Pub Date : 2021-10-15DOI: 10.26420/austincritcarecaserep.2021.1033
R. S., L. Y., Hao G, L. L., S. L, Z. H
Introduction: Severe COVID-19 can cause multiple organ dysfunction or failure, often associated with cardiac dysfunction, known as stress cardiomyopathy or apical spherical syndrome. Patient Concerns: Severe COVID-19 patients in Hebei province have 5 cases of stress cardiomyopathy. Two cases in Cangzhou are summarized from Feb 2020 to May 2020. Diagnosis: Based on the precipitating factor, pathophysiology, Mayo diagnostic criteria and differential diagnosis of stress cardiomyopathy, the patients were diagnosed with stress cardiomyopathy, which is characterized by elevated biomarkers, hemodynamic instability, and cardiomyopathy. Interventions: Early and dynamic monitoring of ECG, myocardial enzymes, cardiac troponin and echocardiography are needed to predict and assess the risk of stress-induced cardiomyopathy. Noradrenaline and dobutamine were continued to be given, and neokine, levosimendan, Cediland and other drugs were given successively to strengthen the heart. Outcomes: After several days of supportive care, the patients’s cardiac output and the apical movement were gradually improved. Conclusion: Reversible stress cardiomyopathy may occur in the setting of COVID-19 infection with elevated cardiac biomarkers and an abnormal ECG and echocardiographic. We should pay more attention to the treatment of stress cardiomyopathy.
{"title":"Covid-19 Combined with Stress Cardiomyopathy: Case Report and Review of the Literature","authors":"R. S., L. Y., Hao G, L. L., S. L, Z. H","doi":"10.26420/austincritcarecaserep.2021.1033","DOIUrl":"https://doi.org/10.26420/austincritcarecaserep.2021.1033","url":null,"abstract":"Introduction: Severe COVID-19 can cause multiple organ dysfunction or failure, often associated with cardiac dysfunction, known as stress cardiomyopathy or apical spherical syndrome. Patient Concerns: Severe COVID-19 patients in Hebei province have 5 cases of stress cardiomyopathy. Two cases in Cangzhou are summarized from Feb 2020 to May 2020. Diagnosis: Based on the precipitating factor, pathophysiology, Mayo diagnostic criteria and differential diagnosis of stress cardiomyopathy, the patients were diagnosed with stress cardiomyopathy, which is characterized by elevated biomarkers, hemodynamic instability, and cardiomyopathy. Interventions: Early and dynamic monitoring of ECG, myocardial enzymes, cardiac troponin and echocardiography are needed to predict and assess the risk of stress-induced cardiomyopathy. Noradrenaline and dobutamine were continued to be given, and neokine, levosimendan, Cediland and other drugs were given successively to strengthen the heart. Outcomes: After several days of supportive care, the patients’s cardiac output and the apical movement were gradually improved. Conclusion: Reversible stress cardiomyopathy may occur in the setting of COVID-19 infection with elevated cardiac biomarkers and an abnormal ECG and echocardiographic. We should pay more attention to the treatment of stress cardiomyopathy.","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124809781","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 : 2021-09-30DOI: 10.26420/austincritcarecaserep.2021.1032
Khadzhynov D, Slowinski T, Schreiber A, Lieker I, H. F., Lehner Lj, Kindgen-Milles D, Eckardt K-U, Budde K, Staeck O
Objective: Regional Citrate Anticoagulation (RCA) for Continuous Renal Replacement Therapy (CRRT) is widely used and leads to an excellent clottingfree filter survival. Despite strict adherence to protocols, in some cases recurrent early filter-clotting occurs. The aim of this observational study was to evaluate the underlying causes and the efficacy of interventions in patients with early recurrent filter-clotting during RCA. Methods: In a retrospective analysis of a cohort of 1183 patients treated with RCA-CRRT we detected 12 patients with early filter-clotting unrelated to protocol violation or any obvious technical or medical reason. Results: All patients were systemically anticoagulated with low molecular weight or unfractionated heparin for at least 24h before initiation of Continuous Veno-Venous Hemodialysis with RCA (RCA-CVVHD). During RCA, all postfilter ionized calcium concentrations were in the target range (mean 0.33±0.05 mmol/L). At the time of the first clotting event, thrombocyte counts were 168±66/ nL. After the clotting events, the systemic anticoagulation was switched to argatroban in all patients. With systemic anticoagulation using argatroban filter lifetime of RCA-CVVHD increased significantly (p<0.001) and clotting-events decreased from 0.61 to 0.10 per 24h. All patients were tested for HIT and 5/12 (42%) had a positive test for hep-PF4-antibodies. Application of argatroban significantly reduced early filter-clotting both in HIT-positive patients as well as in HIT-negative patients. At the time of the first clotting event, no patient had clinical signs of thrombosis or thromboembolism. However, during follow up a thromboembolic event occurred in three patients. Conclusion: In patients with recurrent early filter-clotting despite strict adherence to the citrate protocol undetected HIT or other causes of thrombin activation may be present. Therefore, patients with recurrent early filter clotting in RCA-CVVHD should be screened for HIT or other conditions that may activate thrombin. A significant improvement of filter run-time can be achieved by systemic administration of a thrombin inhibitor both in patients with and without HIT.
{"title":"Recurrent Early Filter Clotting during Continuous Veno-Venous Hemodialysis with Regional Citrate Anticoagulation is Linked to Systemic Thrombin Generation and Heparin Induced Thrombocytopenia Type II: A Retrospective Analysis","authors":"Khadzhynov D, Slowinski T, Schreiber A, Lieker I, H. F., Lehner Lj, Kindgen-Milles D, Eckardt K-U, Budde K, Staeck O","doi":"10.26420/austincritcarecaserep.2021.1032","DOIUrl":"https://doi.org/10.26420/austincritcarecaserep.2021.1032","url":null,"abstract":"Objective: Regional Citrate Anticoagulation (RCA) for Continuous Renal Replacement Therapy (CRRT) is widely used and leads to an excellent clottingfree filter survival. Despite strict adherence to protocols, in some cases recurrent early filter-clotting occurs. The aim of this observational study was to evaluate the underlying causes and the efficacy of interventions in patients with early recurrent filter-clotting during RCA. Methods: In a retrospective analysis of a cohort of 1183 patients treated with RCA-CRRT we detected 12 patients with early filter-clotting unrelated to protocol violation or any obvious technical or medical reason. Results: All patients were systemically anticoagulated with low molecular weight or unfractionated heparin for at least 24h before initiation of Continuous Veno-Venous Hemodialysis with RCA (RCA-CVVHD). During RCA, all postfilter ionized calcium concentrations were in the target range (mean 0.33±0.05 mmol/L). At the time of the first clotting event, thrombocyte counts were 168±66/ nL. After the clotting events, the systemic anticoagulation was switched to argatroban in all patients. With systemic anticoagulation using argatroban filter lifetime of RCA-CVVHD increased significantly (p<0.001) and clotting-events decreased from 0.61 to 0.10 per 24h. All patients were tested for HIT and 5/12 (42%) had a positive test for hep-PF4-antibodies. Application of argatroban significantly reduced early filter-clotting both in HIT-positive patients as well as in HIT-negative patients. At the time of the first clotting event, no patient had clinical signs of thrombosis or thromboembolism. However, during follow up a thromboembolic event occurred in three patients. Conclusion: In patients with recurrent early filter-clotting despite strict adherence to the citrate protocol undetected HIT or other causes of thrombin activation may be present. Therefore, patients with recurrent early filter clotting in RCA-CVVHD should be screened for HIT or other conditions that may activate thrombin. A significant improvement of filter run-time can be achieved by systemic administration of a thrombin inhibitor both in patients with and without HIT.","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132523445","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 : 2021-09-06DOI: 10.26420/austincritcarecaserep/2021.1031
Yazdanpanah F, A. R., C. J.
The pandemic of Coronavirus Disease 2019 (COVID-19) has created many problems in the entire world whether the disease itself, whether fighting back with limited treatment options and prevention tools. Owing to the escalating daily death rates from COVID-19, the development of a vaccine against this new disease was quite fast that the first authorized vaccine got approval less than a year after the onset of the pandemic. Data report different side effects of new COVID-19 vaccines including venous and arterial thrombotic events, vaccine-induced prothrombotic immune thrombocytopenia, vaccine-induced thrombosis with thrombocytopenia, and immune thrombocytopenia. Our case report highlights bilateral pulmonary embolism, six days after the first dose of the COVID-19 mRNA vaccine (Moderna) in a healthy gentleman.
{"title":"COVID-19 Moderna Vaccine and Bilateral Pulmonary Embolism: Case Report","authors":"Yazdanpanah F, A. R., C. J.","doi":"10.26420/austincritcarecaserep/2021.1031","DOIUrl":"https://doi.org/10.26420/austincritcarecaserep/2021.1031","url":null,"abstract":"The pandemic of Coronavirus Disease 2019 (COVID-19) has created many problems in the entire world whether the disease itself, whether fighting back with limited treatment options and prevention tools. Owing to the escalating daily death rates from COVID-19, the development of a vaccine against this new disease was quite fast that the first authorized vaccine got approval less than a year after the onset of the pandemic. Data report different side effects of new COVID-19 vaccines including venous and arterial thrombotic events, vaccine-induced prothrombotic immune thrombocytopenia, vaccine-induced thrombosis with thrombocytopenia, and immune thrombocytopenia. Our case report highlights bilateral pulmonary embolism, six days after the first dose of the COVID-19 mRNA vaccine (Moderna) in a healthy gentleman.","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128077156","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 : 2021-07-05DOI: 10.26420/austincritcarecaserep/2021.1029
W. W, S. D., L. X, Xie H
A 46-year-old white man, presented to the emergency department with backache for 2 weeks, which aggravated with right upper abdominal pain for 1 day without fever. He was homosexual with normal dietary habits and no history of alcoholism or smoking. Contrast-enhanced CT showed a huge mass with several smaller masses underneath occupying the right lobe of liver, with large amount of abdominal and pelvic effusion. The huge liver abscess was punctured under the guidance of bedside ultrasound, and the punctured fluid was also like “anchovy sauce” (a total of 2620ml). The mNGS of the pus near the wall of the abscess cavity showed Entamoeba histolytica. An amoebic liver abscess was diagnosed. The patient’s condition was stable after metronidazole administration and drainage of pus. He was hospitalized in the ICU for 18 days and for another 24 days in the general ward of the hospital. The results obtained in this case highlights that the use of mNGS for rapid diagnosis of huge and ruptured amebic liver abscess in non-endemic areas without capability of serologic tests.
{"title":"Huge and Ruptured Amoebic Liver Abscess Diagnosed by Metagenomic Next-Generation Sequencing","authors":"W. W, S. D., L. X, Xie H","doi":"10.26420/austincritcarecaserep/2021.1029","DOIUrl":"https://doi.org/10.26420/austincritcarecaserep/2021.1029","url":null,"abstract":"A 46-year-old white man, presented to the emergency department with backache for 2 weeks, which aggravated with right upper abdominal pain for 1 day without fever. He was homosexual with normal dietary habits and no history of alcoholism or smoking. Contrast-enhanced CT showed a huge mass with several smaller masses underneath occupying the right lobe of liver, with large amount of abdominal and pelvic effusion. The huge liver abscess was punctured under the guidance of bedside ultrasound, and the punctured fluid was also like “anchovy sauce” (a total of 2620ml). The mNGS of the pus near the wall of the abscess cavity showed Entamoeba histolytica. An amoebic liver abscess was diagnosed. The patient’s condition was stable after metronidazole administration and drainage of pus. He was hospitalized in the ICU for 18 days and for another 24 days in the general ward of the hospital. The results obtained in this case highlights that the use of mNGS for rapid diagnosis of huge and ruptured amebic liver abscess in non-endemic areas without capability of serologic tests.","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125948765","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 : 2021-06-28DOI: 10.26420/austincritcarecaserep/2021.1028
S. Fandel, M. Jahn, F. Herbstreit, A. Kribben, T. Brenner, K. Schmidt
Liver impairment is frequently reported in Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infected patients and contributes to increased morbidity and mortality in critically ill Coronavirus disease-2019 (COVID-19) patients. We report of a 44-year-old male patient with hypoxic and cholestatic liver failure after an initially complicated course of COVID-19 pneumonia with moderate Acute Respiratory Distress Syndrome (ARDS), Acute Kidney Injury (AKI) stage 3 with Kidney Replacement Therapy (KRT), thromboembolic intestinal ischemia with subtotal colectomy and partial resection of the small intestine and septic shock. After considerable clinical improvement we initiated extracorporeal liver support due to progressive hyperbilirubinemia up to 25,3 mg/dl. Within 17 days we conducted 11 sessions of extracorporeal liver support by Fractionated Plasma Separation and Adsorption (FPSA; Prometheus®) until stabilization of liver function occurred. After 52 days of intensive care treatment and successful weaning from ventilation and KRT, the patient was transferred to an Intermediate Care (IMC) unit. To the best of our knowledge, this is the first report of a COVID-19 patient successfully treated with prolonged extracorporeal liver support. Extracorporeal procedures that support liver function should be considered as bridging to recovery in selected COVID-19 patients if liver failure presents a dominant organ dysfunction.
{"title":"Successful Bridging to Recovery Using the Prometheus® Liver Support in a Critical Ill COVID-19 Patient with Acute Liver Failure: A Case Report","authors":"S. Fandel, M. Jahn, F. Herbstreit, A. Kribben, T. Brenner, K. Schmidt","doi":"10.26420/austincritcarecaserep/2021.1028","DOIUrl":"https://doi.org/10.26420/austincritcarecaserep/2021.1028","url":null,"abstract":"Liver impairment is frequently reported in Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infected patients and contributes to increased morbidity and mortality in critically ill Coronavirus disease-2019 (COVID-19) patients. We report of a 44-year-old male patient with hypoxic and cholestatic liver failure after an initially complicated course of COVID-19 pneumonia with moderate Acute Respiratory Distress Syndrome (ARDS), Acute Kidney Injury (AKI) stage 3 with Kidney Replacement Therapy (KRT), thromboembolic intestinal ischemia with subtotal colectomy and partial resection of the small intestine and septic shock. After considerable clinical improvement we initiated extracorporeal liver support due to progressive hyperbilirubinemia up to 25,3 mg/dl. Within 17 days we conducted 11 sessions of extracorporeal liver support by Fractionated Plasma Separation and Adsorption (FPSA; Prometheus®) until stabilization of liver function occurred. After 52 days of intensive care treatment and successful weaning from ventilation and KRT, the patient was transferred to an Intermediate Care (IMC) unit. To the best of our knowledge, this is the first report of a COVID-19 patient successfully treated with prolonged extracorporeal liver support. Extracorporeal procedures that support liver function should be considered as bridging to recovery in selected COVID-19 patients if liver failure presents a dominant organ dysfunction.","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121564283","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 : 2021-05-14DOI: 10.26420/austincritcarecaserep.2021.1027
K. Hirayama, T. Kuroshima, M. Okada, M. Nakayama, E. Miyano, M. Sugawara, K. Hayashi, Y. Horikoshi, D. Kawata, S akauji, N. Kokita, Yamamoto Ai, S. Fujita
Group G Streptococcus (GGS) causes toxic shock syndrome. Its incidence has been increasing in the elderly in recent years. The case is a female patient in her 60s, with rheumatoid arthritis, who developed necrotizing fasciitis in her right thigh. We administered antibacterial agents and debridement frequently at an early stage, followed by aggressive high-protein enteral nutrition and multidisciplinary treatment. During the course of treatment, the patient’s general condition temporarily deteriorated because of fecal contamination. We considered amputation of the lower limb and implantation of a stoma, but finally succeeded in preserving the limb by performing two skin grafts. The patient was able to walk and was discharged on day 66. GGS infection is a risk factor for elderly patients with underlying diseases such as malignancy or immunocompromised states. When necrotizing fasciitis due to fulminant streptococcal infection develops in a proximal limb, amputation of the limb is often necessary to save the patient’s life. In this case, a fulminant GGS infection developed in an immunocompromised patient with active rheumatoid arthritis. Although the risk of limb amputation was high, multidisciplinary treatment enabled functional preservation of the affected limb.
{"title":"A Case of Necrotizing Fasciitis due to Group G Streptococcus with Amputation Avoided of the Affected Limb","authors":"K. Hirayama, T. Kuroshima, M. Okada, M. Nakayama, E. Miyano, M. Sugawara, K. Hayashi, Y. Horikoshi, D. Kawata, S akauji, N. Kokita, Yamamoto Ai, S. Fujita","doi":"10.26420/austincritcarecaserep.2021.1027","DOIUrl":"https://doi.org/10.26420/austincritcarecaserep.2021.1027","url":null,"abstract":"Group G Streptococcus (GGS) causes toxic shock syndrome. Its incidence has been increasing in the elderly in recent years. The case is a female patient in her 60s, with rheumatoid arthritis, who developed necrotizing fasciitis in her right thigh. We administered antibacterial agents and debridement frequently at an early stage, followed by aggressive high-protein enteral nutrition and multidisciplinary treatment. During the course of treatment, the patient’s general condition temporarily deteriorated because of fecal contamination. We considered amputation of the lower limb and implantation of a stoma, but finally succeeded in preserving the limb by performing two skin grafts. The patient was able to walk and was discharged on day 66. GGS infection is a risk factor for elderly patients with underlying diseases such as malignancy or immunocompromised states. When necrotizing fasciitis due to fulminant streptococcal infection develops in a proximal limb, amputation of the limb is often necessary to save the patient’s life. In this case, a fulminant GGS infection developed in an immunocompromised patient with active rheumatoid arthritis. Although the risk of limb amputation was high, multidisciplinary treatment enabled functional preservation of the affected limb.","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117114900","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 : 2021-03-02DOI: 10.26420/AUSTINCRITCARECASEREP.2021.1024
A. Ego, O. Lheureux, J. CreteurJacques
We present a case of patient with spontaneous cardiac tamponade related to a very high 2-plasma concentration of dabigatran, an oral direct-acting thrombin inhibitor. By selectively inhibiting thrombin alone, dabigatran may have antithrombotic efficacy while preserving some other hemostatic mechanisms in the coagulation system and thus potentially mitigating the risk of bleeding. Nonetheless, serious bleeding can occur with dabigatran. We illustrate the management of this life threatening hemorrhagic complication by the combination of cardiac surgery, antagonization of the anticoagulant effect (using Idarucizumab, an humanized monoclonal antibody fragment and continuous renal replacement therapy), and monitoring of the effects on coagulation by thromboelastogram.
{"title":"Managing Life-Threatening Bleeding in Patient with High Plasma Concentration of Dabigatran with Thromboelastogram, Idarucizumab and Renal Replacement Therapy","authors":"A. Ego, O. Lheureux, J. CreteurJacques","doi":"10.26420/AUSTINCRITCARECASEREP.2021.1024","DOIUrl":"https://doi.org/10.26420/AUSTINCRITCARECASEREP.2021.1024","url":null,"abstract":"We present a case of patient with spontaneous cardiac tamponade related to a very high 2-plasma concentration of dabigatran, an oral direct-acting thrombin inhibitor. By selectively inhibiting thrombin alone, dabigatran may have antithrombotic efficacy while preserving some other hemostatic mechanisms in the coagulation system and thus potentially mitigating the risk of bleeding. Nonetheless, serious bleeding can occur with dabigatran. We illustrate the management of this life threatening hemorrhagic complication by the combination of cardiac surgery, antagonization of the anticoagulant effect (using Idarucizumab, an humanized monoclonal antibody fragment and continuous renal replacement therapy), and monitoring of the effects on coagulation by thromboelastogram.","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114707139","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 : 2021-03-02DOI: 10.26420/AUSTINCRITCARECASEREP.2021.1023
Bastanhagh E, Behseresht A
Pain in the process of childbirth is the phenomenon mostly feared by every woman in her pregnancy, and is a major cause of dissatisfaction and embarrassing memories of labor. Usage of lumbar epidural analgesia as a very effective pain management option has solved this problem to a great extent, and its utilization has turned to common practice in most of the women hospitals worldwide. The use of lumbar epidural analgesia in labor is widespread due to its benefits in terms of effective pain relief in comparison with other labor pain treatment options [1]. Vaginal delivery is an extremely painful process accompanied with great emotional disturbance, which may not be possible for the laboring mother to focus and concentrate to understand the anesthetist explanations at that moment and sign the epidural analgesia informed consent properly. On one hand, the laboring mother expresses doubts because of uncertainty on her decision and on the other hand she desperately wants to get rid of the excruciating labor pain by any means possible. Therefore, the decision to have a neuraxial analgesia (epidural, combined spinal epidural) sounds obligatory on this condition. Each of these analgesic methods beside desirable effectiveness in pain management may have some side effects and it is obvious that each complication takes lots of time and patiently concentration for the mother to be precisely understood and the decision making is even beyond of it. Decision making process cannot get precisely completed just in labor time, so free of any upcoming complication, informed consent may not be ethically verified on labor time. Decision making capacity is a complex mental process involving both cognitive and emotional components. Sometimes this complex action is reduced to “understanding” alone. There are uncertainties about decision-making capacity (mental competence) of women in labor in relation to giving informed consent to neuraxial analgesia. Considering these parameters, sufficient information about pain management methods (advantages, side effects, the way each procedure is conducted) should be provided as part of prenatal education and the consent process must be carefully conducted to enhance mothers’ autonomy [2]. To utilize effective methods for presenting the mothers with (like multimedia modules, recorded video of the sample procedure and so on) in late pregnancy should be considered to achieve better understanding and right decision. Patient decision aids are beneficial in clinical anesthesia and studies have shown that patients feel better informed, have better knowledge, and have less anxiety, depression and decisional conflicts after using this method [3]. It has been demonstrated that using decision aids prior to the procedure can significantly reduce the decision conflict, and improve both autonomy and outcome as a united benefit in favor of laboring mothers [4]. It seems that pain-relieving methods (neuraxial and other treatment options) should be
{"title":"Informed Consent for Epidural Analgesia at the Time of Labor Pain, Seems Too Late!","authors":"Bastanhagh E, Behseresht A","doi":"10.26420/AUSTINCRITCARECASEREP.2021.1023","DOIUrl":"https://doi.org/10.26420/AUSTINCRITCARECASEREP.2021.1023","url":null,"abstract":"Pain in the process of childbirth is the phenomenon mostly feared by every woman in her pregnancy, and is a major cause of dissatisfaction and embarrassing memories of labor. Usage of lumbar epidural analgesia as a very effective pain management option has solved this problem to a great extent, and its utilization has turned to common practice in most of the women hospitals worldwide. The use of lumbar epidural analgesia in labor is widespread due to its benefits in terms of effective pain relief in comparison with other labor pain treatment options [1]. Vaginal delivery is an extremely painful process accompanied with great emotional disturbance, which may not be possible for the laboring mother to focus and concentrate to understand the anesthetist explanations at that moment and sign the epidural analgesia informed consent properly. On one hand, the laboring mother expresses doubts because of uncertainty on her decision and on the other hand she desperately wants to get rid of the excruciating labor pain by any means possible. Therefore, the decision to have a neuraxial analgesia (epidural, combined spinal epidural) sounds obligatory on this condition. Each of these analgesic methods beside desirable effectiveness in pain management may have some side effects and it is obvious that each complication takes lots of time and patiently concentration for the mother to be precisely understood and the decision making is even beyond of it. Decision making process cannot get precisely completed just in labor time, so free of any upcoming complication, informed consent may not be ethically verified on labor time. Decision making capacity is a complex mental process involving both cognitive and emotional components. Sometimes this complex action is reduced to “understanding” alone. There are uncertainties about decision-making capacity (mental competence) of women in labor in relation to giving informed consent to neuraxial analgesia. Considering these parameters, sufficient information about pain management methods (advantages, side effects, the way each procedure is conducted) should be provided as part of prenatal education and the consent process must be carefully conducted to enhance mothers’ autonomy [2]. To utilize effective methods for presenting the mothers with (like multimedia modules, recorded video of the sample procedure and so on) in late pregnancy should be considered to achieve better understanding and right decision. Patient decision aids are beneficial in clinical anesthesia and studies have shown that patients feel better informed, have better knowledge, and have less anxiety, depression and decisional conflicts after using this method [3]. It has been demonstrated that using decision aids prior to the procedure can significantly reduce the decision conflict, and improve both autonomy and outcome as a united benefit in favor of laboring mothers [4]. It seems that pain-relieving methods (neuraxial and other treatment options) should be","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127719249","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 : 2021-02-12DOI: 10.26420/AUSTINCRITCARECASEREP.2021.1022
A. Miyoshi, Y. Ueda, K. Sato, T. Kimura
Mullerian adenosarcoma of the endometrium in adolescent girls is extremely rare, with only fifteen cases under 20 years old having been reported to date. We describe here a new case of adolescent Mullerian adenosarcoma and provide an updated review of the previous literature on such rare tumors. Our 19-year-old case presented with a six-month history of prolonged menstruation. She had not yet had any sexual relationship. On gross examination, a fragile mass was seen in her vagina that bled easily. A 4.0×2.0 cm mass was visualized with Magnetic Resonance Imaging (MRI). The tumor seemed to slightly invade the myometrium of the uterine corpus. Transvaginal ultrasound sonography confirmed the presence of a 4.0 cm mass located in the cervix and vagina. The tumor biopsy was diagnosed as a Mullerian adenosarcoma of the endometrium. We performed a Total Abdominal Hysterectomy (TAH) and Bilateral Salpingectomy (BS). The post-surgical specimen was diagnosed as a pT1aNXM0 Mullerian adenosarcoma of the endometrium. The patient did not require adjuvant chemotherapy. She has been monitored every 3 months and has been without recurrence now for 28 months.
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Pub Date : 2021-02-12DOI: 10.26420/austincritcarecaserep/2021.1022
M. A, Ueda Y, S. K, K. T.
Mullerian adenosarcoma of the endometrium in adolescent girls is extremely rare, with only fifteen cases under 20 years old having been reported to date. We describe here a new case of adolescent Mullerian adenosarcoma and provide an updated review of the previous literature on such rare tumors. Our 19-year-old case presented with a six-month history of prolonged menstruation. She had not yet had any sexual relationship. On gross examination, a fragile mass was seen in her vagina that bled easily. A 4.0×2.0 cm mass was visualized with Magnetic Resonance Imaging (MRI). The tumor seemed to slightly invade the myometrium of the uterine corpus. Transvaginal ultrasound sonography confirmed the presence of a 4.0 cm mass located in the cervix and vagina. The tumor biopsy was diagnosed as a Mullerian adenosarcoma of the endometrium. We performed a Total Abdominal Hysterectomy (TAH) and Bilateral Salpingectomy (BS). The post-surgical specimen was diagnosed as a pT1aNXM0 Mullerian adenosarcoma of the endometrium. The patient did not require adjuvant chemotherapy. She has been monitored every 3 months and has been without recurrence now for 28 months.
{"title":"Mullerian Adenosarcoma of the Endometrium in a 19-Year-Old Girl: Case Report and a Literature Review","authors":"M. A, Ueda Y, S. K, K. T.","doi":"10.26420/austincritcarecaserep/2021.1022","DOIUrl":"https://doi.org/10.26420/austincritcarecaserep/2021.1022","url":null,"abstract":"Mullerian adenosarcoma of the endometrium in adolescent girls is extremely rare, with only fifteen cases under 20 years old having been reported to date. We describe here a new case of adolescent Mullerian adenosarcoma and provide an updated review of the previous literature on such rare tumors. Our 19-year-old case presented with a six-month history of prolonged menstruation. She had not yet had any sexual relationship. On gross examination, a fragile mass was seen in her vagina that bled easily. A 4.0×2.0 cm mass was visualized with Magnetic Resonance Imaging (MRI). The tumor seemed to slightly invade the myometrium of the uterine corpus. Transvaginal ultrasound sonography confirmed the presence of a 4.0 cm mass located in the cervix and vagina. The tumor biopsy was diagnosed as a Mullerian adenosarcoma of the endometrium. We performed a Total Abdominal Hysterectomy (TAH) and Bilateral Salpingectomy (BS). The post-surgical specimen was diagnosed as a pT1aNXM0 Mullerian adenosarcoma of the endometrium. The patient did not require adjuvant chemotherapy. She has been monitored every 3 months and has been without recurrence now for 28 months.","PeriodicalId":293488,"journal":{"name":"Austin Critical Care Case Reports","volume":"177 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115210175","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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