Subdural hematoma following lumbar spine surgery

Abstract The occurrence of subdural hematomas following lumbar spine surgical procedures is a rare complication, but one with a high burden of morbidity and mortality, and despite an incidence rate of around 1%, it is a complication which must be considered in this group of patients. We present the case of a male patient, in the fourth decade of life, with a history of neurofibromatosis and spastic quadriparesis, who developed an altered state of consciousness following lumbar tumor resection, ending in a coma. A simple cranial CAT showed evidence of an acute right subdural hematoma which had to be drained via a craniotomy. He had an unsatisfactory postoperative course and died in the intensive care unit due to ARDS. The national literature has little information on this complication, therefore we believe that this case is an important contribution to the literature. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2094).

Toxicological diagnosis in the critical patient: The challenge

Abstract Introduction: A high percentage of patients who survived poisoning will be transferred to the Intensive Care Unit (ICU) to continue their management in relation to the severity of the poisoning, and possible complications that arise in this scenario. The clinical results will depend on several factors, such as the ingested dose, the characteristics of the substance, the time of medical attention, and the pre-existing state of health of the patient. Objective: To review the clinical behavior of poisonings in the critically ill patient. Recent findings: The data bases that yielded relevant bibliographical results were Web of Sciences, Scopus, PubMed, SciELO, and bibliographic references published between 2012 and 2020 were chosen. Conclusions: The clinical behavior of poisonings in the critically ill patient is atypical. The intensivist must have an in-depth knowledge of the behavior and pathophysiology of the toxins since making a medical diagnosis on the stage of the critically ill patient is challenging. The integration of all possible medical tools is required to achieve this in the absence of clinical history, and the implementation of early management strategies is necessary to reach physiological restoration by using a continuous evaluation approach. The severity of poisoning in the critically ill patient demands interdisciplinary management that includes assessment by Clinical Toxicology.