RESUMO
Goldenhar syndrome, a rare congenital anomaly, manifests as craniofacial malformations often necessitating intricate surgical interventions. These procedures, though crucial, can expose patients to diverse postoperative complications, including hemorrhage or infection. A noteworthy complication is stroke, potentially linked to air embolism or local surgical trauma. We highlight a case of a male patient, aged 20 years, who experienced a significant postoperative complication of an ischemic stroke, theorized to be due to an air embolism, after undergoing orthognathic procedures for Goldenhar syndrome. The patient was subjected to LeFort I maxillary osteotomy, bilateral sagittal split ramus osteotomy of the mandible, and anterior iliac crest bone grafting to the right maxilla. He suffered an acute ischemic stroke in the left thalamus post-surgery, theorized to stem from an air embolism. Advanced imaging demonstrated air pockets within the cavernous sinus, a rare and concerning finding suggestive of potential air embolism. This case underscores the intricate challenges in treating Goldenhar syndrome patients and the rare but significant risk of stroke due to air embolism or surgical trauma. Limited literature on managing air embolism complications specific to Goldenhar syndrome surgeries exists. Generally, management includes immediate recognition, positional adjustments, air aspiration via central venous catheters, hyperbaric oxygen therapy, hemodynamic support, and high-flow oxygen administration to expedite air resorption. Our patient was conservatively managed post-surgery, and at a 3-month neurology follow-up, he showed significant improvement with only residual right arm weakness. It emphasizes the imperative of a comprehensive, multidisciplinary approach.
Assuntos
Embolia Aérea , Síndrome de Goldenhar , AVC Isquêmico , Cirurgia Ortognática , Acidente Vascular Cerebral , Humanos , Masculino , Embolia Aérea/etiologia , Embolia Aérea/terapia , Acidente Vascular Cerebral/etiologia , Complicações IntraoperatóriasRESUMO
Gas embolization is a rare but potentially deadly complication of any laparoscopic surgery. There has only been one other report of gas emboli in patients undergoing bariatric surgery. We present a case of gas embolization in a young female patient undergoing Roux-en-Y gastric bypass. Onset of gas embolus was identified by a dramatic drop in End Tidal Carbon Dioxide (ETCO2) followed by drops in blood pressure, heart rate, and oxygen saturation over the following 15 minutes before the patient was stabilized and transferred to the ICU. The surgery was completed three days later without incident, and extensive hepatomegaly was identified. A discussion on pre-operative evaluation, special considerations, and acute management of gas embolization in patients with obesity ensues. We highlight the emerging Jain's point for insufflation, the potential for ultrasound-guided Verres needle insertion, and the paucity of literature evaluating the risk, incidence, and outcomes of gas embolization in patients with obesity.
Assuntos
Embolia Aérea , Derivação Gástrica , Humanos , Feminino , Embolia Aérea/etiologia , Embolia Aérea/terapia , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Adulto , Dióxido de Carbono , Obesidade/complicações , Obesidade Mórbida/complicaçõesRESUMO
A 62-year-old male patient underwent pancreaticoduodenectomy with modified Child reconstruction for distal cholangiocarcinoma. After eight years, a contrast-enhanced computed tomography (CT) revealed a recurrent lesion at the biliojejunal anastomosis, and a biliary stent was placed for obstructive cholangitis in the right posterior segment of the liver. A right hepatectomy was planned for a local recurrent lesion;thus, percutaneous transhepatic portal embolization was performed on the portal vein's right branch to enlarge the left liver. However, he was referred to our department for endoscopic retrograde biliary drainage for the subsequent cholangitis and liver abscess appearance. A double-balloon enteroscope under CO2 insufflation was used to reach the bile duct-jejunal anastomosis. After removing the bile duct stent with grasping forceps, his general condition suddenly deteriorated, causing cardiopulmonary arrest. He was diagnosed with air embolism based on the findings of air in the heart, aorta, and brain on CT after the return of spontaneous circulation. Treatment for the air embolism and subsequent complications continued in the intensive care unit, but he eventually died 114 days after the onset of the air embolism due to his deteriorating general condition. Pathological autopsy revealed cholangiocarcinoma that extends from the porta hepatis to the posterior segment. Additionally, the proximity between the bile duct and vein extended by the adenocarcinoma and the fibrous obstruction of the vein were revealed, indicating the possibility of a bile duct-vein shunt.
Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Colangite , Embolia Aérea , Masculino , Criança , Humanos , Pessoa de Meia-Idade , Colangiopancreatografia Retrógrada Endoscópica , Embolia Aérea/terapia , Embolia Aérea/complicações , Colangite/etiologia , Colangite/cirurgia , Stents/efeitos adversos , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/cirurgia , Ductos Biliares Intra-Hepáticos/patologia , Neoplasias dos Ductos Biliares/cirurgiaRESUMO
BACKGROUND: Iatrogenic cerebral arterial gas embolism (CAGE) caused by invasive medical procedures may be treated with hyperbaric oxygen therapy (HBOT). Previous studies suggested that initiation of HBOT within 6-8 h is associated with higher probability of favorable outcome, when compared to time-to-HBOT beyond 8 h. We performed a group level and individual patient level meta-analysis of observational studies, to evaluate the relationship between time-to-HBOT and outcome after iatrogenic CAGE. METHODS: We systematically searched for studies reporting on time-to-HBOT and outcome in patients with iatrogenic CAGE. On group level, we meta-analyzed the differences between median time-to-HBOT in patients with favorable versus unfavorable outcome. On individual patient level, we analyzed the relationship between time-to-HBOT and probability of favorable outcome in a generalized linear mixed effects model. RESULTS: Group level meta-analysis (ten studies, 263 patients) shows that patients with favorable outcome were treated with HBOT 2.4 h (95% CI 0.6-9.7) earlier than patients with unfavorable outcome. The generalized linear mixed effects model (eight studies, 126 patients) shows a significant relationship between time-to-HBOT and probability of favorable outcome (p = 0.013) that remains significant after correcting for severity of manifestations (p = 0.041). Probability of favorable outcome decreases from approximately 65% when HBOT is started immediately, to 30% when HBOT is delayed for 15 h. CONCLUSIONS: Increased time-to-HBOT is associated with decreased probability of favorable outcome in iatrogenic CAGE. This suggests that early initiation of HBOT in iatrogenic CAGE is of vital importance.
Assuntos
Embolia Aérea , Oxigenoterapia Hiperbárica , Humanos , Cognição , Embolia Aérea/etiologia , Embolia Aérea/terapia , Oxigenoterapia Hiperbárica/efeitos adversos , Doença Iatrogênica , Modelos Lineares , Estudos Observacionais como AssuntoRESUMO
We report the case of an 84-years old female patient who developed cerebral air embolism in association with the indwelling hemodialysis central venous catheter. Pneumocephalus, even though rare, should be included in the differential diagnosis of acute manifestation of neurologic deficits, especially in association with central venous access, surgical interventions or trauma, and requests prompt management. Brain computed tomography scanning remains the investigation of choice.
Assuntos
Cateterismo Venoso Central , Embolia Aérea , Pneumocefalia , Humanos , Feminino , Idoso de 80 Anos ou mais , Cateterismo Venoso Central/efeitos adversos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Coma/etiologia , Tomografia Computadorizada por Raios X/efeitos adversos , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/terapiaRESUMO
BACKGROUND: Arterial cerebral air embolism (CAE) is an uncommon but potentially catastrophic event. Patients can present with focal neurologic deficits, seizures, or coma. They may be treated with hyperbaric oxygen therapy. We review the causes, radiographic and clinical characteristics, and outcomes of patients with CAE. METHODS: We performed a retrospective chart review via an existing institutional database at Mayo Clinic to identify patients with arterial CAE. Demographic data, clinical characteristics, and diagnostic studies were extracted and classified on predefined criteria of diagnostic confidence, and descriptive and univariate analysis was completed. RESULTS: Fifteen patients met criteria for inclusion in our study. Most presented with focal deficits (80%) and/or coma (53%). Seven patients (47%) had seizures, including status epilepticus in one (7%). Five presented with increased muscle tone at the time of the event (33%). Computed tomography (CT) imaging was insensitive for the detection of CAE, only identifying free air in 4 of 13 who underwent this study. When obtained, magnetic resonance imaging typically showed multifocal areas of restricted diffusion. Six patients (40%) were treated with hyperbaric oxygen therapy. Age, Glasgow Coma Scale score at nadir, and use of hyperbaric oxygen therapy were not associated with functional outcome at 1 year in our cohort. Twenty-six percent of patients had a modified Rankin scale score of 0 one year after the event, and functional improvement over time was common after discharge. CONCLUSIONS: A high index of clinical suspicion is needed to identify patients with CAE because of low sensitivity of free air on CT imaging and nonspecific clinical presentation. Acute alteration of consciousness, seizures, and focal signs occur frequently. Because improvement over time is possible even among patients with severe presentation, early prognostication should be approached with caution.
Assuntos
Embolia Aérea , Oxigenoterapia Hiperbárica , Humanos , Coma/terapia , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/terapia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Convulsões/etiologia , Convulsões/terapia , Oxigenoterapia Hiperbárica/efeitos adversosRESUMO
Cerebral air embolism (CAE) is a rare, yet potentially devastating condition characterized by entrance of air into cerebral vasculature, that is nearly always iatrogenic. While many findings of CAE are subclinical and incidental at computed tomography (CT), there remain cases of catastrophic and fatal embolisms. Increasing physician awareness of prevention, presentation, and treatment for CAE is crucial for reducing morbidity and mortality. In this case series, we highlight this preventable entity by comparing three cases of CAE that showcase a diverse array of presentations, radiologic findings, and clinical outcomes. We will also explore predisposing factors, prognostic predictors, diagnostic considerations, and available treatments.
Assuntos
Embolia Aérea , Humanos , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/terapia , Tomografia Computadorizada por Raios XRESUMO
This case report describes the initial care and transport considerations of a pediatric patient who suffered from cerebral gas embolism sustained after inhalation of helium from a pressurized tank. The patient demonstrated neurologic symptoms necessitating hyperbaric oxygen therapy and required fixed wing air transport across a mountain range from a rural community hospital to a tertiary center for the treatment. We review the pathophysiology of cerebral gas embolism and strategies for transporting patients with cerebral gas embolism and other trapped gas.
Assuntos
Embolia Aérea , Hélio , Criança , Feminino , Humanos , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/terapia , Hélio/efeitos adversos , Oxigenoterapia Hiperbárica , Resgate AéreoRESUMO
PURPOSE: We report a case of significant air embolization to the ascending aorta immediately following deployment of EndoAnchors in the aortic arch during a procedure to correct a type 1A endoleak. CASE REPORT: The novel Heli-Fx EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA) was used to deploy helical anchors in the distal aortic arch during a procedure to correct a type 1A endoleak following Zone 2 thoracic endovascular aortic repair of a saccular proximal descending thoracic aorta aneurysm (DTAA). The patient developed ST-segment elevations principally in the inferior leads and severe hypotension moments after EndoAnchor deployment at the proximal edge of the endograft. Transesophageal echocardiogram revealed severe right ventricular hypokinesis and a large amount of air in the ascending aorta. Subsequent management and clinical and radiological 30-day follow-up is presented in addition to a review of the literature and ex vivo testing with the Heli-Fx system to examine potential causes and solutions. CONCLUSION: Precautions, such as pressurized saline infusion to the side port of guiding sheath, should be used whenever manipulating catheters and sheaths such as the EndoAnchor system in the aortic arch to prevent this potentially lethal complication.
Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Embolia Aérea , Procedimentos Endovasculares , Aorta Torácica , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/terapia , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Humanos , Desenho de Prótese , Fatores de Risco , Resultado do TratamentoRESUMO
Hyperbaric oxygen therapy is an existing and approved treatment to address multiple medical conditions, including decompression sickness, air or gas embolism, carbon monoxide poisoning, and profound blood loss when transfusion cannot be accomplished. However, recent efforts have emerged to promote hyperbaric oxygen therapy for other purposes. The most controversial applications have been utilizing this therapy as a treatment for mild traumatic brain injury and post-traumatic stress disorder. As evidence accumulates and the debate continues about whether published studies have satisfied the threshold of clinical significance, a common issue is raised regarding current clinical practices and health insurance coverage as allowed or recommended by the Department of Defense and other federal agencies. This review describes the current federal policies regarding medical insurance issues for providers and clinical practice guidelines as they pertain to alternative uses of hyperbaric oxygen therapy. First, the current policies are explored for what is reimbursable under federal insurance as approved clinical or research usages. Second, these policies are compared to the clinical practice guidelines to determine what might be clinical best practice versus exploratory research. Third, the evidence from government reports is reviewed as supporting documentation for these positions. As such, the current discussion addresses what can and cannot be covered under health insurance and where various federal health care organizations stand currently on using hyperbaric oxygen therapy as an alternative therapeutic technique. The primary goal is informing military healthcare practitioners and prospective patients about the treatment options available to them under current federal guidelines.
Assuntos
Concussão Encefálica , Intoxicação por Monóxido de Carbono , Embolia Aérea , Oxigenoterapia Hiperbárica , Concussão Encefálica/terapia , Intoxicação por Monóxido de Carbono/terapia , Embolia Aérea/terapia , Humanos , Oxigenoterapia Hiperbárica/métodos , Estudos ProspectivosRESUMO
Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure which occurs either at a rate or duration exceeding the capacity of the body to adapt safely. In the following review, we take dysbarisms into account for our analysis. Starting from the underlying physical laws, we will deal with the pathologies that can develop in the most frequently affected areas of the body, as the atmospheric pressure varies when acclimatization fails. Manifestations of dysbarism range from itching and minor pain to neurological symptoms, cardiac collapse, and death. Overall, four clinical pictures can occur: decompression illness, barotrauma, inert gas narcosis, and oxygen toxicity. We will then review the clinical manifestations and illustrate some hints of therapy. We will first introduce the two forms of decompression sickness. In the next part, we will review the barotrauma, compression, and decompression. The last three parts will be dedicated to gas embolism, inert gas narcosis, and oxygen toxicity. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.
Assuntos
Barotrauma , Doença da Descompressão , Embolia Aérea , Oxigenoterapia Hiperbárica , Barotrauma/complicações , Barotrauma/diagnóstico , Doença da Descompressão/complicações , Doença da Descompressão/diagnóstico , Embolia Aérea/terapia , HumanosRESUMO
Since maintenance hemodialysis (HD) first became available in the United States in 1962, there has been tremendous growth in the population of patients with kidney failure. HD has become a routine treatment carried out in outpatient clinics, hospitals, nursing facilities, and in patients' homes. Although it is a complex procedure, HD is quite safe. Serious complications are uncommon due to the use of modern HD machines and water treatment systems as well as the development of strict protocols to monitor various aspects of the HD treatment. The practicing nephrologist must be knowledgeable about life-threatening complications that can occur during HD and be able to recognize, manage, and prevent them. This installment in the AJKD Core Curriculum in Nephrology reviews the pathogenesis, management, and prevention of 9 HD emergencies. The HD emergencies covered include dialyzer reactions, dialysis disequilibrium syndrome, uremic/dialysis-associated pericarditis, air embolism, venous needle dislodgement, vascular access hemorrhage, hemolysis, dialysis water contamination, and arrhythmia episodes.
Assuntos
Emergências , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Edema Encefálico , Descontaminação , Soluções para Diálise/normas , Embolia Aérea/etiologia , Embolia Aérea/fisiopatologia , Embolia Aérea/terapia , Deslocamentos de Líquidos Corporais , Hemólise , Hemorragia/etiologia , Hemorragia/fisiopatologia , Hemorragia/terapia , Humanos , Hipersensibilidade/etiologia , Hipersensibilidade/fisiopatologia , Hipersensibilidade/terapia , Rins Artificiais/efeitos adversos , Agulhas , Nefrologia , Pericardite/etiologia , Pericardite/fisiopatologia , Pericardite/terapia , Falha de Prótese , Esterilização , Uremia/complicações , Purificação da Água/normasRESUMO
BACKGROUND: Surveillance of maternal mortality and severe maternal morbidity is important to identify temporal trends, evaluate the impact of clinical practice changes or interventions, and monitor quality of care. A common source for severe maternal morbidity surveillance is hospital discharge data. On October 1, 2015, all hospitals in the United States transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding for diagnoses and procedures. OBJECTIVE: This study aimed to evaluate the impact of the transition from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding systems on the incidence of severe maternal morbidity in the United States in hospital discharge data. STUDY DESIGN: Using data from the National Inpatient Sample, obstetrical deliveries between January 1, 2012, and December 31, 2017, were identified using a validated case definition. Severe maternal morbidity was defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (January 1, 2012, to September 30, 2015) and the International Classification of Diseases, Tenth Revision, Clinical Modification (October 1, 2015, to December 31, 2017) codes provided by the Centers for Disease Control and Prevention. An interrupted time series and segmented regression analysis was used to assess the impact of the transition from the International Classification of Diseases, Ninth Revision, Clinical Modification to the International Classification of Diseases, Tenth Revision, Clinical Modification coding on the incidence of severe maternal morbidity per 1000 obstetrical deliveries. RESULTS: From 22,751,941 deliveries, the incidence of severe maternal morbidity in the International Classification of Diseases, Ninth Revision, Clinical Modification coding era was 19.04 per 1000 obstetrical deliveries and decreased to 17.39 per 1000 obstetrical deliveries in the International Classification of Diseases, Tenth Revision, Clinical Modification coding era (P<.001). The transition to International Classification of Diseases, Tenth Revision, Clinical Modification coding led to an immediate decrease in the incidence of severe maternal morbidity (-2.26 cases of 1000 obstetrical deliveries) (P<.001). When blood products transfusion was removed from the case definition, the magnitude of the decrease in the incidence of SMM was much smaller (-0.60 cases/1000 obstetric deliveries), but still significant (P<.001). CONCLUSION: After the transition to the International Classification of Diseases, Tenth Revision, Clinical Modification coding for health diagnoses and procedures in the United States, there was an abrupt statistically significant and clinically meaningful decrease in the incidence of severe maternal morbidity in hospital discharge data. Changes in the underlying health of the obstetrical population are unlikely to explain the sudden change in severe maternal morbidity. Although much work has been done to validate the International Classification of Diseases, Ninth Revision, Clinical Modification codes for severe maternal morbidity, it is critical that validation studies be undertaken to validate the International Classification of Diseases, Tenth Revision, Clinical Modification codes for severe maternal morbidity to permit ongoing surveillance, quality improvement, and research activities that rely on hospital discharge data.
Assuntos
Transfusão de Sangue/estatística & dados numéricos , Parto Obstétrico , Classificação Internacional de Doenças , Mortalidade Materna , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Adulto , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/terapia , Coagulação Intravascular Disseminada/epidemiologia , Coagulação Intravascular Disseminada/mortalidade , Coagulação Intravascular Disseminada/terapia , Eclampsia/epidemiologia , Eclampsia/mortalidade , Eclampsia/terapia , Embolia Aérea/epidemiologia , Embolia Aérea/mortalidade , Embolia Aérea/terapia , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Hospitalização , Humanos , Histerectomia/estatística & dados numéricos , Incidência , Morbidade , Complicações do Trabalho de Parto/mortalidade , Complicações do Trabalho de Parto/terapia , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , Transtornos Puerperais/mortalidade , Transtornos Puerperais/terapia , Edema Pulmonar/epidemiologia , Edema Pulmonar/mortalidade , Edema Pulmonar/terapia , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes , Respiração Artificial/estatística & dados numéricos , Síndrome do Desconforto Respiratório/epidemiologia , Síndrome do Desconforto Respiratório/mortalidade , Síndrome do Desconforto Respiratório/terapia , Sepse/epidemiologia , Sepse/mortalidade , Sepse/terapia , Índice de Gravidade de Doença , Choque/epidemiologiaRESUMO
We report the case of a 87-year-old woman admitted to our Emergency Department for mild abdominal pain associated with vomiting. An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe, a finding associated with numerous surgical and medical conditions. The patient was successfully managed with conservative treatment. Isolated intrahepatic gas is a rare radiologic finding; emergency surgery should be performed only when there are signs of associated acute intestinal infarction.
Assuntos
Embolia Aérea/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Idoso de 80 Anos ou mais , Embolia Aérea/terapia , Feminino , Humanos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Endobronchial electrocautery is a common and safe therapeutic endoscopic treatment for malignant airway obstruction. Cerebral arterial air embolism (CAAE) is a rare but potentially fatal complication of endobronchial electrocautery. CASE PRESENTATION: We present the first case of cerebral arterial air embolism after endobronchial electrocautery. A 56-year-old male with a pulmonary tumour in the right upper lobe received repeated endobronchial electrocautery. During the procedure, he experienced unresponsiveness, hypoxemia and bradycardia, and he developed tetraplegia. Brain computed tomography showed several cerebral arterial air emboli with low-density spots in the right frontal lobe. He received hyperbaric oxygen therapy with almost full recovery, except for residual left-sided weakness. CONCLUSIONS: General physicians should realize that CAAE may be a possible complication of endobronchial electrocautery. Several measures, including avoiding positive pressure, lowering ventilatory pressures if possible, avoiding advancing the bronchoscope to occlude the bronchus and using the non-contact technique, should be used to prevent this devastating complication.
Assuntos
Broncoscopia/efeitos adversos , Artérias Cerebrais/diagnóstico por imagem , Eletrocoagulação/efeitos adversos , Embolia Aérea/etiologia , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/terapia , Humanos , Oxigenoterapia Hiperbárica , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Vascular air embolism (VAE) is a rare but important complication that has not been paid enough attention to in the medical process such as surgery and anesthesia. CASE PRESENTATION: We report for the first time that a 54-year-old male patient with central lung cancer developed severe complications of CAE after right pneumonectomy. After targeted first-aid measures such as assisted breathing, mannitol dehydration and antibiotic treatment, the patient gradually improved. The patient became conscious at discharge after 25 days of treatment but left limb was left with nerve injury symptoms. CONCLUSION: We analyzed the possible causes of CAE in this case, and the findings from this report would be highly useful as a reference to clinicians.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Infarto Cerebral/diagnóstico por imagem , Embolia Aérea/diagnóstico , Embolia Intracraniana/diagnóstico , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Complicações Pós-Operatórias/diagnóstico , Angiografia Cerebral , Infarto Cerebral/etiologia , Infarto Cerebral/terapia , Angiografia por Tomografia Computadorizada , Diuréticos Osmóticos/uso terapêutico , Embolia Aérea/complicações , Embolia Aérea/fisiopatologia , Embolia Aérea/terapia , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/terapia , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Respiração ArtificialRESUMO
BACKGROUND: Identification of portal venous gas on radiographic imaging is well documented after the ingestion of hydrogen peroxide, as is its resolution after hyperbaric therapy. Although hyperbaric therapy may resolve the gastrointestinal symptoms associated with the presence of portal venous gas, the principle rationale for performing hyperbaric therapy is to prevent subsequent central nervous system oxygen embolization. CASE REPORT: We describe a patient with portal venous gas identified by computed tomography after the ingestion of 3% hydrogen peroxide, managed without hyperbaric therapy, who subsequently developed portal venous thrombosis. We are not aware of this complication being previously described from hydrogen peroxide ingestion. The case is complicated by the coexistence of a self-inflicted stab wound, leading to exploratory laparotomy in a patient predisposed to arterial vascular occlusion. Why Should an EmergencyPhysicianBeAware of This? Emergency physicians will encounter patients after the ingestion of hydrogen peroxide who, despite not having symptoms of central nervous system emboli, have portal venous gas identified on radiographic imaging. Being aware that the principle rationale for prophylactic utilization of hyperbaric therapy is to prevent subsequent central nervous system emboli, and that in at least one case, delayed-onset portal venous thrombosis has occurred without hyperbaric therapy may help contribute to clinical decision-making.
Assuntos
Embolia Aérea , Oxigenoterapia Hiperbárica , Trombose Venosa , Ingestão de Alimentos , Embolia Aérea/etiologia , Embolia Aérea/terapia , Humanos , Peróxido de Hidrogênio/efeitos adversos , Veia Porta/diagnóstico por imagem , Trombose Venosa/etiologiaRESUMO
Gas embolism is a potential and often life-threatening complication of central venous catheters. We report a case of air embolism after tearing of the central catheter associated with severe acute respiratory distress syndrome. The severity of the clinical situation meant choices had to be made regarding the order of treatments. This clinical case provided useful eye-openers for patient management regarding the prioritization of treatments as well as the possibilities offered by hyperbaric oxygen therapy.
Assuntos
Cateteres Venosos Centrais/efeitos adversos , Embolia Aérea/terapia , Oxigenoterapia Hiperbárica/métodos , Síndrome do Desconforto Respiratório/complicações , Adolescente , Embolia Aérea/etiologia , Humanos , Masculino , Posicionamento do Paciente/métodos , Pneumonia Aspirativa/diagnóstico por imagem , Decúbito VentralRESUMO
A 52-year-old male accidentally ingested approximately 100 mL of 35% hydrogen peroxide (H2O2), resulting in the sudden onset of gastrointestinal and neurologic symptoms. Non-contrast abdominal CT revealed extensive portal venous gas and gastric pneumatosis. The patient was treated with hyperbaric oxygen therapy which resulted in complete resolution of symptoms. The case highlights the therapeutic value of hyperbaric oxygen therapy in the treatment of vascular gas embolism and mitigation of concentrated H2O2 ingestion toxicity.
Assuntos
Anti-Infecciosos Locais/intoxicação , Embolia Aérea/terapia , Peróxido de Hidrogênio/intoxicação , Oxigenoterapia Hiperbárica/métodos , Veia Porta , Acidentes Domésticos , Embolia Aérea/induzido quimicamente , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estômago/diagnóstico por imagemRESUMO
Hydrogen peroxide (H2O2) ingestion can cause vascular gas embolism (GE). Hyperbaric oxygen therapy (HBO2) is known to improve neurological abnormalities in patients with arterial gas embolism (AGE). Previously, HBO2 based on the U.S. Navy Table 6 diving protocol has been adopted for treating AGE and preventing the progression of portal venous GE, caused by H2O2 ingestion, to AGE. However, the indication and protocol for HBO2 have not been established for GE related to H2O2 ingestion. Herein, we describe a case in which GE caused by H2O2 ingestion was treated using HBO2 with a short protocol. A 69-year-old female patient presented with abdominal pain, vomiting, and transient loss of consciousness after ingesting 35% H2O2. Computed tomography revealed gastric wall and portal venous gas. She was administered an HBO2 protocol with 2.8-atmosphere absolute (ATA) compression for 45 minutes. This was followed by a 2.0-ATA treatment for 60 minutes with a five-minute air break, after which all gas bubbles disappeared. After HBO2 treatment, brain magnetic resonance imaging revealed focal cytotoxic edema lesions; however, the patient was discharged without additional symptoms.