embolism (AGE) or post-mortem offgasing diagnoses. A Radiological Alteration Index (RAI) was calculated from the scan. RESULTS: Based on the dive history, the intra-cadaveric gas was diagnosed as deriving from decomposition (one case, minimal RAI of 61), post-mortem decompression artifacts (two cases, intermediate RAI between 60 and 85) and barotrauma/AGE (three cases, maximal RAI between 85 and 100), illustrating a large distribution inside the bodies. CONCLUSION: MDCT scans should be interpreted simultaneously with compositional analysis of intra-cadaveric gases. Intra-cadaveric gas sampling and analysis may become useful tools for understanding and diagnosing scuba diving fatalities. In cases with short post-mortem delays, the CO2 concentration of the cardiac gas provides relevant information about the circumstances and cause of death when this parameter is interpreted in combination with the diving profile.


Assuntos
Barotrauma/diagnóstico , Doença da Descompressão/diagnóstico , Mergulho/efeitos adversos , Afogamento/diagnóstico , Gases/análise , Tomografia Computadorizada Multidetectores , Mudanças Depois da Morte , Adulto , Idoso , Ar , Artefatos , Autopsia , Barotrauma/complicações , Dióxido de Carbono/análise , Cromatografia Gasosa , Descompressão/efeitos adversos , Afogamento/etiologia , Embolia Aérea/complicações , Embolia Aérea/diagnóstico , Artéria Femoral , Veia Femoral , Coração/diagnóstico por imagem , Humanos , Hidrogênio/análise , Veias Jugulares , Masculino , Pessoa de Meia-Idade , Nitrogênio , Oxigênio/análise , Veia Subclávia , Condutividade Térmica
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