Cases reported "Heart Arrest"

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1/109. theophylline therapy for near-fatal cheyne-stokes respiration. A case report.

    BACKGROUND: cheyne-stokes respiration is characterized by periodic breathing that alternates with hypopnea or apnea. OBJECTIVE: To describe the effect of theophylline on near-fatal cheyne-stokes respiration. DESIGN: Case report. SETTING: Tertiary referral center. PATIENT: A 48-year-old diabetic woman with a history of three cardiorespiratory arrests, a normal coronary arteriogram, normal left ventricular function, and severe cheyne-stokes respiration. MEASUREMENTS: oxygen saturation, intra-arterial blood pressure, central venous pressure, chest wall movement, electrocardiography, electromyography, electroencephalography, electro-oculography, minute ventilation, arterial blood gases, and serum theophylline levels. RESULTS: After intravenous administration of 1.2 mg of theophylline at 0.6 mg/kg per hour (serum level, 5.6 microg/mL), both cheyne-stokes respiration and oxygen desaturation were markedly attenuated. After infusion of 2.4 mg of theophylline (serum level, 11.6 microg/mL), cheyne-stokes respiration resolved completely. No change was seen with placebo. cheyne-stokes respiration did not recur during outpatient treatment with oral theophylline. CONCLUSION: theophylline may be a rapid and effective therapy for life-threatening cheyne-stokes respiration.
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2/109. Expeditious diagnosis of primary prosthetic valve failure.

    Primary prosthetic valve failure is a catastrophic complication of prosthetic valves. Expeditious diagnosis of this complication is crucial because survival time is minutes to hours after valvular dysfunction. The only life-saving therapy for primary prosthetic valve failure is immediate surgical intervention for valve replacement. Because primary prosthetic valve failure rarely occurs, most physicians do not have experience with such patients and appropriate diagnosis and management may be delayed. A case is presented of a patient with primary prosthetic valve failure. This case illustrates how rapidly such a patient can deteriorate. This report discusses how recognition of key findings on history, physical examination, and plain chest radiography can lead to a rapid diagnosis.
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3/109. The management of non-traumatic cardiac arrest in the operating room with cardiopulmonary bypass.

    We present a case of a 29-year-old woman whom, while undergoing an elective gynecological procedure, acutely arrested. Closed chest cardiopulmonary compressions were not effective. Fortuitously, the cardiac surgical team was in an adjacent operating room, about to start an elective bypass case. After sternotomy, the patient was placed on cardiopulmonary bypass within 20 min of the arrest. The patient achieved return of spontaneous circulation and was ultimately discharged with only mild extremity weakness. The etiology of the arrest was never fully explained. Open chest massage and cardiopulmonary bypass should be considered early in the management of unexpected cardiac arrest, especially in the operating room where surgical expertise should be immediately available. Surgeons and anesthesiologists need to be aware of, and consider, the possibility of employing these techniques.
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4/109. On scene thoracotomy: a case report.

    We report a case of on scene resuscitative thoracotomy performed by an anaesthetist on a patient in cardiac arrest following a stab wound to the chest. The patient made a good recovery and was discharged from hospital within 2 weeks. The rationale for performing resuscitative thoracotomy and who should perform this procedure are discussed.
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5/109. Unexplained asystole during thoracotomy irrigation: a case report.

    This case presentation involves a 76-year-old man with a 60-year history of smoking one and a half packs of cigarettes per day, who presented for a transurethral resection of the prostate (TURP). A preadmission chest x-ray revealed a left upper lobe lung lesion that was suggestive of carcinoma by subsequent computerized axial tomography. The TURP procedure was postponed, and the patient was advised to undergo an open thoracotomy biopsy with possible left upper lobectomy. The patient consented, and an open thoracotomy biopsy confirmed carcinoma. A left upper lobectomy was then performed. The operative procedure was significant for a 12-second acute episode of atrioventricular standstill during post-thoracotomy thoracic irrigation with warm saline. Return of sinus rhythm occurred spontaneously after cessation of irrigation. The operative field was closed, and the patient's recovery was unremarkable. Postoperative evaluation was unremarkable, and the patient was discharged 1 week later. Anatomic and physiologic vagal mechanisms are reviewed, and application to this case presentation is discussed.
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6/109. Favorable outcome in a large left heart air embolism: lessons from an unusual complication of a noninvasive chest scan.

    OBJECTIVE: To report an unusual life-threatening complication of the performance of a computed tomographic (CT) scan of the chest. DESIGN: Case report. SETTING: University hospital. PATIENT: An intubated patient with blunt thoracic trauma. INTERVENTION: Performance of a CT scan of the chest at full inspiration. MAIN RESULT: With air insufflation, a large left ventricular air embolism occurred as a consequence of an airway breach, revealed by the simultaneous existence of a mild bilateral anterior pneumothorax. CONCLUSION: CT scan of the chest in patients at risk of airway breach (patients with acute respiratory distress syndrome, trauma patients) should first be performed at full expiration, not full inspiration.
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keywords = chest
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7/109. Morbid hypocalcemia associated with phosphate enema in a six-week-old infant.

    A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medications. After stabilization he was transferred to the neonatal intensive care unit for further management. His initial laboratory tests revealed a serum calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum phosphorus level of 28.5 mg/dL (normal range: 2.4-4.5 mg/dL). During the first week of admission, the infant's mother reported that she had administered a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him. The infant was discharged after 12 days of hospitalization. Anticipatory guidance on the stool patterns and behavior of infants can prevent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be addressed with all parents at early well-child visits to avoid hazardous complications of treatments. hypocalcemia, seizures, premature infants, enema.
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8/109. Traumatic asphyxia complicated by unwitnessed cardiac arrest.

    We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple-blue neck and face discoloration. These facial changes can mimic those seen with massive closed head injury; however, cerebral injury after traumatic asphyxia usually occurs due to cerebral hypoxia. When such features are observed, the diagnosis of traumatic asphyxia should be considered. Prompt treatment with attention to the reestablishment of oxygenation and perfusion may result in good outcomes.
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9/109. Deaths of children during an outbreak of hand, foot, and mouth disease in sarawak, malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group.

    From April through June 1997, 29 previously healthy children aged <6 years (median, 1.5 years) in Sarawak, malaysia, died of rapidly progressive cardiorespiratory failure during an outbreak of hand, foot, and mouth disease caused primarily by enterovirus 71 (EV71). The case children were hospitalized after a short illness (median duration, 2 days) that usually included fever (in 100% of case children), oral ulcers (66%), and extremity rashes (62%). The illness rapidly progressed to include seizures (28%), flaccid limb weakness (17%), or cardiopulmonary symptoms (of 24 children, 17 had chest radiographs showing pulmonary edema, and 24 had echocardiograms showing left ventricular dysfunction), resulting in cardiopulmonary arrest soon after hospitalization (median time, 9 h). Cardiac tissue from 10 patients showed normal myocardium, but central nervous system tissue from 5 patients showed inflammatory changes. brain-stem specimens from 2 patients were available, and both specimens showed extensive neuronal degeneration, inflammation, and necrosis, suggesting that a central nervous system infection was responsible for the disease, with the cardiopulmonary dysfunction being neurogenic in origin. EV71 and possibly an adenovirus, other enteroviruses, or unknown cofactors are likely responsible for this rapidly fatal disease.
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10/109. Complete recovery of consciousness in a patient with decorticate rigidity following cardiac arrest after thoracic epidural injection.

    A 46-yr-old man with dysaesthesia (burning sensation) following herpes zoster in the left upper chest region was treated with a single thoracic (T2/T3) epidural injection (1.0% lidocaine 3 ml 0.125% bupivacaine 3 ml) as an outpatient. Twenty minutes after the injection, a nurse noticed the patient to be unconscious with dilated pupils, apnoea and cardiac arrest. Following immediate cardiopulmonary resuscitation, the patient was treated with an i.v. infusion of thiamylal sodium 2-4 mg kg-1 h-1 and his lungs were mechanically ventilated. When the patient developed a characteristic decorticate posture, mild hypothermia (oesophageal temperature, 33-34 degrees C) was induced. On the 17th day of this treatment, after rewarming (35.5 degrees C) and discontinuation of the barbiturate, the patient responded to command. weaning from the ventilator was successful on the 18th day. About 4 months after the incident, the patient was discharged with no apparent mental or motor disturbances. We suggest that mild hypothermia with barbiturate therapy may have contributed to the successful outcome in this case.
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