An unusual case of nonocclusive mesenteric ischemia in a young girl

Nonocclusive mesenteric ischemia is a type of acute mesenteric ischemia with high mortality seen mostly in elderly cardiac patients. We present a 21-year-old healthy student with nonocclusive mesenteric ischemia along with radiological evidence of hepatic portal venous gas and pneumatosis intestinalis, with subsequent fatality. Its significance and its possible etiology are discussed

Spontaneous central vein thrombosis in a patient with activated protein C resistance and dengue infection: An association or causation?

Spontaneous central vein thrombosis is a rare and potentially fatal condition in critical care setting. Activated protein C resistance due to homozygous factor V Leiden mutation is an exceptional cause of central venous thrombosis. We recently treated a healthy female student who presented with acute febrile illness, septic shock, and encephalopathy. Neck ultrasonography (USG) prior to an attempt of right internal jugular vein (IJV) cannulation revealed non compressibility of the vein along with absence of venous blood flow. Right IJV and subclavian vein thrombus was confirmed subsequently in USG Doppler by radiologist. Radiological evidence of distal pulmonary artery embolism in pulmonary angiography was also evident. Further investigations demonstrated homozygous Factor V Leiden mutation and activated factor C resistance and Dengue IgM positivity in our patient. Intravenous heparin followed by oral vitamin K anticoagulants (OVKA) aided in her recovery. Spontaneous intravascular thrombosis with activated protein C resistance and the relationship of acute Dengue infection were explored in our report

The practice of tracheostomy decannulation—a systematic review

Abstract Decannulation is an essential step towards liberating tracheostomized patients from mechanical ventilation. However, despite its perceived importance, there is no universally accepted protocol for this vital transition. Presence of an intact sensorium coordinated swallowing and protective coughing are often the minimum requirements for a successful decannulation. Objective criteria for each of these may help better the clinical judgement of decannulation. In this systematic review on decannulation, we focus attention to this important aspect of tracheostomy care

Postoperative acute anisocoria and old traumatic brain injury

Anisocoria is an uncommon entity in general postoperative intensive care. We present a case of a 45-year-old man suffering from severe acute pancreatitis with a past history of traumatic brain injury (TBI), who developed hypertension, bradycardia and anisocoria soon after re-exploration surgery under general anaesthesia. Computed tomography showed no new lesion. Measures directed towards reducing intracranial pressure resulted in amelioration in about 12h. The possible role of old TBI in the causation of anisocoria during general anaesthesia and resuscitation has been explored in this report

Impact of an educational intervention on errors in death certification: An observational study from the intensive care unit of a tertiary care teaching hospital

Background: A high incidence of errors occur while filling up death certificates in hospitals. The purpose of this study was to analyze the impact of an educational intervention on errors in death certification in an intensive care unit (ICU). Patients admitted to ICUs by virtue of being critically ill have a higher mortality than other hospitalized patients. This study was designed to see if any improvement could be brought about in filling death certificates. Materials and Methods: Educating sessions, interactive workshops, and monthly audits for the department resident doctors were conducted. One hundred and fifty death certificates were audited for major and minor errors (75 before and 75 after the educational intervention) over a period of 18 months. Fisher′s exact test was applied to statistically analyze the data. Results: There was a significant decrease in major errors like mechanism without underlying cause of death (60.0 vs. 14.6%, P < 0.001), competing causes (88.0 vs. 13.3%, P < 0.001), and improper sequencing (89.3 vs. 36.0%, P < 0.001). There was also a significant decrease in minor errors such as use of abbreviations (89.3 vs. 29.3%, P < 0.001) and no time intervals (100.0 vs. 22.6%, P < 0.001). Conclusion: Authors conclude that death certification errors can be significantly reduced by educational interventional programs

Pandemic (H1N1) 2009 influenza: Experience from a critical care unit in India

This case series details our experience with seven patients with pandemic (H1N1) 2009 influenza from an intensive care unit in India.All the patients had respiratory failure requiring ventilation except one;two patients developed pneumothorax. Of the seven patients, two died (28.5%) and five recovered. Four patients had co-morbid conditions and one was morbidly obese; all the five patients were discharged alive