A&A practice
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Case Reports
Difficult Removal of a Nasogastric Tube Because of Knot Formation Around a Nasotracheal Tube: A Case Report.
Knotting of a nasogastric (NG) tube around a left nasotracheal tube occurred in the pharynx during its blind insertion via the right nares. Unusual resistance was encountered during its advancement and attempted withdrawal. The nasotracheal tube moved in tandem with the NG tube. The NG tube was cut and the lower portion removed via the mouth and the upper portion removed via the right nares.
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Case Reports
When All Else Fails: Novel Use of Angiotensin II for Vasodilatory Shock: A Case Report.
Angiotensin (AT) II is an endogenous hormone that acts on venous and arterial smooth muscle to cause vasoconstriction. Recent trials have sparked great interest in its ability to be used as a vasopressor for catecholamine-refractory hypotension. Herein, we describe the successful use of AT II in a patient with a colonic perforation with septic shock refractory to conventional treatment. After AT II initiation, there was an immediate reduction in catecholamine requirement, and the patient survived.
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Case Reports
The Erector Spinae Plane Block Provides Complete Surgical Anesthesia in Breast Surgery: A Case Report.
We described the first ultrasound-guided erector spinae plane block that provided complete surgical anesthesia for a right-sided mastectomy and axillary dissection in a patient with high cardiovascular risk. The block targeted at T5, and 20 mL of 0.5% ropivacaine with epinephrine 1:200,000 and dexamethasone 8 mg was administered. ⋯ The patient reported no pain and remained hemodynamically stable throughout the 2.5-hour procedure. At the end of the surgery, patient received morphine 2 mg and dipyrone 2 g intravenously, and demanded no analgesic until 24 hours after the procedure.
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The goal of this study was to use the American Board of Anesthesiology Objective Structured Clinical Examination (OSCE) content outline as a blueprint to develop and administer a 9-station mock OSCE with station-specific checklists to senior residents (n = 14). The G- and Ф-coefficient reliability estimates were 0.76 and 0.61, respectively. Residents judged the scenarios as either extremely or somewhat realistic (88%). It is feasible to develop and administer a mock OSCE with rigorous psychometric characteristics.
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Case Reports
Radiofrequency Ablation of the Stellate Ganglion for Management of Acute Digital Ischemia: A Case Report.
The authors present a report of a pulsed radiofrequency ablation of the stellate ganglion performed on a patient with microemboli to the hand from a thrombosed abandoned arteriovenous fistula. The patient was initially managed using vasodilators and anticoagulation. ⋯ Ablation of the stellate ganglia increased perfusion to his hand and likely prevented amputation that has lasted for approximately 1 year. While radiofrequency ablation is more commonly used for pain syndromes, this is an example of its use in the treatment and potential treatment of acute ischemia.