ABSTRACT
Acute respiratory failure (ARF) is a frequent emergency department (ED) presentation. The definition and common causes of ARF are discussed in this article and ED management of the condition is discussed, using an illustrative case report. The paper considers the role of B-type natriuretic peptide in diagnosis and non-invasive ventilation (NIV) in treatment. Intensive care unit admission denial is common in ARF, although the evidence base is lacking. Finally, the decision-making process is described when a patient with ARF fails to improve with NIV.
Subject(s)
Critical Care , Emergency Service, Hospital , Pulmonary Disease, Chronic Obstructive/therapy , Respiration, Artificial , Respiratory Insufficiency/therapy , Aged , Female , Humans , Pulmonary Disease, Chronic Obstructive/complications , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiologyABSTRACT
INTRODUCTION: Pregnancy in a rudimentary horn is although rare, but is associated with the risk of rupture and life threatening hemorrhage. With the use of ultrasound the diagnosis can be made before symptoms occur. Management usually consists of excision of the rudimentary horn along with the pregnancy and the ipsilateral tube, traditionally by laparotomy. MATERIALS AND METHODS: We present a case of a 16-week ruptured rudimentary horn pregnancy diagnosed intraoperatively and managed laparoscopically in the presence of massive haemoperitoneum, which is first of its kind along with literature review. CONCLUSION: This case demonstrates that laparoscopy is a feasible approach and can provide rapid diagnosis and control of bleeding in such cases provided there is availability of efficient multi-disciplinary teamwork, optimal anesthesia, advanced cardiovascular monitoring, laparoscopic expertise and ability to convert rapidly to laparotomy if required.
