Category: Case Summary

ECMO for Respiratory Failure

ECMO for Respiratory Failure

Steve Mathieu1 Comment

A 40 year old lady was admitted under the medical team with pneumonia. She was normally well with no history of respiratory illnesses. On day two of her hospital admission she became more hypoxic necessitating continuous-positive-airway-pressure. Her condition rapidly worsened and her chest x-ray showed diffuse bilateral infiltrates. An echocardiogram demonstrated normal systolic function. She was intubated and ventilated. Despite sedation, ARDSnet ventilation, paralysis and then proning her, she remained severely hypoxaemic. A therapeutic bronchoscopy was performed prior to proning but did not improve her condition.

Should she be referred for consideration of ECMO and was is this evidence to support it’s use?

Read More »

Hypertriglyceridaemia Induced Acute Pancreatitis

Hypertriglyceridaemia Induced Acute Pancreatitis

Steve MathieuLeave a comment

A young man is admitted to the surgical unit with several months of worsening abdominal pain. It has become much more severe over the last 24 hours. A CT scan shows evidence of acute pancreatitis with no gallstones or biliary duct dilatation.. He is normally well with no history of alcohol excess. His triglyceride level is elevated at 83.7mmol/L and a diagnosis of hypertriglyceridaemia induced acute pancreatitis is made. 

What is hypertriglyceridaemia induced acute pancreatitis and how is it treated?

Read More »

Mannitol and Sodium Bicarbonate in Rhabdomyolysis

Mannitol and Sodium Bicarbonate in Rhabdomyolysis

ICM Case SummariesLeave a comment

A patient with polytrauma develops compartment syndrome with an ischaemic leg 24hrs into his admission. He undergoes revascularisation and fasciotomies, but develops rhabdomyolysis and acute kidney injury with a CK that peaks at over 100,000.

Is there a role for mannitol and bicarbonate in the management of his rhabdomyolysis and AKI?Read More »

Delirium

Delirium

Steve MathieuLeave a comment

A patient underwent a laparotomy due to bowel perforation with peritonitis and septic shock and required ventilation for several days. He was sedated with midazolam and fentanyl. After extubation he became agitated overnight, pulled out his invasive monitoring lines and was attempting to climb out of bed.

How should his acute confusional state be managed?Read More »

Diagnosing Ventilator Acquired Pneumonia

Diagnosing Ventilator Acquired Pneumonia

ICM Case SummariesLeave a comment

A 65 year old woman developed a left lower lobe hospital acquired pneumonia following a elective laparoscopic procedure for which she was ventilated for 4 days. Twenty four hours post extubation, she developed hypoxic respiratory failure with bilateral patchy shadowing on chest X-ray. She was reintubated and subsequently grew Pseudomonas aeruginosa from tracheal aspirate.

How do we diagnose Ventilator Associated Pneumonia (VAP)?Read More »

Use of PEEP in ARDS

Use of PEEP in ARDS

ICM Case SummariesLeave a comment

A young woman was admitted with respiratory failure requiring invasive ventilation. She had bilateral lobar consolidation and positive urinary pneumococcal antigen. She was ventilated with protective lung strategies but required FiO2 of between 0.8-1.0. A PEEP of 18 was set. She was ventilated for over 2 weeks, and was tracheostomised but was discharged from the ICU after 3 weeks.

How is PEEP utilised in the ventilatory strategies in the management of Adult Respiratory Distress Syndrome?Read More »

Intensive Care Acquired Weakness

Intensive Care Acquired Weakness

ICM Case SummariesLeave a comment

A cardiovascularly fit 65 year old man was admitted with septic shock secondary to community acquired pneumonia, which progressed to multi-organ failure. During his recovery it was noted that he had generalised weakness with no focal neurology. He underwent respiratory weaning, and rehabilitation therapy over the next 4 weeks but had persistent weakness at his ICU discharge.

How can ICU-acquired weakness be diagnosed and managed?Read More »

Pentoxifylline in Alcoholic Hepatitis

Pentoxifylline in Alcoholic Hepatitis

ICM Case Summaries1 Comment

A 28 year old male presented to the Emergency Department with an upper gastrointestinal bleed. This was managed  with resuscitation and endoscopic diathermy and adrenaline injection This was his first presentation to secondary care with complications from his significant alcohol intake. He reported drinking at least 50 units of alcohol per week. Ultrasound examination demonstrated an enlarged liver with changes consistent with steatosis. On day 3 of his admission, he became tachycardic, tachypnoeic and increasingly lethargic. Examination revealed jaundice, bi-basal lung crepitations and mild confusion. Investigation confirmed an acute hepatitis by blood chemistry and repeat ultrasound. In the absence of any other cause, a diagnosis of acute alcoholic hepatitis was considered.

In patients with acute alcoholic hepatitis, does pentoxifylline reduce mortality?Read More »

Decompressive Laparotomy in Abdominal Compartment Syndrome

Decompressive Laparotomy in Abdominal Compartment Syndrome

ICM Case SummariesLeave a comment

A 55 yr old man developed severe necrotizing pancreatitis with multiorgan failure. One week into his illness he had developed multiple intra-abdominal collections and had high intra-abdominal pressures. Initial conservative management failed, percutaneous drainage of his collections failed to reduce the abdominal pressures, and he underwent decompressive laparotomy.

What is the evidence behind the current guidelines for the measurement of intra-abdominal hypertension and the use of decompressive laparotomy in the management of Abdominal Compartment Syndrome?Read More »