Blind nasogastric lube insertion: be careful

Nasogastric tubes are used in all specialties of medical practice. In critically ill patients, these feeding tubes provide enteral nutrition, which maintains enteric mucosal integrity as well as the immune system of the body, less risk of sepsis and decrease in length of intensive care stay. The insertion of nasogastric tube [NGT] is being considered as a simple blind bedside procedure but this procedure is not free of complications and can be fatal as these tubes can be malpositioned into the respiratory tract or central nervous system. Critically ill patients with endotracheal and tracheostomy tube are at particular risk for malpositioning of the nasogastric tubes due to loss of protective reflexes. Here we report three cases, two intubated and one patient with tracheostomy, in whom the enteral feeding tube was malpositioned into the respiratory system, detected early and a new one inserted in correct position, confirmed by x-ray. The aim of this report is to increase awareness about malpositioning of gastric feeding tubes, proper confirmation of their positioning, risk factors for malpositioning and its prevention

Fatal headache of pregnancy: a case report and review of literature

Due to its variable clinical presentation cerebral venous sinus thrombosis [CVST] is a rare, potentially fatal and challenging condition that is more common in females, with pregnancy, puerperium and the use of oral contraceptive being the risk factors identifiable in up to 80% of cases. Hereditary prothrombotic conditions such as protein C and S, antithrombin III deficiency, and anticardiolipin antibodies are responsible for the condition in many patients. Severe headache is the presenting symptom in most cases. A high index of suspicion is needed for diagnosis although newer imaging procedures have led to earlier diagnosis and management with improved outcomes; magnetic resonance imaging with venography is the investigation of choice. The first line of therapy is intravenous heparin and local thrombolysis can be done in cases deteriorating despite adequate heparinization. Decompression craniotomy may be helpful. Here we report a fatal case of CVST in a pregnant lady with severe headache and anticardiolipin antibody syndrome