Rapid intubation and extubation

BACKGROUND: Anti-synthetase syndrome (AS) is a rare autoimmune idiopathic inflammatory myopathy (IIM) with diverse manifestations, including arthritis, interstitial lung disease (ILD), Raynaud's phenomenon, unexplained persistent fever, and mechanic's hands. CASE PRESENTATION: We present the case of a 72-year-old woman, previously healthy, who was admitted to our hospital for treatment of cough and rapid breathing. The patient had elevated white blood cells and C-reactive protein, and tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2)...

Meningitis is a rare but possible complication of sinusitis. We present a case of a 21-year-old woman with a history of fever, headache and nasal obstruction who presented at the emergency department with psychomotor agitation. Orotracheal intubation and invasive mechanical ventilation were given to protect airway. Blood analysis showed leukocytosis and elevated C-reactive protein. Cerebral and maxillofacial computed tomography (CT) demonstrated pansinusitis with gas foci more prominent in the left frontal sinus with an area of ​​bone rarefaction on the posterior wall with possible communication with the cranial cavity...

Ethylene glycol (EG) is an organic compound used in antifreeze. In 2020 alone, there were 5,277 EG exposures, with only 617 reported as intentional ingestions. Therefore, encountering EG toxicity is rare; however, it is essential to identify it promptly based on a focused history, exam, and rapid identification of commonly associated EG-induced metabolic derangements. If the diagnosis is not made within 12 hours of ingestion or exposure, severe morbidity and mortality can occur. Previous reports of EG poisoning have occurred in the setting of a lactate gap (LG) and osmolar gap (OG); however, they also had commonly associated findings of EG toxicity such as high anion gap acidosis (HAGMA), acute kidney injury (AKI), hypocalcemia, calcium oxalate stones, and suggestive histories of EG ingestion...

INTRODUCTION: In spontaneously breathing neonates, surfactant can be administered via thin catheter while enabling the own breathing (less invasive surfactant administration [LISA]). Alternatively, the neonate is intubated for surfactant delivery (intubation, surfactant, rapid extubation [INSURE]). Thus, the aim was to provide an overview of the efficacy of the LISA compared to INSURE. METHODS: We performed an umbrella review of previous meta-analyses including randomized controlled trials...

Juvenile dermatomyositis (JDM) is a rare systemic autoimmune disease characterized by cutaneous findings, muscle inflammation, and vasculopathy. Patients with antimelanoma differentiation associated gene 5 (anti-MDA5) JDM may have subtle muscle weakness, absence of pathognomonic rashes, and more polyarthritis and ulcerative skin lesions when compared with other JDM subtypes. Although there is a known association of rapidly progressive interstitial lung disease (RP-ILD) in patients with anti-MDA5 dermatomyositis, few case reports describe this association in the pediatric literature...

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care...

BACKGROUND: Laryngeal mask airway surfactant administration (S-LMA) has the potential benefit of surfactant administration whilst avoiding endotracheal intubation and ventilation, ventilator-induced lung injury and bronchopulmonary dysplasia (BPD). OBJECTIVES: To evaluate the benefits and harms of S-LMA either as prophylaxis or treatment (rescue) compared to placebo, no treatment, or intratracheal surfactant administration via an endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) or extubate at standard criteria (S-ETT) or via other less-invasive surfactant administration (LISA) methods on morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome (RDS)...

A 54-year-old male with severe hypoxia was transferred to our hospital after choking on a mochi. Chest computed tomography revealed negative pressure pulmonary edema without pneumothorax. Endotracheal intubation was performed, and pressure-controlled ventilation was initiated. Following admission to the intensive care unit, his respiratory condition was stable in both the supine and left decubitus positions. However, every time he was placed in the right decubitus position, the tidal volume decreased by half, and SpO₂ dropped rapidly to 80%, which recovered soon after returning to the supine position...

BACKGROUND: With the widespread application of metagenomic next-generation sequencing (mNGS) in pathogen detection, the reports of severe Chlamydia psittaci ( C. psittaci ) pneumonia are increasing. It is essential to determine the best management of severe C. psittaci pneumonia. CASE DESCRIPTION: This report describes a 51-year-old male patient who presented with symptoms of expectoration, relative bradycardia, and dyspnea. Lung computed tomography (CT) on day 1 (D1) showed consolidation of the left lower lobe...

OBJECTIVE: To identify risk factors associated with adverse airway events (AAEs) in primary oral cancer patients undergoing tumor ablation followed by free tissue transfer without prophylactic tracheostomy. METHODS: We retrospectively collected primary oral cancer patients who underwent tumor ablation surgery following free-tissue transfer without prophylactic tracheostomy during February 2017 to June 2019 in Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan...

The 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway differ significantly from prior guidelines, particularly regarding paediatric patients. These guidelines place new emphasis on establishing a multidisciplinary team led by an anaesthetist trained in paediatric anaesthesia. Here, we demonstrate the clinical application of the new guidelines by presenting the case of a 16-month-old girl with a rapidly growing mandibular mass. The new guidelines stipulated the need for multidisciplinary team assembly; planning with indirect laryngoscopy; the availability of surgical tracheostomy and extracorporeal membrane oxygenation; and multiple 'time out' stops to confirm team members and plans...

Objective: To analyze the clinical data of laryngeal airway diseases in infants and provide reference for the standardized diagnosis and treatment of the disease. Methods: From June 2022 to August 2023, analyze the clinical data of 4 cases of children with laryngeal airway diseases recently admitted to Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, and summarize the experience and lessons of diagnosis and treatment by consulting relevant literature. Results: Three cases had symptoms such as laryngeal wheezing, dyspnea, backward growth and development, etc...

BACKGROUND: Rheumatic fever is still a major cause of mitral valve (MV) stenosis in the developing world. Few patients with critical rheumatic MV stenosis can present with acute cardiogenic shock (CS) that requires urgent treatment with circulatory support and definitive valvular repair or replacement. CASE SUMMARY: A 37-year-old gentleman was admitted with heart failure, CS Society for Cardiovascular Angiography and Interventions D, and atrial fibrillation with a rapid ventricular response...

Neuroleptic malignant syndrome (NMS) is a potentially fatal side effect that occurs in patients taking antipsychotics. Patients with NMS are often forced to rechallenge antipsychotic medications to control the underlying psychiatric symptoms. We present a case of severe recurrence of NMS in a patient in whom the administration of antipsychotics was restarted two days after NMS resolution. A 19-year-old man with somatic symptom disorder had been transported for fever, tachycardia, rigidity, and disturbance of consciousness...

This case report presents a 33-year-old woman who presented to the emergency department with abdominal pain and gingival and vaginal bleeding. She admitted to using synthetic cannabinoids, and contamination with brodifacoum was suspected, for which qualitative testing was positive. The patient was discharged with an improved international normalized ratio (INR) seven days later with oral vitamin K. Fourteen days after discharge, she re-presented with widespread ecchymosis, leg swelling, and intermittent gingival and vaginal bleeding...

OBJECTIVE: To describe the current practices in invasive patent ductus arteriosus (PDA) closure (surgical ligation or transcatheter occlusion) in very low birth weight (VLBW) infants and changes in patient characteristics and outcomes from 2016 to 2021 among US children's hospitals. STUDY DESIGN: We evaluated a retrospective cohort of VLBW infants (birth weight 400-1499g and gestational age 22-31 weeks) who had invasive PDA closure within 6 months of age from 2016 to 2021 in children's hospitals in the Pediatric Health Information System...

A 72-year-old female with symptomatic cholelithiasis was posted for laparoscopic cholecystectomy. She had been previously posted for the same surgery at a different center, but the surgery was not performed due to failed intubation. On airway examination, reduced thyromental distance, prominent incisors, and retrognathia were observed. We planned and executed rapid sequence intubation under videolaryngoscope guidance using The Anaesthetist Society Scope, and the surgery proceeded uneventfully. At the end of the surgery, she was extubated over a bougie, observed, and shifted out without complications...

INTRODUCTION: Pregnant patients are at risk of several possible complications during the peripartum period. Amniotic fluid embolism (AFE) is a peripartum complication with high mortality and morbidity. The sudden entry of amniotic fluid into the maternal circulation causes a rapid and dramatic sequence of clinical events called AFE. The reported incidence of AFE after a cesarean section is around 19%, and after a normal delivery, it is 11%. AFE causing multiple embolisms is not reported in the literature, nor is the use of point-of-care ultrasound (POCUS) in the diagnosis of AFE...

Systemic anesthesia in penguins is often achieved using inhalation anesthetic agents alone, and information on injectable drugs for systemic anesthesia is limited. General anesthesia with a minimal effect on circulatory dynamics is necessary to perform noninvasive examinations and treatments in animals, including penguins. In this study, alfaxalone (ALFX), an injectable anesthetic agent, was examined to establish the optimal anesthetic method for gentoo penguins ( Pygoscelis papua ). Alfaxalone was administered intravenously through the metatarsal vein, and anesthesia was maintained by a constant rate infusion (CRI)...

A girl was brought into the emergency room after a non-penetrating cervical trauma. On physical examination, a rapidly progressing chest subcutaneous emphysema was denoted. The child was immediately intubated and mechanical ventilation was initiated. The CT-scan revealed a rupture to the posterior wall of the trachea and a pneumomediastinum. The child was transferred to the paediatric intensive care unit. A conservative approach was chosen, including tracheal intubation as a bypass through the tracheal injury, sedation to reduce the risk of further tracheal trauma and prophylactic antibiotic therapy...