Sudden respiratory deterioration in the positive pressure ventilated patient: an organized approach to diagnosis and therapy.

A case of sudden deterioration in the respiratory status of a 28-year-old man being manually ventilated is presented. The patient's deterioration was presumed to be secondary to malfunction of the expiratory valve of the Ambu bag. The resulting high pressure generated in the system caused the patient to develop a bilateral pneumothorax, pneumomediastinum, and displacement of the endotracheal tube into the oropharynx. An organized approach to the diagnosis and treatment of the rapid deterioration in the respiratory status of a manually ventilated patient is presented.

Cervical hydatidiform mole causing severe vaginal hemorrhage: a case report.

BACKGROUND: First-trimester vaginal bleeding occurs in approximately 20% of pregnancies and is a frequent cause of emergency department evaluation. Hydatidiform mole, although relatively rare, typically presents as intermittent vaginal bleeding during the first trimester of pregnancy. CASE: A 37-year-old woman had severe vaginal bleeding secondary to cervical implantation of a hydatidiform mole. Treatment included stay sutures, similar to those used in cervical cerclage, to control the hemorrhage and allow stabilization of the patient. Evaluation showed that the hydatidiform mole appeared to have been confined to the cervix, and much of the tissue was removed or spontaneously passed while obtaining hemostasis. CONCLUSION: A very rare case of hydatidiform mole with cervical implantation presented as a massive vaginal hemorrhage. The use of stay sutures in a manner similar to cervical cerclage allowed stabilization while further evaluation and treatment were contemplated.

Neurologically intact survivor of prolonged ventricular fibrillation: a case for intermediate dose epinephrine and postresuscitation infusion.

The authors point out that our understanding of the optimal dose of epinephrine used in the resuscitation of patients in cardiac arrest continues to evolve. Doses greater than the standard 1 mg of epinephrine every 5 minutes have been studied and shown to increase the rate of return of spontaneous circulation. However, reports of neurologically intact survivors of prolonged cardiac arrest are rare. The authors report a neurologically intact survivor of prolonged ventricular fibrillation with severe mixed acidosis who responded to intermediate doses of epinephrine and epinephrine infusion, where standard amounts had failed. Further research should be directed into the relationship between postresuscitation epinephrine infusions and neurologic outcome.

Delayed presentation of intrapericardial diaphragmatic hernia, an unusual cause of colon obstruction.

The earliest symptoms of diaphragmatic hernia may not appear until viscera incarcerate in it years after the causal injury. The most unusual site for a diaphragmatic hernia to occur is through the central tendon of the diaphragm into the pericardium. We present the case of a 43-year-old man who suffered a bowel obstruction when the transverse colon and omentum became incarcerated in the intrapericardial diaphragmatic hernia. The defect presumably resulted from blunt chest and abdominal trauma received 15 years earlier. The delayed presentation of intrapericardial diaphragmatic hernia is reviewed, and recommendations for evaluation and treatment are made.

Aortoiliac occlusion secondary to atherosclerotic plaque rupture as the result of blunt trauma.

Abdominal aortic injuries secondary to blunt trauma are uncommon, particularly without associated visceral injury or external signs of localized trauma. Blunt trauma-induced abdominal aortic injuries most frequently result in intimal tearing. The most common mechanism is localized impact over the lower abdomen from sudden deceleration against a fixed object. We present the case of a patient with atheromatous plaque rupture in the distal abdominal aorta associated with acute aortoiliac occlusion as the result of a fall. Atherosclerotic disease may be present in young asymptomatic individuals and may be a predisposing factor for aortic intimal tearing. A high degree of suspicion and periodic reassessment of peripheral circulation in trauma patients are required to ensure early diagnosis of this injury.