Pub Date : 2019-08-08DOI: 10.33118/OAJ.REP.2019.01.011
N. Shah
Background: Alcohol withdrawal is a life-threatening condition characterized by a myriad of physiologic changes including tachycardia, hypertension, lowered seizure threshold, hallucinations, and potential for delirium tremens. Benzodiazepines remain the gold standard for treatment of alcohol withdrawal, although few studies have compared barbiturates to benzodiazepines as first-line treatment. Methods: This study is a single patient chart review. Results: Over the course of his hospital stay, in addition to receiving a continuous infusion of dexmedetomidine, the patient received a total of 389 mg lorazepam, 650 mg phenobarbital, 40 mg haloperidol, 25 mg quetiapine, 5 mg midazolam, and 75 mg diphenhydramine. Conclusion: Phenobarbital is an effective first line agent for management of alcohol withdrawal and may be a safer and more effective treatment with lower rates of intubation and shorter hospital stays than benzodiazepines. It is particularly successful in patients who require high doses of benzodiazepines or ICU admission. Furthermore, the role of dexmedetomidine infusions in alcohol withdrawal remains unclear but may play a critical role in mitigating tachycardia and hypertension though it poses a risk of bradycardia and hypotension. Keywords: Alcohol withdrawal, Dexmedetomidine, Precedex, Phenobarbital, Ativan, Lorazepam, CIWA, GABA channel.
{"title":"Dexmedetomidine infusions and phenobarbital in the treatment of an unusual presentation of benzodiazepine-resistant alcohol withdrawal","authors":"N. Shah","doi":"10.33118/OAJ.REP.2019.01.011","DOIUrl":"https://doi.org/10.33118/OAJ.REP.2019.01.011","url":null,"abstract":"Background: Alcohol withdrawal is a life-threatening condition characterized by a myriad of physiologic changes including tachycardia, hypertension, lowered seizure threshold, hallucinations, and potential for delirium tremens. Benzodiazepines remain the gold standard for treatment of alcohol withdrawal, although few studies have compared barbiturates to benzodiazepines as first-line treatment.\u0000Methods: This study is a single patient chart review.\u0000Results: Over the course of his hospital stay, in addition to receiving a continuous infusion of dexmedetomidine, the patient received a total of 389 mg lorazepam, 650 mg phenobarbital, 40 mg haloperidol, 25 mg quetiapine, 5 mg midazolam, and 75 mg diphenhydramine. \u0000Conclusion: Phenobarbital is an effective first line agent for management of alcohol withdrawal and may be a safer and more effective treatment with lower rates of intubation and shorter hospital stays than benzodiazepines. It is particularly successful in patients who require high doses of benzodiazepines or ICU admission. Furthermore, the role of dexmedetomidine infusions in alcohol withdrawal remains unclear but may play a critical role in mitigating tachycardia and hypertension though it poses a risk of bradycardia and hypotension.\u0000Keywords: Alcohol withdrawal, Dexmedetomidine, Precedex, Phenobarbital, Ativan, Lorazepam, CIWA, GABA channel.","PeriodicalId":309875,"journal":{"name":"OA Journal of Case Reports","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121247032","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 : 2019-05-07DOI: 10.33118/OAJ.REP.2019.01.010
B. Layla
The development of unilateral pulmonary edema at the time of reexpansion is a rare complication often associated with aspirational drainage of a pneumothorax. It has been described exceptionally in the postoperative course of a pleural surgery. The main involved factors are prolonged atelectasis, reexpansion pulmonary effusion, the importance and duration of pleural effusion. This complication must be known to anesthesiologist during thoracic surgery for its mortality, which is evaluated at 20% in the litterature and that an early diagnosis allows the an effective treatment. We report an acute respiratory distress in the immediate postoperative course of pleuropulmonary decortication for a recurrent tuberculous pleurisy. Keywords: Unilateral Pulmonary Edema, Pneumothorax, Pleural Effusion.
{"title":"Acute unilateral reexpansion pulmonary edema after pleuropulmonary decortication","authors":"B. Layla","doi":"10.33118/OAJ.REP.2019.01.010","DOIUrl":"https://doi.org/10.33118/OAJ.REP.2019.01.010","url":null,"abstract":"The development of unilateral pulmonary edema at the time of reexpansion is a rare complication often associated with aspirational drainage of a pneumothorax. It has been described exceptionally in the postoperative course of a pleural surgery. The main involved factors are prolonged atelectasis, reexpansion pulmonary effusion, the importance and duration of pleural effusion.\u0000\u0000This complication must be known to anesthesiologist during thoracic surgery for its mortality, which is evaluated at 20% in the litterature and that an early diagnosis allows the an effective treatment.\u0000\u0000We report an acute respiratory distress in the immediate postoperative course of pleuropulmonary decortication for a recurrent tuberculous pleurisy.\u0000\u0000Keywords: Unilateral Pulmonary Edema, Pneumothorax, Pleural Effusion.","PeriodicalId":309875,"journal":{"name":"OA Journal of Case Reports","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124724234","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 : 2019-02-23DOI: 10.33118/oaj.rep.2019.01.009
I. K. Iríbar Diéguez
There is currently no emergency congress without a table and/or ultrasonography workshop at the bedside and recently the new guidance on the management of syncope has been published (ESC Guide 2018 on the diagnosis and treatment of syncope [1]). Together with the possibility of cushioning the problem of the excess of requests for complementary tests in the emergency departments, we believe that this article combines both aspects and provides an interesting point of reflection. Keywords: Syncope, Pulmonary embolism, Ultrasound at the bedside, Supplementary tests.
{"title":"Introduction of ultrasound at the bedside in the differential diagnosis of the pulmonary embolism as a cause of syncope","authors":"I. K. Iríbar Diéguez","doi":"10.33118/oaj.rep.2019.01.009","DOIUrl":"https://doi.org/10.33118/oaj.rep.2019.01.009","url":null,"abstract":"There is currently no emergency congress without a table and/or ultrasonography workshop at the bedside and recently the new guidance on the management of syncope has been published (ESC Guide 2018 on the diagnosis and treatment of syncope [1]). Together with the possibility of cushioning the problem of the excess of requests for complementary tests in the emergency departments, we believe that this article combines both aspects and provides an interesting point of reflection. \u0000Keywords: Syncope, Pulmonary embolism, Ultrasound at the bedside, Supplementary tests.","PeriodicalId":309875,"journal":{"name":"OA Journal of Case Reports","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134600349","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 : 2018-07-25DOI: 10.33118/OAJ.CLIN.2019.01.005
L. Knapen, A. Dingemans, S. Croes
Crizotinib is an orally available tyrosine kinase inhibitor, approved for treatment of anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1) rearrangement-positive non-small cell lung cancer (NSCLC). According to the product leaflet, crizotinib capsules should be swallowed whole, and should not be crushed, dissolved or opened. However, this manner of administration is not always possible. At present, literature is lacking regarding the absorption of crizotinib via percutaneous endoscopic jejunostomy (PEJ) tube. We report a case of a patient with ALK+ NSCLC who was administered crizotinib via PEJ tube. An adequate steady state crizotinib trough concentration was reached, resulting in a metabolic response. Safety for the caregiver was ensured since the administration of crizotinib was made without crushing or opening the capsule. This case supports the option for providing crizotinib via PEJ tube in patients who have ALK+ NSCLC and are unable to swallow whole capsules. This option might also apply to the administration of other ALK inhibitors. Keywords: Crizotinib, ALK inhibitor, percutaneous endoscopic jejunostomy tube, pharmacokinetics, non-small cell lung cancer.
{"title":"Administration of crizotinib via jejunostomy tube: A case report","authors":"L. Knapen, A. Dingemans, S. Croes","doi":"10.33118/OAJ.CLIN.2019.01.005","DOIUrl":"https://doi.org/10.33118/OAJ.CLIN.2019.01.005","url":null,"abstract":"Crizotinib is an orally available tyrosine kinase inhibitor, approved for treatment of anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1) rearrangement-positive non-small cell lung cancer (NSCLC). According to the product leaflet, crizotinib capsules should be swallowed whole, and should not be crushed, dissolved or opened. However, this manner of administration is not always possible. At present, literature is lacking regarding the absorption of crizotinib via percutaneous endoscopic jejunostomy (PEJ) tube. We report a case of a patient with ALK+ NSCLC who was administered crizotinib via PEJ tube. An adequate steady state crizotinib trough concentration was reached, resulting in a metabolic response. Safety for the caregiver was ensured since the administration of crizotinib was made without crushing or opening the capsule. This case supports the option for providing crizotinib via PEJ tube in patients who have ALK+ NSCLC and are unable to swallow whole capsules. This option might also apply to the administration of other ALK inhibitors.\u0000\u0000Keywords: Crizotinib, ALK inhibitor, percutaneous endoscopic jejunostomy tube, pharmacokinetics, non-small cell lung cancer.","PeriodicalId":309875,"journal":{"name":"OA Journal of Case Reports","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114086661","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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