Chest
-
Death resulting from COVID-19 in a hospital during the pandemic has meant death in isolation. Although many health care providers (HCPs) have struggled with end-of-life (EOL) care for these patients, the various strategies across hospitals are not well known. ⋯ Proper application and awareness of the four themes may help HCPs to implement better EOL care. To compensate for limited memories resulting from isolation and rapid progression of the disease, communicating and creating humanistic episodes are emphasized. ICU diaries and the HCPs' arrangements based on cultural funerary procedures could be provided as grief care for the family and to build trust. EOL education and building partnerships among palliative care staff and nonmedical personnel on a regular basis may enhance the capacity to deliver the necessary support for EOL care.
-
Observational Study
Diaphragmatic thickness and excursion in infants born preterm with bronchopulmonary dysplasia compared to term or near term infants: a prospective observational study.
Diaphragmatic atrophy associated with mechanical ventilation is reported in pediatric and adult patients, but a similar association has not been described in preterm infants with bronchopulmonary dysplasia (BPD). ⋯ In infants with BPD, DTexp was significantly lower, whereas DTF and DE were significantly higher, compared with healthy, age-matched control participants. Future studies are required and should focus on describing the evolution of diaphragmatic dimensions in preterm infants with and without BPD.
-
A 53-year-old woman with a history of pulmonary embolism treated with rivaroxaban came to the ED after 4 days of acutely worsening dyspnea and chest pressure. On arrival, her temperature was 36.7 °C; heart rate, 71 beats/min; BP, 98/59 mm Hg; respiratory rate, 22 breaths/min; and Spo2 95% on room air. Her WBC count was elevated at 15,770/μL; hemoglobin, 13.3 g/dL; platelets, 280,000/μL; INR (international normalized ratio), elevated at 1.66; and partial thromboplastin time, elevated at 18.8 s. Serum chemistry results were unremarkable, and pro-brain natriuretic peptide was slightly elevated at 530 pg/mL (normal, < 300 pg/mL).
-
Case Reports
A 25-Year-Old Patient With Chest Wall Erythema and Tenderness Who Was Ventilated Mechanically.
A 25-year-old man with cerebral palsy, scoliosis, and ventilator dependence since SARS-CoV-2 infection 11 months earlier presented with a 2-week history of chest redness and swelling. The area of erythema and edema was located on the left side of the anterior chest and had grown to approximately 9 cm in diameter over the 2 weeks. It was tender to palpation. ⋯ He did have increased, thick, yellow secretions from his tracheostomy, but no fevers. He was born in the Dominican Republic and moved to the United States as a child. He had not traveled anywhere outside the United States in more than a decade.
-
Multiple trials have demonstrated the efficacy of therapies targeting the RAS/MAPK pathway in children with Langerhans cell histiocytosis (LCH), but less is known about the success of this strategy in adults or in LCH that is the result of mutations other than BRAF V600E. A 53-year-old woman who has never smoked presented to our clinic with multisystem, multifocal LCH that resulted from an uncommon BRAF N486_P490del mutation. Low dose, and even intermittent, MEK inhibitor (trametinib) therapy was associated with rapid improvement in almost all of her disease manifestations, including regression of masses in her groin and neck, reduction in seizure frequency and intensity, improvement in white matter lesions on MRI, diabetes insipidus, dyspnea, and cognitive and memory functions. We conclude that MEK inhibitor therapy was effective for BRAF mutation-associated adult multisystem LCH, including CNS manifestations, in this patient.