Hampton’s Hump: A Notable Radiographic Finding in a Patient with Infectious Endocarditis

Infectious endocarditis is a relatively uncommon entity that may present with a variety of clinical scenarios, ranging from a stable patient with nonspecific symptoms to a critically ill patient suffering from embolic disease. We report a case of an otherwise healthy 35-year-old female who presented to the Emergency Department with gradually progressive dyspnea, weight loss, and lower extremity edema. As part of her initial evaluation, a chest radiograph was performed and demonstrated Hampton’s Hump, a peripheral wedge-shaped opacity consistent with a possible pulmonary infarct. Further diagnostic investigation in the Emergency Department led to an unanticipated diagnosis of infectious endocarditis. This case serves as an important reminder that nonspecific diagnostic findings need to be appropriately considered in context and is a rare demonstration of Hampton’s Hump associated with infectious endocarditis.

Management and Outcome of a Neurologically Intact Infant with Pierre Robin Sequence and Dandy-Walker Variant Diagnosed with Large Hemispheric Brain Abscess – Case Report

Pierre Robin sequence (PRS) is a condition consisting of three essential components: micrognathia or retrognathia, cleft palate, and glossoptosis. It can be part of multiple congenital anomalies. We present the case and outcome of a 3-month-old clinically stable patient who has PRS with Dandy-Walker variant – which is a rare presentation in the literature – with a large right hemispheric brain abscess, treated with multiple minimally-invasive surgical drainage procedures with adjuvant antibiotics.

Cavitary Covid Lesions - An Unusual Imaging Feature

On January 30, 2020, the coronavirus disease 2019 (Covid-19), formerly known as the 2019 novel coronavirus (2019-nCoV), was declared as a global health emergency by the World Health Organization. Coronavirus disease 2019 (Covid-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Imaging plays an essential role in the evaluation of Covid-19, with chest computed tomography (CT) being the major modality in diagnosing and managing Covid-19 pneumonia. Common signs of Covid-19 pneumonia on chest CT scan are ground-glass opacities, consolidation, nodules, and linear opacities, halo and reverse halo signs. It can be accompanied by a “crazy-paving” pattern, air bronchograms, pleural hypertrophy, and pleural effusion. Cavitations are known to occur but are rare presentations. There are cases reported in the literature of the development of pulmonary cavity after bacterial infection in the late recovery stage in SARS patients. We present a case report of this rare entity in Covid-19 infection in a previously stable patient

Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study

BackgroundLimited research regarding administration of timed medication infusions in the prehospital environment has identified wide variability with accuracy, timing, and overall feasibility. This study was a pragmatic, randomized, controlled, crossover study comparing two different techniques for medication infusion administration. We hypothesized that the use of a metronome-based technique would decrease medication dosage errors and reduce time to administration for intravenous medication infusions. Methods Forty-two nationally registered paramedics were randomized to either a metronome-based technique versus a standard stopwatch-based technique. Each subject served as a control. Subjects were asked to establish an infusion of amiodarone at a dose of 150 mg administered over 10 minutes, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and multiple linear regression were used for data analysis. Results When compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal, fewer mid-infusion adjustments, and greater ease of use. Conclusions Use of a metronome technique for establishing medication infusion rates may help prehospital clinicians provide safer and more precise medication delivery.

Page kidney post ureteroscopy: a case report

Renal injury after surgical intervention is not uncommon in current urological practice with most complication would be anticipated in high risk patient. Subcapsular renal hematoma is not known complication post some urological interventions such as extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and trauma. Few cases of subcapsular hematomas are reported as a complication post ureteroscopy in the literature. Clinical spectrum varies from spontaneous resolution through acute renal failure secondary to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that applying external compression on the renal parenchyma could cause hypertension. Various management options are mentioned in literature and depend upon the severity and presentation. Percutaneous drainage is an option for the management of subcapsular hematoma in hemodynamically stable patient.

Pandemics 2020 –COVID 19 Silent Hypoxia and Polysubstance Use: A Unique Case Report

The coronavirus (COVID-19) pandemic continues to bring challenges in identification and management of which the “happy hypoxic” or silent hypoxia presentation has been found to present its own unique challenge. A 67-year-old African American COVID-19 positive female presents to the emergency department (ED) with a chief complaint of decreased oral intake and responsiveness, oriented and stable, with oxygen saturations found to drop as low as 47%. The patient was successfully managed with supplemental oxygen and determined to be a “happy hypoxic” with recent polysubstance abuse. Silent hypoxia or the “happy hypoxic” patient is another unique phenomenon associated with the variable presentations of COVID-19. Multiple etiologies and pathophysiologic explanations exist to explain this stable patient whom would otherwise be expected to require aggressive management with a poor prognosis. An alternative diagnosis should be explored for those silent hypoxic patients with symptoms.

Reducing inappropriate arterial blood gas testing in a level III intensive care unit: a before-and-after observational study

Background: Arterial blood gas (ABG) analysis is the most frequently performed test in intensive care units (ICUs), often without a specific clinical indication. This is costly and contributes to iatrogenic anaemia. Objectives: To reduce the number of ABG tests performed and the proportion that are inappropriate. Design, setting and participants: The indications for ABG analysis were surveyed at a 58-bed level III ICU during fortnightly periods before and after a multifaceted educational intervention which included the introduction of a clinical guideline. The number of ABG tests performed during the period July–December 2017 was compared with that for the period July–December 2018. Tests were predefined as inappropriate if performed at regular time intervals, at change of shift, concurrently with other blood tests or after a treatment was ceased on a stable patient or after ventilatory support or oxygen delivery was decreased in an otherwise stable patient. The study was enrolled on the Quality Improvement Projects Register and ethics approval was waived by the local ethics committee. Results: There was a 31.3% bed-day adjusted decrease in number of ABG tests performed (33 005 v 22 408; P < 0.001), representing an annual saving of A$770 000 and 100 litres of blood. The proportion of inappropriate ABG tests decreased by 47.3% (54.2% v 28.6%; P < 0.001) and the number of inappropriate ABG tests per bed-day decreased by 71% (2.8 v 0.8; P < 0.001). Patient outcomes before and after the intervention did not differ (standardised mortality ratio, 0.65 v 0.63; P = 0.22). Conclusion: Staff education and implementation of a clinical guideline resulted in substantial decreases in the number of ABG tests performed and the proportion of inappropriate ABG tests.