A&A practice
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A 46-year-old man presented with severe refractory posterior shoulder pain due to a left scapular fracture sustained during a motor vehicle collision. Despite multimodal oral and intravenous analgesics, the patient's pain remained difficult to control. A continuous paravertebral nerve block was performed between the second and third thoracic vertebrae resulting in excellent analgesia of the scapular pain. This case suggests that a continuous thoracic paravertebral block placed between the second and third vertebrae may be considered as part of multimodal analgesia in patients with scapular fractures.
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Case Reports
Initiation of Cardiopulmonary Bypass in a High-Risk Patient Under Regional Anesthesia: A Case Report.
A 34-year-old man presented with a large right ventricular (RV) intracardiac mass obstructing RV inflow and outflow as well as a concomitant pericardial effusion displaying physiological signs of tamponade. The patient underwent awake femorofemoral cannulation for cardiopulmonary bypass (CPB) under regional anesthesia with initiation of CPB before induction of general anesthesia. This unconventional approach avoided hemodynamic perturbations in this high-risk patient. Regional anesthesia provided predictable analgesia compared to local infiltration for improved toleration of cannulation.
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Approximately 30% of health care workers (HCWs) fail the respirator fit test. Evidence suggests that addressing face leaks in the 3M respirator enhances its fit and improves its efficacy. ⋯ Sixty-eight percent of HCWs who failed the fit test with their first-choice respirator passed with a modified adhesive respirator. To increase the efficacy and safety of 3M respirators, ineffective face seals need substantial improvement in design.
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Case Reports
E-cigarette, or Vaping, Product Use-Associated Lung Injury-Lessons Learned: A Case Series.
E-cigarette, or vaping, product use has been declared an epidemic, and a new disease has emerged from their use. We describe 4 patients with significant acute lung injury related to e-cigarette use who underwent bronchoscopy and bronchoalveolar lavage. All cases posed anesthetic challenges, including increased airway reactivity, hypoxia, increasing oxygen requirements, and, in 2 severe cases, the need for continued postprocedural mechanical ventilatory support. It is imperative that all members of the treating team are aware of the disproportionate risk of respiratory complications to anticipate the possible need for increased postprocedural respiratory support.
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Intravenous infusion of a subanesthetic dose of ketamine has been shown to improve neuropathic pain. However, ketamine-induced liver injury can occur. ⋯ Furthermore, drug-induced liver injury can cause acute liver failure. Therefore, we recommend close monitoring of liver enzymes every 1 to 2 days during ketamine infusions.