1/103. Hyperbaric chamber-related decompression illness in a patient with asymptomatic pulmonary sarcoidosis.An asymptomatic 46-yr-old male sustained an acute neurologic insult, appearing during the decompression phase of a 50-m dry hyperbaric chamber dive. The right hemisyndrome was most probably related to diving, since symptoms responded rapidly to the early commenced recompression therapy. Further diagnostics revealed a previously unknown pulmonary sarcoidosis with bilateral pulmonary opacities and pleural adhesions that might have predisposed to arterial gas embolism secondary to pulmonary barotrauma. This case may illustrate a potential risk of decompression illness even during dry chamber dives in patients suffering from asymptomatic pleuro-parenchymal pulmonary disease. The value of chest X-ray in the medical assessment of fitness to dive is therefore emphasized.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
2/103. Cerebral arterial gas embolism in air force ground maintenance crew--a report of two cases.Two cases of cerebral arterial gas embolism (CAGE) occurred after a decompression incident involving five maintenance crew during a cabin leakage system test of a Hercules C-130 aircraft. During the incident, the cabin pressure increased to 8 in Hg (203.2 mm Hg, 27 kPa) above atmospheric pressure causing intense pain in the ears of all the crew inside. The system was rapidly depressurized to ground level. After the incident, one of the crew reported chest discomfort and fatigue. The next morning, he developed a sensation of numbness in the left hand, with persistence of the earlier symptoms. A second crewmember, who only experienced earache and heaviness in the head after the incident, developed retrosternal chest discomfort, restlessness, fatigue and numbness in his left hand the next morning. Both were subsequently referred to a recompression facility 4 d after the incident. Examination by the diving Medical Officer on duty recorded left-sided hemianesthesia and Grade II middle ear barotrauma as the only abnormalities in both cases. Chest x-rays did not reveal any extra-alveolar gas. Diagnoses of Static Neurological decompression Illness were made and both patients recompressed on a RN 62 table. The first case recovered fully after two treatments, and the second case after one treatment. magnetic resonance imaging (MRI) of the brain and bubble contrast echocardiography performed on the first case 6 mo after the incident were reported to be normal. The second case was lost to follow-up. decompression illness (DCI) generally occurs in occupational groups such as compressed air workers, divers, aviators, and astronauts. This is believed to be the first report of DCI occurring among aircraft's ground maintenance crew.- - - - - - - - - - ranking = 0.16666666666667keywords = ill (Clic here for more details about this article) |
3/103. Pulmonary venous air embolism following accidental patient laceration of a hemodialysis catheter.As the number of patients at home with indwelling central venous catheters increases, more complications from their use will present to the emergency department. We report a case of pulmonary venous air embolism after a patient inadvertently severed the distal few centimeters of an indwelling central venous catheter.- - - - - - - - - - ranking = 0.16666666666667keywords = ill (Clic here for more details about this article) |
4/103. Venous air embolism from central venous catheterization: a need for increased physician awareness.OBJECTIVES: To report a series of patients with clinically diagnosed venous air embolism (VAE) and major sequelae as a complication of the use of central venous catheters (CVCs), to survey health care professionals' practices regarding CVCs, and to implement an educational intervention for optimizing approaches to CVC insertion and removal. SETTING: Tertiary care, university-based 806-bed medical center. INTERVENTIONS: We surveyed 140 physicians and 53 critical care nurses to appraise their awareness of the proper management and complications of CVCs. We then designed, delivered, and measured the effects of a multidisciplinary educational intervention given to 106 incoming house officers. MEASUREMENTS AND MAIN RESULTS: Although most physicians (127, 91%) chose the Trendelenburg position for CVC insertion, only 42 physicians (30%) reported concern for VAE. On CVC removal, only 36 physicians (26%) cited concern for VAE. Some physicians (13, 9%) reported elevating the head of the bed during CVC removal, possibly increasing the risk of VAE. awareness of VAE or its prevention did not correlate with the level of physician training, experience, or specialty. After the educational intervention, concern for and awareness of proper methods of prevention of VAE improved (p < .001). At 6-month follow-up, reported use of the Trendelenburg position continued, but concern cited for VAE had returned to baseline. CONCLUSIONS: There is inadequate awareness of VAE as a complication of CVC use. Focused instruction can improve appreciation of this potentially fatal complication and knowledge of its prevention, but the effect declines rapidly. To achieve a more sustained improvement, a more intensive, hands-on, periodic educational program will likely be necessary, as well as reinforcement through enhanced supervision of CVC insertion and removal practices.- - - - - - - - - - ranking = 0.16666666666667keywords = ill (Clic here for more details about this article) |
5/103. Portal venous gas associated with splenic abscess secondary to colon cancer.We report a successfully treated case accompanied by portal venous gas, which was associated with splenic abscess due to penetration of colon cancer. In June, 1998, a 67-year-old Japanese man was referred to our hospital because of a continuous fever over 40 degrees C and portal venous gas detected by computed tomography (CT). CT revealed low density areas in the spleen and wall thickening of the descending colon next to the spleen. barium-enema examination demonstrated an extrinsic filling defect in the splenic flexure of the colon. splenectomy, resection of the pancreatic tail and left hemicolectomy were performed Histopathological studies showed moderately differentiated adenocarcinoma, which made a fistula at the bottom of the ulceration to the spleen. The postoperative course was uneventful. The portal venous gas was likely to have resulted from a bacterial infection in the portal venous systems secondary to the splenic abscess.- - - - - - - - - - ranking = 0.16666666666667keywords = ill (Clic here for more details about this article) |
6/103. neurologic manifestations of cerebral air embolism as a complication of central venous catheterization.OBJECTIVE, patients, AND methods: A severe case of cerebral air embolism after unintentional central venous catheter disconnection was the impetus for a systematic literature review (1975-1998) of the clinical features of 26 patients (including our patient) with cerebral air embolism resulting from central venous catheter complications. RESULTS: The jugular vein had been punctured in eight patients and the subclavian vein, in 12 patients. embolism occurred in four patients during insertion, in 14 patients during unintentional disconnection, and in eight patients after removal and other procedures. The total mortality rate was 23%. Two types of neurologic manifestations may be distinguished: group A (n = 14) presented with encephalopathic features leading to a high mortality rate (36%); and group B (n = 12) presented with focal cerebral lesions resulting in hemiparesis or hemianopia affecting mostly the right hemisphere, with a mortality rate as high as 8%. In 75% of patients, an early computed tomography indicated air bubbles, proving cerebral air embolism. Hyperbaric oxygen therapy was performed in only three patients (12%). A cardiac defect, such as a patent foramen ovale was considered the route of right to left shunting in 6 of 15 patients (40%). More often, a pulmonary shunt was assumed (9 of 15 patients; 60%). For the remainder, data were not available. CONCLUSION: When caring for critically ill patients needing central venous catheterization, nursing staff and physicians should be aware of this potentially lethal complication.- - - - - - - - - - ranking = 0.16666666666667keywords = ill (Clic here for more details about this article) |
7/103. The role of computed tomography in the diagnosis of arterial gas embolism in fatal diving accidents in tasmania.Four cases of fatal diving accidents in tasmania are presented, highlighting the role of CT in the investigation of diving fatalities. The CT technique allows rapid diagnosis when arterial gas embolism (AGE) is suspected. The traditional method of investigation, underwater autopsy, is a difficult procedure that requires specialized training in which the subtle diagnosis of AGE may be completely missed. Facilities for performing underwater autopsies are normally available only in tertiary referral centres, and therefore the diagnosis of AGE may be missed due to lack of facilities. The use of CT in the diagnosis of AGE in divers was first utilized in the early 1980s but has still not become widely adopted in forensic practice. This radiological technique has the advantage of being sensitive, quick, reliable, readily available and provides a permanent record. For hospitals that do not have a resident forensic pathologist, a CT scan can be easily performed and interpreted to eliminate the possibility of AGE. There are a number of pitfalls in the diagnosis of AGE with CT, particularly intravascular gas production following postmortem fermentation and off-gassing. awareness of these pitfalls will help the radiologist in making a correct diagnosis of AGE.- - - - - - - - - - ranking = 0.33333333333333keywords = ill (Clic here for more details about this article) |
8/103. Ultrasonographic detection of portal branches and hepatic vein gas associated with mesenteric artery occlusion: a new finding correlated with patient prognosis?The diagnosis of bowel infarction is still a challenge. In some cases, portal venous gas is an associated feature and in these patients, the prognosis is very poor. We report on our experience with two consecutive cases in which ultrasonography showed gas in the portal venous branches, and also in the hepatic veins in one of them. At laparotomy, advanced bowel necrosis was found, and both patients died within 24 hours. Other cases of portal venous gas associated with bowel infarction have been reported, but this is the first report of gas also being found in the hepatic veins. There may be a relationship between the amount of gas in the intrahepatic veins and the stage of bowel ischemia. Confirmation of this might improve the selection of patients and eliminate unnecessary procedures.- - - - - - - - - - ranking = 0.16666666666667keywords = ill (Clic here for more details about this article) |
9/103. Pulmonary venous air embolism in hyaline membrane disease.A newborn infant with the respiratory distress syndrome in whom pulmonary venous air embolism (PVAE) developed as a complication of positive pressure therapy is reported. The underlying pathophysiology in this disorder is probably the development of alveolar-capillary fistulae secondary to unduly high intrabronchial pressures. An increased awareness by radiologists and clinicians of PVAE as a potential complication of aggressive respiratory therapy will result in more frequent recognition of this uncommon but lethal disorder.- - - - - - - - - - ranking = 0.33333333333333keywords = ill (Clic here for more details about this article) |
10/103. Lung isolation for the prevention of air embolism in penetrating lung trauma. A case report.PURPOSE: To illustrate a new airway and ventilatory management strategy for patients with unilateral penetrating lung injury. Emphasis is placed on avoiding positive pressure ventilation (PPV)-induced systemic air/gas embolism (SAE) through traumatic bronchiole-pulmonary venous fistulas. CLINICAL FEATURES: A 14-yr-old male, stabbed in the left chest, presented with hypovolemia, left hemopneumothorax, an equivocal acute abdomen, and no cardiac or neurological injury. In view of the risk of SAE, we did not ventilate the left lung until any fistulas, if present, had been excised. After pre-oxygenation, general anesthesia was induced and a left-sided double-lumen tube (DLT) was placed to allow right-lung ventilation. bronchoscopy was performed. The surgeons performed a thorascopic wedge resection of the lacerated lingula. Upon completion of the repair, two-lung ventilation was instituted while the ECG, pulse oximetry, PETCO2, and blood pressure were monitored. Peak inflation pressure was increased slowly and was well tolerated up to 50 cm H2O. The patient's intravascular status was maintained normal. CONCLUSION: patients with lung trauma are at risk of developing SAE when their lungs are ventilated with PPV. In a unilateral case, expectant non-ventilation of the injured lung until after repair is recommended.- - - - - - - - - - ranking = 0.16666666666667keywords = ill (Clic here for more details about this article) |
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