1/6. The Mt. Tyndall incident.The authors describe the 53-hour rescue of a 6-foot, 1-inch tall, 250-pound hiker in the face of harsh environmental conditions in sequoia National Park. This 43-year-old man fell 25 feet, injured his leg, and was noted to be hypothermic and hypovolemic. weather, altitude, and the patient's size delayed and complicated his evacuation. After being carried down 1,500 vertical feet, he was hoisted into a hovering helicopter and flown to University Medical Center in Fresno, california. On arrival, the patient was determined to have a comminuted subtrochanteric right femur fracture, which was ultimately repaired surgically. The authors also discuss some of the unique aspects of wilderness and National Park Service EMS.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/6. Prolonged cardiovascular collapse due to unrecognized latex anaphylaxis.We present a case of a prolonged anaphylactic reaction that occurred in temporal relationship to the administration of cefazolin. Subsequent allergy testing was positive for latex and negative for cefazolin-both unexpected results. Our case illustrates that medications administered before the onset of anaphylaxis should not be assumed to be the causative allergen and that a latex allergy should be considered in the differential diagnosis. Because the etiology of an anaphylactic reaction cannot be immediately determined, patients experiencing intraoperative cardiovascular collapse should be treated in a latex-free environment. IMPLICATIONS: We describe a patient who experienced latex-induced intraoperative anaphylaxis. The event coincided with antibiotic administration, which prompted us to erroneously assume that the causative allergen was medication related. Allergy to latex must always be considered as a potential culprit of perioperative cardiovascular collapse.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/6. Hypovolaemic shock by rat bites. A paradigmatic case of social deprivation.This report describes an unusual complication of a comparatively common problem of rat bites, causing a near fatal case of hypovolaemic shock. An 8 month old girl was bitten on her head and hands by norway rats (Rattus norvegicus) while sleeping after falling from her parent's bed. She could not be attended to because of her parents' alcoholic condition. She was found in hypovolaemic shock. She required ventilatory and haemodynamic support for five days. At late follow up, the child had no medical problem. In this case, evident social risk factors include extreme poverty, poor hygiene, and rat infested environment, which are frequently associated in potential rat bite victims.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/6. Acute management of a cyanotic episode in an infant after a Norwood procedure.In infants with a Norwood stage I reconstruction, the respiratory management to direct pulmonary to systemic blood flow ratio is of critical importance. Disturbance of this delicate blood-flow balance can occur causing rapid deterioration of the infant's condition requiring urgent interventions. However, the emergency staff personnel that are generally the first to be called may not be familiar with these patients' complex pathophysiology. We report on the resuscitation of an infant with a Norwood circulation who developed deep central cyanosis in an out-of-hospital environment. The infant deteriorated because of stenoses in both the neoaortic arch and the aortopulmonary shunt. Emergency therapy, especially for out-of-hospital treatment, can only consist of basic measures, which are discussed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/6. Hypoelectrolytemia, hypovolemia, and alkalosis in cystic fibrosis with wood-burning stove in winter.Hypoelectrolytemia, alkalosis, and shock were present in an infant subsequently diagnosed as having cystic fibrosis (CF). Environmental temperature control was poorly maintained by a wood-burning stove in winter and contributed to the process of fluid and electrolyte loss. Pediatricians must consider CF and other processes when electrolytes and fluid are lost during environmental heat excess.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/6. shock in the operating room.Many factors may contribute to producing a shock state within the surgical environment. The classic causes of shock--hypovolemia, cardiac failure, and sepsis--occur commonly in the operating room. Additionally, concurrent surgery and anesthesia may contribute to produce clinical shock. Surgery may produce hypovolemia from "third space" loss and/or from blood loss. Some anesthetic drugs, by inhibiting the autonomic nervous system, impair the body's ability to compensate for hypovolemia, cardiac failure, or sepsis. Other entities such as tension pneumothorax, drug allergy, or mechanical factors produced by surgical exposure may contribute to hemodynamic compromise of the patient. shock that occurs outside the surgical suite may also be produced by a variety of insults. One or more factors may contribute to inadequate tissue perfusion, thus making diagnosis of the cause(s) of shock a clinical challenge. Presented in this review is an anesthesiologist's approach to shock on a macrocirculatory level. Two important concepts are vital to this approach. First, one must act immediately to restore adequate perfusion to the brain and heart when confronted with a patient in shock. This is possible without knowing the specific cause(s) of the poor perfusion. Second, a rapid, accurate diagnosis of the cause(s) must be made if the patient is slow to respond to the initial therapy. Through the use of pulmonary artery catheterization, the factors producing any given shock state may be identified, and appropriate therapy may be instituted and monitored.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |