1/28. 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.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/28. Case report of a patient with an intimal sarcoma of the pulmonary trunk presenting as a pulmonary embolism.A fatal case of an 89-year-old woman with an intimal sarcoma obstructing the pulmonary trunk and an open foramen ovale is presented. Clinical symptoms, physical examination and further evaluation originally raised suspicion of a pulmonary embolism. Recent classification systems, specific radiological and pathological characteristics of sarcomas of the pulmonary trunk are discussed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/28. Cardiac arrest during exercise: anomalous left coronary artery from the pulmonary trunk.Anomalous origin of the left coronary artery from the pulmonary trunk is associated with high mortality in infancy but in rare cases the condition is diagnosed in adults. The present report describes three adult cases of this anomaly. Two of the patients (age 18 and 34 years) were resuscitated from cardiac arrest, which had occurred in relation to physical exercise. The third patient (20 years) had presented with angina pectoris and signs of ischaemia on exercise ECG. In all patients, coronary arteriography revealed a large right coronary artery with collateral filling of the left coronary artery, which originated from the pulmonary trunk. A successful surgical correction of the anomalous coronary artery was performed in two of the patients.- - - - - - - - - - ranking = 0.37710952265352keywords = physical (Clic here for more details about this article) |
4/28. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest.In a victim of very deep accidental hypothermia, 9 h of resuscitation and stabilisation led to good physical and mental recovery. This potential outcome should be borne in mind for all such victims.- - - - - - - - - - ranking = 0.37710952265352keywords = physical (Clic here for more details about this article) |
5/28. 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.- - - - - - - - - - ranking = 0.37710952265352keywords = physical (Clic here for more details about this article) |
6/28. Puncture wound during CPR from sternotomy wires: case report and discussion of periresuscitation infection risks.Performing resuscitations presents multiple infectious risks to critical care providers. Potential sources for infection include direct contact with blood and other bodily fluids and possible inoculation through needlestick injuries. In this article, we present a case of a cardiac care unit nurse who, while providing cardiopulmonary resuscitation, suffered a puncture wound to her left hand from the patient's sternotomy wires from previous cardiac surgery. The patient died despite these resuscitation efforts. He was seronegative for human immunodefiency virus, hepatitis b, and hepatitis c, and the nurse's wound healed without complications. This is the first reported case of such an injury occurring during a resuscitation. It demonstrates how a subtle, invisible, and unrecognized physical risk could cause infection in critical care providers.- - - - - - - - - - ranking = 0.37710952265352keywords = physical (Clic here for more details about this article) |
7/28. Amnesic syndrome and severe ataxia following the recreational use of 3,4-methylene-dioxymethamphetamine (MDMA, 'ecstasy') and other substances.A 26-year-old woman suffered disseminated intravascular coagulation (DIC) and a brief respiratory arrest following recreational use of 3,4-methylene-dioxymethamphetamine (MDMA; 'ecstasy'), together with amyl nitrate, lysergic acid (LSD), cannabis and alcohol. She was left with residual cognitive and physical deficits, particularly severe anterograde memory disorder, mental slowness, severe ataxia and dysarthria. Follow-up investigations have shown that these have persisted, although there has been some improvement in verbal recognition memory and in social functioning. magnetic resonance imaging and quantified positron emission tomography investigations have revealed: (i) severe cerebellar atrophy and hypometabolism accounting for the ataxia and dysarthria; (ii) thalamic, retrosplenial and left medial temporal hypometabolism to which the anterograde amnesia can be attributed; and (iii) some degree of fronto-temporal-parietal hypometabolism, possibly accounting for the cognitive slowness. The putative relationship of these abnormalities to the direct and indirect effects of MDMA toxicity, hypoxia and ischaemia is considered.- - - - - - - - - - ranking = 0.37710952265352keywords = physical (Clic here for more details about this article) |
8/28. Malfunctioning electrocardiographic monitor simulating sinus arrest.A 64-year-old patient was admitted to the hospital with a history of two syncopal episodes. The results of the physical examination, resting electrocardiogram and His-bundle study were all normal. Study with a 24-hour ECG monitor (Holter) was at first interpreted as demonstrating periods of sinus arrest. However, more careful examination revealed that these actually represented transient speeding of the monitor tape, perhaps secondary to a semiconductor malfunction. Such monitor malfunction may stimulate severe rhythm disturbances.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/28. Postictal asystole during ECT.BACKGROUND: Asystole is an uncommon but potentially fatal complication of electroconvulsive therapy (ECT). Several risks for poststimulus asystole have been described, but risks for asystole at other times have not. METHOD: Two instances of ECT postictal asystole in healthy adult males are reported. Features in common are identified. RESULTS: features shared differ from risk factors for poststimulus asystole. In common were adult but not geriatric age, male sex, good physical and cardiac health, mesomorphic habitus, anticholinergic pretreatment, vigorous ECT seizure, and low resting heart rate. Both patients showed postictal bradyarrhythmia at the previous ECT. CONCLUSIONS: Postictal asystole has apparent similarities to postexertional asystole in athletes. The combination of higher pretreatment doses of an atropinic agent, a sympatholytic agent, and close monitoring of postictal cardiac rhythm should be considered with patients similar to ours, especially after occurrence of postictal bradyarrhythmia.- - - - - - - - - - ranking = 0.37710952265352keywords = physical (Clic here for more details about this article) |
10/28. Complete recovery after 2 h of cardiopulmonary resuscitation following high-dose prostaglandin treatment for atonic uterine haemorrhage.We report the case of a 31-year-old woman who delivered twins by Caesarean section in whom atonic uterine haemorrhage developed 6 h postoperatively. During conservative treatment with the high-dose prostaglandin analogs sulprostone (PGE(2)) and dinoprost (PGF(2alpha)), acute pulmonary oedema and cardiac decompensation developed and, subsequently, the patient suffered cardiopulmonary arrest. After a 2h-period of cardiopulmonary resuscitation (CPR), it was possible to restore and stabilize circulation under the highest dose of catecholamines. Despite 2h of CPR, the patient was discharged from hospital 3 months later without any major physical or neurocognitive deficit.- - - - - - - - - - ranking = 0.37710952265352keywords = physical (Clic here for more details about this article) |
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