Heart & lung : the journal of critical care
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The purpose of this study was to examine the meaning and relative importance that family members of older patients in the intensive care unit (ICU) ascribed to dignity. ⋯ Insight into the concerns of family members related to the dignity of the older critically ill patient may be useful in guiding nurses as they provide care in what are often fast-paced, highly technical environments. Meeting well established family needs as well as attending to the unique concerns identified in this study will assist nurses in supporting the older, critically ill patient's dignity.
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Case Reports
Fatal rupture of aortic root abscess following native aortic valve enterococcal endocarditis.
We describe the case of a 66-year-old male, who was referred to our cardiology department with suspected endocarditis, following an enterococcal bacteremia. Transesophageal echocardiography showed vegetations on a native trileaflet aortic valve. ⋯ The patient was transferred to a specialist cardiac center, but was unsuitable for major surgery and died a week later. We discuss this rare and devastating complication of infective endocarditis.
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Pulmonary embolism may be often promptly diagnosed just by bedside echocardiography, in the case of new onset severe right ventricular enlargement, increased pulmonary pressure and dyspnea. However, CT confirmation could be required in the presence of contrasting findings during diagnostic work up. We report the case of a 79-year old woman who presented with acute dyspnea, right ventricular enlargement and leftward septal shift. ⋯ Visceral pleural and lymphonodular infiltration suspected for malignancy was also present. We hypothesize that acutely increased pulmonary pressures and enlarged right ventricle were caused by the infiltrating pulmonary mass, presumably a lung tumor, partly involving left pulmonary artery branches and by tumor pulmonary embolism. A diagnosis of pulmonary thrombo-embolism exclusively based on echocardiography may be occasionally misleading without a careful diagnostic work-up.
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We report the case of a middle age patient presenting with Tako-Tsubo cardiomyopathy (TTC) complicated by cardiogenic shock that was successfully handled with milrinone. A 64-year old man presented with cardiogenic shock after benzodiazepine and alcohol intoxication. A slight elevation of troponin and typical left ventricular ballooning without coronary lesions suggested TTC. ⋯ TTC is responsible for severe transient left ventricular dysfunction occurring after physical or psychological stress. The major pathophysiological mechanism involved is disproportionate catecholamine secretion, which may stun the myocardium. We considered if treatment of this unique physiopathology with catecholamines could be dangerous in these patients and if alternative inotropes such as milrinone should be preferred.
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Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay). ⋯ PVA occurs frequently in a variety of types although the majority of PVA is ineffective trigger. The study uncovered previously unidentified waveforms that may indicate that there is a greater range of PVAs than previously reported. Newly described PVA, in particular, PVA combined in one breath, may signify substantial patient distress or poor physiological circumstance that clinicians should investigate.