ABSTRACT
Pregnant women are at high risk of coronavirus disease 2019 (COVID-19) complications, including acute respiratory distress syndrome (ARDS) and the need for mechanical ventilation. There is no literature on the optimal strategy for the management of difficult-to-wean pregnant and early postpartum patients. We report two cases of pregnant women with COVID-19 pneumonia and ARDS, who required mechanical ventilation and high doses of analgesia, and sedation with neuromuscular blocking agents to facilitate ventilation and oxygenation. Both patients had a tracheostomy procedure to facilitate weaning from mechanical ventilation and sedation. Shortly after tracheostomy, sedation and analgesia, along with ventilatory support were weaned off. Both patients were discharged home. These cases propose early tracheostomy as a strategy to facilitate weaning from mechanical ventilation and sedation in pregnant and early postpartum patients.
ABSTRACT
Datura stramonium (also called thorn apple or Jimson weed) is a plant that contains atropine, scopolamine, and hyoscyamine, giving it anticholinergic effects when consumed. We report the case of a 32-year-old male in Qatar who intentionally ingested seeds from Jimson weed mixed with milk. The patient became severely confused and delirious, eventually requiring admission to the intensive care unit (ICU) for two days for management. The patient was discharged safely with no complications afterward. The case is unique in that Jimson weed is not common in Qatar, and due to the adverse effects of this plant, this case serves to highlight to both the general population and healthcare professionals the effects of ingestion and the appropriate management plan for toxicity caused by Jimson weed.
ABSTRACT
BACKGROUND: Fat embolism syndrome (FES) is a multi-organ dysfunction caused by the fat emboli. The diagnostic of FES remains a challenge for clinicians. The clinical criteria including those of Gurd's and Wilson's although universally used for its diagnosis are not specific. Different methods of imaging are increasingly performed in the patients with presumed FES. The objective of this study is to determine whether there is a correlation between the clinical parameters and the imaging findings in confirming the FES diagnosis. METHODS: Patients admitted with FES were identified from the surgical intensive unit registry and enrolled in this study. Patient's demographic data, admission diagnosis, associated injuries, comorbid conditions, time to deteriorate, surgical duration, clinical manifestations, imaging findings and outcome were recorded. Data was entered into the SPSS program and required tests were applied for comparisons with a p value <0.05 considered as significant. RESULTS: A total of 81 patients were enrolled in this study. Majority of patients (51/63%) were young male and without comorbidity (58/71.6%). About a half of the patients (49.4%) underwent intramedullary nailing for long bone fracture. Respiratory insufficiencies occurred in 98% patients and of them 11.1% had diffuse alveolar hemorrhage. Neurological deterioration was seen in 70% of the patients while the petechial skin rash was rare (2.5%). All patients had an abnormal chest x-ray but chest computerized tomography scan (CT) showed patchy alveolar opacities in 49 (60.5%) of them. Cerebral edema was a common finding in the CT brain while the brain magnetic resonance imaging (MRI) revealed a typical star field appearance in 28.4% of the patients. There was a significant correlation (P<0.05) between the major and minor clinical criteria components and abnormal imaging findings. CONCLUSIONS: The FES is common in young males with long bone fractures. Respiratory distress and neurological deterioration were common presentations. We suggest that the all patients with suspected FES by clinical criteria should have imaging studies to confirm the diagnosis.
