Respiratory medicine case reports
-
Respir Med Case Rep · Jan 2020
Case ReportsProne positioning to improve oxygenation and relieve respiratory symptoms in awake, spontaneously breathing non-intubated patients with COVID-19 pneumonia.
Emergency departments are facing an unprecedented challenge in dealing with patients who have coronavirus disease 2019 (COVID-19). The massive number of cases evolving to respiratory failure are leading to a rapid depletion of medical resources such as respiratory support equipment, which is more critical in low- and middle-income countries. In this context, any therapeutic and oxygenation support strategy that conserves medical resources should be welcomed. ⋯ Self-proning can be used in the management of selected patients with COVID-19 pneumonia. Here, we describe our experience with two COVID-19-positive patients who were admitted with respiratory failure. The patients were successfully managed with self-proning and noninvasive oxygenation without the need for intubation.
-
Respir Med Case Rep · Jan 2020
Case ReportsDetection of SARS-CoV-2 by bronchoscopy after negative nasopharyngeal testing: Stay vigilant for COVID-19.
Real-time polymerase chain reaction (RT-PCR) detection of severe acute respiratory syndrome coronavirus (SARS-CoV-2) is required for diagnosis of coronavirus disease 2019 (COVID-19). Sensitivity of RT-PCR nasopharyngeal (NP) testing is presumed to be high, but there is no gold standard against which this has been determined. The objective was to determine whether lower respiratory tract infection (LRTI), detected in bronchoalveolar lavage fluid (BALF), occurs in the absence of upper respiratory tract infection with clinical testing of both specimen types. ⋯ These data demonstrate that SARS-CoV-2 LRTI occurs in the presence of negative NP testing. NP testing may underestimate the prevalence of COVID-19 and has implications for spread of SARS-CoV2 in the community and healthcare setting.
-
Respir Med Case Rep · Jan 2019
Case ReportsUse of point-of-care ultrasound to assess esophageal insufflation during bag mask ventilation: A case report.
Bag-valve-mask ventilation is a basic airway management technique often used in patients with acute respiratory failure. Although highly effective in providing oxygenation and ventilation, this technique has been associated with gastric regurgitation and tracheal aspiration. In this case, the esophagus visualized with bedside ultrasonography during bag-mask ventilation of an unresponsive and critically ill patient. ⋯ Cricoid pressure did not prevent esophageal insufflation. Ultrasound-guided probe pressure attenuated esophageal insufflation. This case depicts a unique instance of using a novel method to assess breath delivery during bag mask ventilation of a critically ill patient.
-
Respir Med Case Rep · Jan 2019
Case ReportsBilateral pneumothorax after pacemaker placement "Buffalo chest".
Bilateral pneumothoraces following unilateral subclavian vein cannulation is a rare complication. It is usually associated with an intrapleural communication which can be congenital or formed following cardiothoracic and mediastinal surgeries, or trauma. The term Buffalo chest was used to define a single chest cavity with no anatomic separation of the two hemithoraces. ⋯ In distinction, the pleural cavities in humans are entirely separated. We describe an 83-year-old female without prior history of cardiothoracic surgery, trauma or lung disease, who underwent dual chamber pacemaker placement using a left subclavian vein access and developed bilateral pneumothoraces following the procedure. The bilateral pneumothoraces were completely resolved with single left-sided thoracostomy tube placement suggesting the patient had "Buffalo chest".
-
Respir Med Case Rep · Jan 2019
Case ReportsDisseminated tuberculosis with severe immune thrombocytopenia.
Immune thrombocytopenia is an autoimmune condition with increased platelet destruction. Immune thrombocytopenic purpura is an uncommon and rare manifestation of tuberculosis. ⋯ Due to severe thrombocytopenia patient was managed with IVIg and steroids along with anti tubercular therapy. Early diagnosis and treatment with Anti tubercular therapy is important for effective control of bleeding manifestations.