Chang Gung medical journal
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Tension pneumothorax is not a rare complication of mechanical ventilation, but its occurrence immediately after intubation with a double-lumen endotracheal tube (DLT) is very rare. Subsequent impairment of the respiratory and cardiovascular function can be life threatening if it is not detected early enough and managed properly. ⋯ Herein we report a case of tension pneumothorax and pneumoperitoneum which occurred immediately after DLT intubation. It appeared before one-lung ventilation was applied because of an inappropriately small-sized and malpositioned DLT.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of ultrasound-guided axillary brachial plexus block: a comparative study with nerve stimulator-guided method.
The aim of this study was to compare the efficacy of axillary brachial plexus block using an ultrasound-guided method with the nerve stimulator-guided method. We also compared the efficacy of ultrasound-guided single-injection with those of double-injection for the quality of the block. ⋯ Ultrasound-guided axillary brachial plexus block, using either single- or double-injection technique, provided excellent sensory and motor blockades with fewer adverse events.
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Totally implantable venous devices (TIVDs) are used increasingly in patients with cancers and other debilitating diseases requiring long-term chemotherapy, total parental nutrition, and fluid replacement. The TIVDs are surgically inserted and fixed in the soft tissues of the chest wall to prevent infection and accidental dislodgment. ⋯ Catheter fracture and cardiac migration is a rare complication and most reported cases have developed between the clavicle and the first rib as a consequence of a pinch-off sign. We present two patients with metastatic colon cancers with unusual catheter fracture site and migration and discuss the clinical implications.
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A case of low back pain syndrome was diagnosed due to spinal metastasis with unknown primary origin. During anesthesia for surgical stabilization, unexpected airway obstruction occurred after endotracheal intubation. Fiber-optic bronchoscopic examination showed narrowing of the trachea and main bronchi caused by extrinsic compression. ⋯ Airway obstruction was relieved thereafter. The extrinsic lesion was diagnosed as mediastinal lung cancer. The mechanism and management of this airway compromise caused by mediastinal tumor is discussed.
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Severe community-acquired pneumonia (CAP) is associated with high mortality. The choice of antibiotics should be guided by the distribution of bacterial pathogens. The purpose of this study was to analyze the causative bacteria and outcomes of patients with severe CAP in a medical intensive care unit (MICU) in Taiwan. The results may provide a basis of guidance for future empirical antibiotic treatments. ⋯ Gram-negative bacilli were the most-common causative pathogens among patients with severe CAP requiring mechanical ventilation. Antipseudomonal antibiotics or a carbapenem should be considered to cover Pseudomonas species, extended-spectrum beta-lactamase-producing strains, and Acinetobacter species. If the isolated bacteria are gram-positive, care should be taken to cover the possibility of ORSA. Old age and higher APACHE II scores were associated with higher mortality.