A&A practice
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The risk of aerosol transmission has been a key factor for the rapid dissemination of the coronavirus pandemic. Transportation of coronavirus disease 2019 (COVID-19)-infected patients with active air leaks could expose unprotected health care personnel and other patients to aerosolized viral particles. ⋯ It involves placing an Ultipor100 viral filter on the suction port of the drain system as well as sealing off the safety valve. This mechanism allows positive pressure from an air leak to escape while on water seal while trapping viral particles.
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Case Reports
Potential Patent Blue V Overdose in a Patient Undergoing Free-Flap Breast Reconstruction: A Case Report.
The case of a patient who experienced serious adverse effects following a potential overdose of Patent Blue V dye (PVB) is presented here. A 65-year-old woman developed cardiac arrythmias and circulatory instability 35 minutes after receiving 100 mg PVB during breast cancer surgery. ⋯ However, mast-cell tryptase levels were normal and subsequent allergy testing for all potential allergens was negative. This case highlights that life-threatening reactions to perioperative PVB should not always be attributed to anaphylaxis; systemic toxicity could occur with an overdose.
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The right supraclavicular fossa view allows for ultrasonographic visualization of the central veins. A preprocedural scan of an asymptomatic 38-year-old man referred for peripherally inserted central catheter (PICC) insertion revealed a large thrombus in the right brachiocephalic vein. ⋯ Using the right supraclavicular view, the PICC was visualized in the left brachiocephalic vein, and the catheter was followed to its final position, avoiding contact with the thrombus. Thus, the right supraclavicular fossa view allowed for the detection of relevant pathology and facilitated an alternative feasible strategy with real-time catheter guidance during PICC insertion.
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Bronchospasm in children is common; however, due to its sudden nature, radiographic correlation is uncommon. We planned a computed tomography (CT) coronary angiogram for a 5-year-old child for evaluation of Kawasaki disease. ⋯ Repeat CT scan documented well-aerated lung fields. The development of acute bronchospasm under anesthesia results in definite changes in the CT scan of the thoracic cavity as evidenced by this incident.
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Case Reports
Palliative Nerve Block for Penile Calciphylaxis: A Case Report on Ultrasound-Guided Phenol Neurolysis.
A 78-year-old man with uncontrolled diabetes, heart failure, and hemodialysis-dependent end-stage renal disease presented with intractable penile pain secondary to calciphylaxis and necrosis of his glans penis. Given pain refractory to pharmacologic management and refusal of surgery, treatment entailed an ultrasound-guided dorsal penile nerve block with 5 mL of aqueous 4% phenol bilaterally. The patient reported immediate relief and died pain-free 3 months later. While phenol nerve blocks are increasingly uncommon due to local tissue toxicity, the precision of ultrasound leverages phenol's denaturing and axonal demyelinating properties to facilitate long-term targeted neurolysis to palliate chronic nonmalignant pain.