A&A practice
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Point-of-care ultrasound may elucidate reversible causes of cardiac arrest, and its use is supported by international guidelines in the periarrest setting. We present a case in which the treatment of cardiac arrest caused tension pneumothoraces and cardiac tamponade by pneumopericardium. ⋯ Cardiac imaging was false negative for tamponade, because the latter was caused by air and not fluid. Diagnoses are not to be excluded with inconclusive point-of-care ultrasound examinations, which should prompt further clinical evaluation and imaging.
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Cuff positions of endotracheal tubes should be confirmed to ensure safe anesthesia. However, determining the cuff positions relative to the cricoid by using chest radiography or fiberoptic bronchoscopy is difficult. ⋯ Thereafter, we adjusted the endotracheal tube depths and confirmed the cuff positions relative to the cricoid. Longitudinal ultrasound images over the larynx and trachea can help confirm the distance from the caudal edge of the cricoid to the saline-inflated cuff.
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Rapid sequence induction and intubation was performed for a patient in respiratory distress after a gunshot wound to the neck. Resistance was noted distal to vocal cords. With a bronchoscope unavailable, the endotracheal tube was advanced with a corkscrew maneuver. ⋯ The patient was emergently explored. An intraluminal bullet was removed, lateral wall tracheal defect was repaired, and a tracheostomy was placed. The intubating provider should secure the airway by the method they are most comfortable, have high suspicion of airway injury, and prepare to manage airway disruption.
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We report a gravida in fulminant acute respiratory distress syndrome, mechanically ventilated at 27 weeks estimated gestational age, who further deteriorated into severe combined hypercarbic, hypoxemic respiratory failure. At 30 weeks estimated gestational age, she was placed on venovenous extracorporeal membrane oxygenation (ECMO) because of refractory respiratory failure. Her physical status improved without fetal deterioration. ⋯ Six days later, complications of ECMO (pulmonary hemorrhage) led to emergent abdominal delivery of a living male child. She was successfully weaned from ECMO 8 days later. The implications of ECMO during pregnancy are discussed.