Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Apr 2007
[Medical treatment by bilateral endobronchial intubation of iatrogenic tracheal lesion in intensive care].
We report one case of tracheal lesion following a change of cannula of tracheotomy in intensive care. The clinical features were respiratory failure, bilateral pneumothorax and subcutaneous emphysema. ⋯ The location of the lesion and the features of the patient made us choose a conservative treatment by bilateral endobronchial intubation. The different treatments of the tracheal lesions and the practical achievement of conservative treatment are discussed.
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The authors report the case of 2-old-caucasian women in the pre- and interhospital setting, who presented chest pain with ST segment elevation. Coronary angiography did not show any significant coronary lesion, ventriculography revealed typical aspect of tako-tsubo. It resolved in a short time, with normalisation of the left ventricule function. ⋯ The aetiopathegenia is still uncertain. The differential diagnosis with an acute coronary syndrome with thrombosis is not yet possible. Clinical or biological criteria allowing early diagnosis would lead to optimize the therapeutic management.
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Management of septic shock requires complex and multiple diagnostic as well as therapeutic procedures in a limited time-frame. This issue is a major source of medical errors. The author presents a critical analysis of tools (guidelines, clinical path, algorithm, check-lists) to help physicians for the management of patients with septic shock.
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Ann Fr Anesth Reanim · Apr 2007
Case Reports[Metabolic acidosis in a context of acute severe asthma].
In a context of asthma, lactic acidosis may occur during beta2-agonist therapy. Several cases have been reported during its administration by intravenous and/or inhaled route. This side-effect seems rather unknown and the mechanism for compensation of metabolic acidosis by hyperventilation may worsen dyspnoea and mislead clinicians. ⋯ We report the case of a 50-year-old man hospitalized for an acute major asthma, who received a salbutamol continuous infusion associated with inhaled terbutaline. A serum lactate level of 13 mmol/l was noted eight hours after the introduction of the bronchodilator treatment. After reducing doses of beta2-agonists, the evolution was favourable, regarding both respiratory and metabolic aspects, with a rapid decrease of the serum lactate level, which finally returned to normal level after 32 hours of hospitalization.