Peripartum cardiac failure in a woman with Graves' disease.

A case of peripartum cardiac failure is reported in a 20-year-old gravida 3, para 3 black female. The patient was 6 weeks postpartum. Graves' disease had been diagnosed in the first trimester of her pregnancy. The patient presented to the emergency department with complaints of fever, abdominal pain, shortness of breath, and chest pain. Physical examination revealed signs of congestive heart failure and anasarca. Chest x-ray revealed bilateral pleural effusions, and an abdominal series was consistent with ascites. Bedside electrocardiogram revealed pan-hypokinesis of all four cardiac chambers. The authors believe that this is the first case reported in the literature of peripartum cardiac failure occurring in a patient with Graves' disease.

Prehospital use of pulse oximetry in rotary-wing aircraft.

A prospective study of 200 patients was conducted to evaluate the use of pulse oximetry as an adjunct to clinical monitoring of clinically ill patients transported by rotary-wing aircraft with non-pressurized cabins. Thirty-four subjects (17%) were found to have significant hemoglobin desaturation of less than 90%, as defined by pulse oximetry (SpO 2). Data were recorded continuously for later review. Desaturation often was noted prior to alterations in vital signs or clinical appearance. In 32 of 34 hypoxemic subjects (94%), therapeutic interventions corrected the low SpO 2. The use of pulse oximetry permitted measures for cardiorespiratory support to be instituted and assessed more rapidly than otherwise would have been possible. The availability of a continuous record of SpO 2 facilitated detailed review of case management. It is concluded that the use of pulse oximetry is a practical and valuable adjunct for monitoring critically ill patients transported by rotary-wing aircraft.

Odontogenic cervical necrotizing fasciitis.

Necrotizing fasciitis is a severe soft-tissue infection characterized by diffuse necrosis of fascia and subcutaneous tissue; initially, skin and muscle are usually spared. The trunk, abdomen, perineum, and extremities are the most commonly involved areas. The case of a 55-year-old man with a cervical necrotizing fasciitis from an infected tooth is presented. The medical history, etiology, anatomy, precipitating factors, clinical presentation, and therapy of this infection are discussed. Early recognition allows effective therapy with aggressive surgical intervention, broad-spectrum antibiotics, and supportive care. Misdiagnosis (eg, as cellulitis) and delayed surgical treatment can result in severe systemic toxicity and a mortality rate that approaches 40%.