Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1147
Jackson Martin, B. Williams, M. Otahbachi
Patients with end-stage renal disease are at increased risk for the development of uremic pericarditis or dialysis-associated pericarditis, and either comorbidity can be complicated by pericardial effusion. Patients with end-stage renal disease complaining of dyspnea and chest pain demand a robust differential diagnosis, which can delay an appropriate intervention. Here we describe a patient with pericarditis and hemopericardium causing symptomatic pericardial effusion.Keywords: Uremic hemopericardium, uremic pericarditis, pericardiocentesis
{"title":"Hemopericardium in chronic kidney disease: An uncommon manifestation of pericarditis with a bloody pericardial effusion","authors":"Jackson Martin, B. Williams, M. Otahbachi","doi":"10.12746/swrccc.v11i47.1147","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1147","url":null,"abstract":"Patients with end-stage renal disease are at increased risk for the development of uremic pericarditis or dialysis-associated pericarditis, and either comorbidity can be complicated by pericardial effusion. Patients with end-stage renal disease complaining of dyspnea and chest pain demand a robust differential diagnosis, which can delay an appropriate intervention. Here we describe a patient with pericarditis and hemopericardium causing symptomatic pericardial effusion.Keywords: Uremic hemopericardium, uremic pericarditis, pericardiocentesis","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"363 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76552734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1159
G. Berdine
{"title":"Equity vs. Equality","authors":"G. Berdine","doi":"10.12746/swrccc.v11i47.1159","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1159","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75070704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1143
C. Guerin, Addie Pederson, Tristin Chaudhury, K. Freedman, Coby Ray
This case report describes a patient with uncontrolled type 2 diabetes mellitus who received steroids for an outpatient infection of COVID-19. The steroid course combined with his acute illness likely contributed to his development of extremely high blood sugar levels (790 mg/dL) and subsequent hyperosmolar hyperglycemic syndrome. In this compromised state, he contracted invasive mucormycosis of the right sinuses and right orbit. This fungal infection caused him to lose his eye and, later, his life. Prescribing systemic steroids comes with many risks. Providers must be careful to use them only when absolutely indicated, especially in patients who are vulnerable to complications, such as those with uncontrolled type 2 diabetes. This case is a grim example of the dangers that can occur with systemic steroid usage.
{"title":"A disfiguring and fatal case of mucormycosis after dexamethasone treatment for a COVID-19 infection","authors":"C. Guerin, Addie Pederson, Tristin Chaudhury, K. Freedman, Coby Ray","doi":"10.12746/swrccc.v11i47.1143","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1143","url":null,"abstract":"This case report describes a patient with uncontrolled type 2 diabetes mellitus who received steroids for an outpatient infection of COVID-19. The steroid course combined with his acute illness likely contributed to his development of extremely high blood sugar levels (790 mg/dL) and subsequent hyperosmolar hyperglycemic syndrome. In this compromised state, he contracted invasive mucormycosis of the right sinuses and right orbit. This fungal infection caused him to lose his eye and, later, his life. Prescribing systemic steroids comes with many risks. Providers must be careful to use them only when absolutely indicated, especially in patients who are vulnerable to complications, such as those with uncontrolled type 2 diabetes. This case is a grim example of the dangers that can occur with systemic steroid usage.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75867235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1155
C. Peralta, J. Ramos
Traumatic chylothorax most commonly occurs after thoracic surgeries with a few cases reported in patients after abdominal surgery. Effusions usually are caused by a pleural reaction during the postoperative period. However, this can also occur from disruption of the thoracic duct during the surgical procedure. The initial approach is conservative with supportive measures, including drainage by ultrasound-guided thoracentesis and diet modification, and surgery is rarely needed. Having a medical history preceding abdominal surgery is always important to consider the possibility of a pancreatic pleural fistula, which can be excluded by an abdominal computed tomography. Lymphangiography is considered the gold standard diagnostic tool, but its use is limited to cases unresponsive to conservative measures. In this patient, a lymphangiography or surgical intervention was not performed since the patient improved after initial management with no recurrent pleural effusion. A new pleural effusion after abdominal surgery must include chylothorax in the differential diagnosis.Keywords: Traumatic chylothorax, hiatal hernia repair, thoracic duct, lymphangiography, abdominal computed tomography
{"title":"Milky fluid from where? You are about to find out…","authors":"C. Peralta, J. Ramos","doi":"10.12746/swrccc.v11i47.1155","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1155","url":null,"abstract":"Traumatic chylothorax most commonly occurs after thoracic surgeries with a few cases reported in patients after abdominal surgery. Effusions usually are caused by a pleural reaction during the postoperative period. However, this can also occur from disruption of the thoracic duct during the surgical procedure. The initial approach is conservative with supportive measures, including drainage by ultrasound-guided thoracentesis and diet modification, and surgery is rarely needed. Having a medical history preceding abdominal surgery is always important to consider the possibility of a pancreatic pleural fistula, which can be excluded by an abdominal computed tomography. Lymphangiography is considered the gold standard diagnostic tool, but its use is limited to cases unresponsive to conservative measures. In this patient, a lymphangiography or surgical intervention was not performed since the patient improved after initial management with no recurrent pleural effusion. A new pleural effusion after abdominal surgery must include chylothorax in the differential diagnosis.Keywords: Traumatic chylothorax, hiatal hernia repair, thoracic duct, lymphangiography, abdominal computed tomography","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84453029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1179
M. Ansari, Aliakbar Arvandi, Marina Iskandir, Geoff Thomas, A. Pham, Ardalan Naghian, Cole Pollina, Anthony Bruccoliere, Elwin Rutayomba, Steven Daley, Victoria Acosta, Lewis Kelly, Kanishka Goel, Dixon Santana, John Griswold, S. Shurmur, Steven Berk
Peripheral arterial disease (PAD) is a clinical manifestation of atherosclerosis, affecting primarily the peripheral vasculature in the lower extremities. In its terminal form, PAD can result in critical limb ischemia with subsequent amputation if inappropriately managed. As the prevalence of PAD continues to rise in the United States, disparities in its incidence and treatment have become a major focus point of cardiovascular research. However, most research efforts thus far have focused on the presentation and treatment of PAD in men. Given that women appear to be just as affected by PAD as men, more emphasis is needed on understanding the disparities and challenges affecting women with PAD. This paper aims to identify disparities in the treatment of PAD between males and females, with a closer look at gender disparities between Hispanic and non-Hispanic patients. Keywords: Peripheral arterial disease, women, Hispanics, disparities
{"title":"The impact of gender on differences in the diagnosis of peripheral arterial disease: the staggering effects of social determinants seen highest in women","authors":"M. Ansari, Aliakbar Arvandi, Marina Iskandir, Geoff Thomas, A. Pham, Ardalan Naghian, Cole Pollina, Anthony Bruccoliere, Elwin Rutayomba, Steven Daley, Victoria Acosta, Lewis Kelly, Kanishka Goel, Dixon Santana, John Griswold, S. Shurmur, Steven Berk","doi":"10.12746/swrccc.v11i47.1179","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1179","url":null,"abstract":"Peripheral arterial disease (PAD) is a clinical manifestation of atherosclerosis, affecting primarily the peripheral vasculature in the lower extremities. In its terminal form, PAD can result in critical limb ischemia with subsequent amputation if inappropriately managed. As the prevalence of PAD continues to rise in the United States, disparities in its incidence and treatment have become a major focus point of cardiovascular research. However, most research efforts thus far have focused on the presentation and treatment of PAD in men. Given that women appear to be just as affected by PAD as men, more emphasis is needed on understanding the disparities and challenges affecting women with PAD. This paper aims to identify disparities in the treatment of PAD between males and females, with a closer look at gender disparities between Hispanic and non-Hispanic patients. \u0000 \u0000Keywords: Peripheral arterial disease, women, Hispanics, disparities","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83370564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1177
Aliakbar Arvandi, Anthony Bruccoliere, Cole Pollina, Elwin Rutayomba, Marina Iskandir, Jason B Wischmeyer, L. Jenkins, S. Shurmur, M. Ansari
Introduction: In May 2022, there was a worldwide shortage of contrast, including Iodine 270 mg/mL Visipaque/Iodixanol Injection. Due to the severe shortage, our catheterization lab had depleted its stores of Iodine 270 mg/mL Visipaque and could only acquire the Iodine 320 mg/mL Visipaque/Iodixanol Injection. Following the switch, a subset of our patients began experiencing similar severe and some life-threatening adverse reactions that could not be attributed to other causes.Methods: A retrospective review of all adverse reactions from interventional procedures performed with the new contrast in September 2022 and October 2022 was collected. Patient demographics, allergies, comorbidities, medications used (including sedation), adverse reactions, and type of contrast formulation were recorded and analyzed.Results: Seven cases were identified using the Iodine 320 mg/mL Visipaque/Iodixanol Injection contrast with dilution done as per procedure. No other change was adopted in either medication used or procedure. Three patients experienced post-procedural nausea and vomiting. One patient with no psychological history experienced brief but extreme agitation and aggression. Five patients required overnight admission due to severe postoperative shivering. Two of these patients required urgent warming measures, and one patient recorded a life-threatening temperature, requiring drastic cooling measures. In addition, one patient (patient 3) was readmitted to ICU with high-grade fever and chills. The common factor in all patients was the development of shivering a few hours after administration of the new contrast. All patients recovered after receiving medications to treat symptoms and hypertension.Conclusion: Our review identified several adverse reaction cases over the course of a couple months immediately following the change in contrast used. Once the supply of the original Iodine 270 mg/mL Iodixanol Injection was restored, adverse reactions ceased, and none occurred in the following months. Disruptions in the supply chain imposed by COVID-19 forced departure from preferred methods and adaptation to maintain continuity of care. Even as the worst of the global pandemic is over, health care providers must continue to be proactive and adaptive to the long-term disruptions of health care caused by the ripple effects of COVID-19. Key words: COVID-19, angiography, contrast agents, adverse reactions
{"title":"Impact of COVID-19 on a cardiac catheterization lab in the post-COVID-19 era","authors":"Aliakbar Arvandi, Anthony Bruccoliere, Cole Pollina, Elwin Rutayomba, Marina Iskandir, Jason B Wischmeyer, L. Jenkins, S. Shurmur, M. Ansari","doi":"10.12746/swrccc.v11i47.1177","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1177","url":null,"abstract":"Introduction: In May 2022, there was a worldwide shortage of contrast, including Iodine 270 mg/mL Visipaque/Iodixanol Injection. Due to the severe shortage, our catheterization lab had depleted its stores of Iodine 270 mg/mL Visipaque and could only acquire the Iodine 320 mg/mL Visipaque/Iodixanol Injection. Following the switch, a subset of our patients began experiencing similar severe and some life-threatening adverse reactions that could not be attributed to other causes.Methods: A retrospective review of all adverse reactions from interventional procedures performed with the new contrast in September 2022 and October 2022 was collected. Patient demographics, allergies, comorbidities, medications used (including sedation), adverse reactions, and type of contrast formulation were recorded and analyzed.Results: Seven cases were identified using the Iodine 320 mg/mL Visipaque/Iodixanol Injection contrast with dilution done as per procedure. No other change was adopted in either medication used or procedure. Three patients experienced post-procedural nausea and vomiting. One patient with no psychological history experienced brief but extreme agitation and aggression. Five patients required overnight admission due to severe postoperative shivering. Two of these patients required urgent warming measures, and one patient recorded a life-threatening temperature, requiring drastic cooling measures. In addition, one patient (patient 3) was readmitted to ICU with high-grade fever and chills. The common factor in all patients was the development of shivering a few hours after administration of the new contrast. All patients recovered after receiving medications to treat symptoms and hypertension.Conclusion: Our review identified several adverse reaction cases over the course of a couple months immediately following the change in contrast used. Once the supply of the original Iodine 270 mg/mL Iodixanol Injection was restored, adverse reactions ceased, and none occurred in the following months. Disruptions in the supply chain imposed by COVID-19 forced departure from preferred methods and adaptation to maintain continuity of care. Even as the worst of the global pandemic is over, health care providers must continue to be proactive and adaptive to the long-term disruptions of health care caused by the ripple effects of COVID-19. \u0000Key words: COVID-19, angiography, contrast agents, adverse reactions","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77797075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1153
Pragati Basera, T. Singh, T. Haque
{"title":"Rounded atelectasis","authors":"Pragati Basera, T. Singh, T. Haque","doi":"10.12746/swrccc.v11i47.1153","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1153","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85135026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1167
Jesse York, K. Nugent
Supportive care with mechanical ventilation is the cornerstone of management for acute respiratory distress syndrome (ARDS). Positive end-expiratory pressure (PEEP) is often applied in mechanically ventilated patients with ARDS to improve oxygenation; however, determining the optimal PEEP level—the pressure that maximizes clinical benefit while minimizing risks of ventilator-induced lung injury and other harms—for each patient can be challenging. Recently, transthoracic lung ultrasonography (also called lung ultrasound) has been proposed as a tool to guide PEEP determination in patients with ARDS. This paper reviews the history of use of lung ultrasound as a method to guide PEEP determination and the four published studies which compared it to other techniques of PEEP determination, such as the oxygenation and PV-curve methods.
{"title":"Using lung ultrasound to guide PEEP determination in mechanically ventilated patients with acute respiratory distress syndrome","authors":"Jesse York, K. Nugent","doi":"10.12746/swrccc.v11i47.1167","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1167","url":null,"abstract":" Supportive care with mechanical ventilation is the cornerstone of management for acute respiratory distress syndrome (ARDS). Positive end-expiratory pressure (PEEP) is often applied in mechanically ventilated patients with ARDS to improve oxygenation; however, determining the optimal PEEP level—the pressure that maximizes clinical benefit while minimizing risks of ventilator-induced lung injury and other harms—for each patient can be challenging. Recently, transthoracic lung ultrasonography (also called lung ultrasound) has been proposed as a tool to guide PEEP determination in patients with ARDS. This paper reviews the history of use of lung ultrasound as a method to guide PEEP determination and the four published studies which compared it to other techniques of PEEP determination, such as the oxygenation and PV-curve methods.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77109268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-25DOI: 10.12746/swrccc.v11i47.1157
G. Del Rio-Pertuz, B. Rogers, A. Lahoti, L. Jenkins
Compartment syndrome is a very rare but possibly devastating complication of coronary angiography when a trans-radial approach is used. The trans-ulnar approach is an attractive option in cases with anatomic variations of the radial artery or weak radial pulses. Even though it is expected that the trans-ulnar approach has a similar risk of developing compartment syndrome like trans-radial approach, the literature does not have many case reports describing this complication. Here we report a case of a woman who developed forearm compartment syndrome after trans-ulnar coronary intervention in the setting of ST-segment elevation myocardial infarction.
{"title":"Forearm compartment syndrome after a trans-ulnar coronary intervention in a patient with ST segment elevation myocardial infarction","authors":"G. Del Rio-Pertuz, B. Rogers, A. Lahoti, L. Jenkins","doi":"10.12746/swrccc.v11i47.1157","DOIUrl":"https://doi.org/10.12746/swrccc.v11i47.1157","url":null,"abstract":"Compartment syndrome is a very rare but possibly devastating complication of coronary angiography when a trans-radial approach is used. The trans-ulnar approach is an attractive option in cases with anatomic variations of the radial artery or weak radial pulses. Even though it is expected that the trans-ulnar approach has a similar risk of developing compartment syndrome like trans-radial approach, the literature does not have many case reports describing this complication. Here we report a case of a woman who developed forearm compartment syndrome after trans-ulnar coronary intervention in the setting of ST-segment elevation myocardial infarction.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81320932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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