A & A case reports
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Cardiofaciocutaneous syndrome is a rare syndrome that is characterized by distinct craniofacial features, cardiac abnormalities, and multiple organ involvement. Patients may present with pulmonary stenosis, hypertrophic cardiomyopathy, micrognathia, a short neck, laryngomalacia, and tracheomalacia; all of which may significantly impact the perioperative course of these patients. We describe a 6-year-old child with cardiofaciocutaneous syndrome presenting for an orthopedic procedure. He had an uneventful perioperative and postoperative course.
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Case Reports
High-frequency percussive ventilation: a new strategy for separation from extracorporeal membrane oxygenation.
We report the case of a 48-year-old woman who developed severe septic shock and lung injury after community-acquired pneumonia. She was supported on arteriovenous extracorporeal membrane oxygenation (ECMO) for 19 days. ⋯ During the 4 days of HFPV, the chest radiograph improved, as did gas exchange and clearance of pulmonary secretions. HFPV may be a promising strategy for improving lung recruitment and airway clearance during separation from ECMO in the critically ill patient.
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We present the case of a 62-year-old woman with an advanced metastatic lung tumor that required palliative debulking. Perioperative placement of a surgical clip in the dura of the thoracic spinal cord caused a dural breach, which ultimately caused a pneumocephalus. An awareness of this association is important, especially in patients undergoing thoracic resections. We also describe our approach to the management of this condition.
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Case Reports
Superimposed cocaine-induced rhabdomyolysis in a patient with aortic dissection rhabdomyolysis.
A 52-year-old man presented with acute, sharp chest pain radiating to the back and abdomen after using cocaine 18 hours previously. Computed tomographic angiography revealed a type B aortic dissection that extended to the iliac arteries. ⋯ The combination of aortic dissection and creatine kinase toxicity was extensive enough to cause permanent renal failure and paraplegia below T6. The severity of the patient's symptoms was attributed to concomitant cocaine-induced rhabdomyolysis and aortic dissection rhabdomyolysis.
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A patient with an endobronchial tumor and critical airway obstruction developed hypoxia and hypercarbia and, subsequently, cardiac arrest during a palliative laser core-out excision. The differential diagnosis included tension pneumothorax, as well as airway obstruction due to swelling of residual tumor or to blood clots. ⋯ Immediate bedside lung ultrasonography provided real-time information leading to the stabilization of the patient. This case provides compelling motivation for anesthesiologists to acquire this easily learned skill.