Percutaneous retrieval of an inferior vena cava filter causing right ureter obstruction.

Retrievable inferior vena cava filters (IVCFs) are known to provide safe and effective pulmonary embolism protection when used appropriately. Long-term complications have been reported over the past 10 years, including vena cava perforation, filter migration, strut fracture, and injury to adjacent structures. This article describes the case of a 44-year-old woman who presented with right ureteral obstruction from strut impingement by a Bard Recovery IVCF (Tempe, AZ, USA). The filter had been in place for 6 years, and the authors were successful in retrieving it using a percutaneous endovascular approach, despite an unexpected chronic right innominate vein occlusion. In addition to highlighting the technical feasibility of long-term retrieval, this case underscores the importance of an IVCF registry to improve retrieval rates. This close monitoring and timely retrieval of filters may help prevent serious long-term complications.

A Rare Case of Fat Embolism Syndrome Masquerading as COVID-19 Pneumonia.

In the wake of the novel coronavirus disease 2019 (COVID-19) pandemic and its associated mortality and virulence, a high clinical suspicion must be maintained for all patients presenting with respiratory failure. However, there are well-known disease processes that may have a similar presentation. We present a case of a 25-year-old male who suffered a right tibia fracture after a motor vehicle collision. He had acute hypoxic respiratory failure within 24 hours of admission, requiring mechanical ventilation. His condition significantly improved with airway pressure release mode of ventilation and proning. Although his chest CT demonstrated characteristic findings of COVID-19, he subsequently tested negative. The differential included aspiration pneumonia and fat embolism syndrome from the lower extremity fracture. Fat embolism syndrome can very closely mimic COVID-19. The rapid onset and improvement of symptoms coupled with serial negative COVID-19 testing may aid in the diagnosis.

Cardiac tamponade secondary to iatrogenic needle decompression in blunt force trauma.

The proper treatment for tension pneumothorax is rapid needle decompression. This procedure is frequently performed in the field for trauma patients who have clinical symptoms of pneumothorax. The procedure itself has a high rate of failure due to improper placement, operator inexperience, or chest wall thickness. A 22-year-old unrestrained driver in a high-speed motor vehicle collision was found unconscious and subsequently had needle decompression for decreased breath sounds in the field. The patient was initially stable upon arrival but progressed to cardiac arrest. She had a thoracotomy in the emergency department that showed cardiac tamponade followed by return of spontaneous circulation. On formal thoracotomy, it was discovered that the patient had an iatrogenic cardiac injury from the angiocatheter placed during needle decompression. Needle decompression is a lifesaving procedure, but it is associated with high failure rates and possibility for iatrogenic injury.

COVID-19: Healthy environmental impact for public safety and menaces oil market.

COVID-19 seems as global emergency, by infectious virus, caused respiratory illness like having symptoms of flue, sickness, headache, and difficulty in breathing. Within months the world has been transformed into new order, thousands of people died and many more are fallen ill due to COVID-19 outbreak. China was the first country to see the outbreak and the first country to control it. However, the disease has broken out in Europe, the Middle East, the United States and other places. The United States has the highest number of cases in the world.

A selective placement strategy for surgical feeding tubes benefits trauma patients.

BACKGROUND: The indications for surgical feeding tube (SFT) placement in trauma patients are poorly defined. Patient selection is critical as complications from SFTs have been reported in up to 70% of patients. A previous analysis by our group determined that 25% of the SFTs we placed were unnecessary and that older patients, patients with head and spinal cord injuries, and patients who needed a tracheostomy were more likely to require long-term SFTs. Following this study, we modified our institutional guidelines for SFT placement. We hypothesized that a more selective placement strategy would result in fewer unnecessary SFTs. METHODS: A retrospective review of all adult patients from 2012 to 2016 with an intensive care unit length of stay longer than 4 days and an SFT placed during admission was conducted. This group was compared to data collected prior to our change in practice (2007-2010). Data from 2011 were excluded as a washout period. "Necessary" SFT use was defined per established guidelines as either daily use of the SFT through discharge or for 28 days or longer and "unnecessary" SFT use as all others. RESULTS: Two hundred fifty-seven SFTs were placed from 2007 to 2010 and 244 from 2012 to 2016. Following implementation of our selective SFT placement strategy, unnecessary SFT placement decreased from 25% in 2007 to 2010 to 8% in 2012 to 2016 (p < 0.0001). Significant predictors of necessary SFT placement by univariate regression were as follows: increasing age (odds ratio [OR] 1.03/year; 95% confidence interval [CI], 1.01-1.04), head injury (OR, 2.80; 95% CI, 1.71-4.60), cervical spinal cord injury (OR, 4.42; 95% CI, 1.34-14.50), and need for tracheostomy (OR, 1.41; 95% CI, 2.21-7.67). The overall complication rate was 11% (9% in the selective group vs. 13% in the preselective group, p = 0.2574) and was highest following open SFT placement (22%). CONCLUSION: A selective placement strategy for SFTs in our trauma population resulted in fewer unnecessary SFTs and a trend toward fewer complications. Surgical feeding tubes should be placed through a percutaneous approach whenever possible. LEVEL OF EVIDENCE: Therapeutic study, level IV.