Unrecognized B line mimicked pneumothorax on M mode ultrasound

One of the most signifcant fndings on lung ultrasound (LUS) are comet tail artifacts, also called B-lines or “lung rockets”. Te causes of such phenomena are fuidthickened interlobular septa due to increased extravascular lung water or clinical pulmonary edema. Te B-lines are defned as discrete, echogenic, vertical, laser-like signals which arise from the pleural line and extend to the bottom of the screen. (1) However, although originally described as an easily detectable sign, recent reports indicate that other artifacts, such as Z or E lines, may be mistakenly interpreted as B lines (and vice versa). Z lines are short, broad, vertical comet tail artifacts arising from the pleural line, but not reaching the distal edge of the screen. Tese can be seen in normal lungs, as well as with pneumothorax. E lines are vertical lines, which do not arise from the pleural line, as they originate from subcutaneous collections of gas (subcutaneous emphysema). Tey are not synchronous with respiratory movements, but they do erase A lines, and may therefore be mistaken for true B lines. (2) Visualization of B lines is considered to rule out pneumothorax (PNX) with a negative predictive value of 100%. On the other hand, visualization of a stratosphere sign (bar code - BC) and a “lung point sign” (the junction between PNX and an infating lung) on M mode are established as pathognomonic LUS fndings for PNX. Recently, these two fndings were described in a patient with chronic obstructive pulmonary disease and without PNX. Te authors concluded that these were visualized due to the presence of bullous emphysema, where trapped air in large pulmonary bulla mimicked PNX. (3) We present the images and a video clip with presentation of BC on M mode, caused by an (unrecognized) B line, mistakenly diagnosed as PNX. In this case, BC was caused by overlapping the unrecognized B line with the cursor (line) in M mode during respiratory movements in a mechanically ventilated patient. When the B line is not on the M mode cursor, the display shows a normal M mode ultrasound lung fnding, termed the”sea shore” sign (fgure 1). When the B line crosses the M mode cursor, BC is displayed (fgure 2), and alterations of the “sea shore sign” and BC sign can easily be mistaken for a "lung point sign" (video clip). Tese images point out the importance of clear identifcation and distinction of B lines from (in some cases) similar Z and E lines. Both 2-D and M-modes of LUS should be used and interpreted for accurate diagnostic value

Life saving use of ECMO in an obstetric patient with massive hemorrhage following uterine atony: a case report

The aim of this case report is to present the life saving use of extracorporeal membrane oxygenation (ECMO) in an obstetric patient with acute cardiorespiratory collapse following massive bleeding caused by an atonic uterus post partum. A 39-year-old patient, following a spontaneous abortion at 21 weeks of pregnancy, developed uterine atony and massive bleeding and was ultimately referred to the operating room for an emergent hysterectomy. Postoperatively, she was referred to the intensive care unit (ICU) where she developed severe acute respiratory distress syndrome (ARDS) that was successfully treated by employing ECMO. Following discontinuation of ECMO, her treatment was further complicated by a manifest hemolytic transfusion reaction. Although extensive testing was done to establish the cause of this reaction, we were unable to find it. The patient responded well to treatment with erythropoietin (EPO) and corticosteroids as well as a restrictive transfusion regime. This treatment pointed to a possible immune reaction to massive transfusions of blood products. This case demonstrated the importance of early aggressive treatment using ECMO in reversal of life threatening ARDS, as well as the need for a judicious approach when transfusing blood products

Life saving use of ECMO in an obstetric patient with massive hemorrhage following uterine atony: a case report

The aim of this case report is to present the life saving use of extracorporeal membrane oxygenation (ECMO) in an obstetric patient with acute cardiorespiratory collapse following massive bleeding caused by an atonic uterus post partum. A 39-year-old patient, following a spontaneous abortion at 21 weeks of pregnancy, developed uterine atony and massive bleeding and was ultimately referred to the operating room for an emergent hysterectomy. Postoperatively, she was referred to the intensive care unit (ICU) where she developed severe acute respiratory distress syndrome (ARDS) that was successfully treated by employing ECMO. Following discontinuation of ECMO, her treatment was further complicated by a manifest hemolytic transfusion reaction. Although extensive testing was done to establish the cause of this reaction, we were unable to find it. The patient responded well to treatment with erythropoietin (EPO) and corticosteroids as well as a restrictive transfusion regime. This treatment pointed to a possible immune reaction to massive transfusions of blood products. This case demonstrated the importance of early aggressive treatment using ECMO in reversal of life threatening ARDS, as well as the need for a judicious approach when transfusing blood products

Unrecognized B line mimicked pneumothorax on M mode ultrasound

One of the most signifcant fndings on lung ultrasound (LUS) are comet tail artifacts, also called B-lines or “lung rockets”. Te causes of such phenomena are fuidthickened interlobular septa due to increased extravascular lung water or clinical pulmonary edema. Te B-lines are defned as discrete, echogenic, vertical, laser-like signals which arise from the pleural line and extend to the bottom of the screen. (1) However, although originally described as an easily detectable sign, recent reports indicate that other artifacts, such as Z or E lines, may be mistakenly interpreted as B lines (and vice versa). Z lines are short, broad, vertical comet tail artifacts arising from the pleural line, but not reaching the distal edge of the screen. Tese can be seen in normal lungs, as well as with pneumothorax. E lines are vertical lines, which do not arise from the pleural line, as they originate from subcutaneous collections of gas (subcutaneous emphysema). Tey are not synchronous with respiratory movements, but they do erase A lines, and may therefore be mistaken for true B lines. (2) Visualization of B lines is considered to rule out pneumothorax (PNX) with a negative predictive value of 100%. On the other hand, visualization of a stratosphere sign (bar code - BC) and a “lung point sign” (the junction between PNX and an infating lung) on M mode are established as pathognomonic LUS fndings for PNX. Recently, these two fndings were described in a patient with chronic obstructive pulmonary disease and without PNX. Te authors concluded that these were visualized due to the presence of bullous emphysema, where trapped air in large pulmonary bulla mimicked PNX. (3) We present the images and a video clip with presentation of BC on M mode, caused by an (unrecognized) B line, mistakenly diagnosed as PNX. In this case, BC was caused by overlapping the unrecognized B line with the cursor (line) in M mode during respiratory movements in a mechanically ventilated patient. When the B line is not on the M mode cursor, the display shows a normal M mode ultrasound lung fnding, termed the”sea shore” sign (fgure 1). When the B line crosses the M mode cursor, BC is displayed (fgure 2), and alterations of the “sea shore sign” and BC sign can easily be mistaken for a "lung point sign" (video clip). Tese images point out the importance of clear identifcation and distinction of B lines from (in some cases) similar Z and E lines. Both 2-D and M-modes of LUS should be used and interpreted for accurate diagnostic value

MALNUTRITION AND PREOPERATIVE EVALUATION: OBJECTIVE ASSESSMENT OF NUTRITIONAL STATUS

Malnutricija je nerijetko, posebice u kirurških bolesnika, neprepoznato i/ili neadekvatno liječeno stanje. Iako je to najče{će posljedica nedovoljne edukacije medicinskog osoblja, nedovoljno poznavanje odgovarajućih metoda procjene nutricijskog statusa, značajno pridonosi neprepoznavanju nutricijskih poremećaja. U ovom preglednom radu navedene su osnovne metode procjene nutricijskog statusa bolesnika (antropometrijska mjerenja, mjerenja, funkcionalni testovi, laboratorijski testovi i bioelektrična impedanca) te naznačene njihove glavne prednosti i nedostaciMalnutrition goes largely undiagnosed and/or untreated, particularly among surgical patients. This is mainly due to the lack of nutritional training among medical staff, but also lack of proper protocols for screening and assessment of nutritional status. In this review article the main methods (anthropometric measurements, functional assessment, laboratory tests and bioelectrical impedance analysis) are described with their advantages and disadvantages in surgical patients

MALNUTRITION AND PREOPERATIVE EVALUATION: OBJECTIVE ASSESSMENT OF NUTRITIONAL STATUS

Malnutricija je nerijetko, posebice u kirurških bolesnika, neprepoznato i/ili neadekvatno liječeno stanje. Iako je to najče{će posljedica nedovoljne edukacije medicinskog osoblja, nedovoljno poznavanje odgovarajućih metoda procjene nutricijskog statusa, značajno pridonosi neprepoznavanju nutricijskih poremećaja. U ovom preglednom radu navedene su osnovne metode procjene nutricijskog statusa bolesnika (antropometrijska mjerenja, mjerenja, funkcionalni testovi, laboratorijski testovi i bioelektrična impedanca) te naznačene njihove glavne prednosti i nedostaciMalnutrition goes largely undiagnosed and/or untreated, particularly among surgical patients. This is mainly due to the lack of nutritional training among medical staff, but also lack of proper protocols for screening and assessment of nutritional status. In this review article the main methods (anthropometric measurements, functional assessment, laboratory tests and bioelectrical impedance analysis) are described with their advantages and disadvantages in surgical patients

A brief reeducation in cardio-pulmonary resuscitation after six months-the benefit from timely repetition

Objectives. Sudden cardiac death is a major cause of death in today\u27s world. During the minutes passing from the onset of cardiac arrest to the arrival of professional help, the cardiac arrest victim can only rely upon cardio-pulmonary resuscitation (CPR) provided by educated bystanders. Our aim was to explore the possibility of whether a short and affordable course of CPR reeducation could have a significant effect on skills retention and quality of CPR delivered. Methods. We performed a prospective randomized study that included 72 first and second year medical students who had no clinical experience and no prior training in CPR. Subjects were educated in CPR in accordance with a standardized CPR education protocol. Six months later, half of the studied group (randomly chosen) underwent short reeducation in CPR. One year after initial education they were all tested for CPR skills. The results were printed and filmed. Results. Students who attended the short reeducation were significantly better in approaching the victim safely, in obtaining a clear airway and in checking the pulse of the victim. Conclusions. A short and inexpensive course of reeducation, carried out six months after initial education, may render CPR performance more effective for the victim and safer for the rescuer

Donor Management

Moždano mrtvi donori osnovni su izvor organa u transplantacijskoj medicini, a preživljavanje transplantata kao i morbiditet i mortalitet primaoca uvelike ovise o kvalitetnoj pripremi davatelja u preeksplantacijskom razdoblju. U prikazanom kraćem preglednom radu autori navode osnovne kriterije za eksplantaciju pojedinih organa te obrazlažu važnije patofiziološke posljedice moždane smrti i njihov negativan utjecaj na pojedine organske sustave. Autori ukratko prikazuju anesteziolo ško-intenzivističke mjere bitne za prezervaciju organa u pre- i eksplantacijskom razdoblju.Brain dead donors represent the main source of organs in transplantation medicine. The survival of transplant, morbidity and mortality of the recipient depends greatly on the preoperative care and medical management of donors. In this short paper the authors enumerates basic criteria needed in transplantation of individual organs and explaining significant pathophysiologic consequences of brain death on multiorgan function. Also, the role of anesthesiologic and intensive care medicine measures for organ preservation in pre- and explantation period are stresse

Donor Management

Moždano mrtvi donori osnovni su izvor organa u transplantacijskoj medicini, a preživljavanje transplantata kao i morbiditet i mortalitet primaoca uvelike ovise o kvalitetnoj pripremi davatelja u preeksplantacijskom razdoblju. U prikazanom kraćem preglednom radu autori navode osnovne kriterije za eksplantaciju pojedinih organa te obrazlažu važnije patofiziološke posljedice moždane smrti i njihov negativan utjecaj na pojedine organske sustave. Autori ukratko prikazuju anesteziolo ško-intenzivističke mjere bitne za prezervaciju organa u pre- i eksplantacijskom razdoblju.Brain dead donors represent the main source of organs in transplantation medicine. The survival of transplant, morbidity and mortality of the recipient depends greatly on the preoperative care and medical management of donors. In this short paper the authors enumerates basic criteria needed in transplantation of individual organs and explaining significant pathophysiologic consequences of brain death on multiorgan function. Also, the role of anesthesiologic and intensive care medicine measures for organ preservation in pre- and explantation period are stresse