Critical Care and Shock

February 2007

Perforated Pre-pyloric Ulcer Presenting with ST elevation on EKG

A 66 year-old female with long-standing history of rheumatoid arthritis on chronic steroid therapy, presented for routine kyphoplasty for a compression fracture of L1 and L2. Pre-operative electrocardiogram (EKG) revealed a normal sinus rhythm and no abnormalities. Her intra-operative course was complicated by severe hypotension. A post operative EKG revealed ST elevation in inferior and lateral leads with ST changes. She underwent a left heart catheterization that revealed normal coronary arteries and an ejection fraction of 70%.

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Massive Pericardial Effusion as a Presentation of Hypothyroidism

A 46 year-old Hispanic female with no past medical history, and no history of trauma presented to the hospital with complaints of shortness of breath worsening gradually over past two months. The patient’s physical examination was remarkable for diminished heart sounds at auscultation. A complete blood count chemistry was within normal limit. Collagen vascular profi le was negative. A chest x-ray revealed enlarged cardiac shilloute suggestive of pericardial effusion. A computed tomography (CT) scan of chest showed massive pericardial effusion.

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Severe Complications of Herbal Medicines

Herbal medicines are being increasingly used for treatment of variety of disorders. Herbal medicines are generally thought to lack severe side effects. Despite of the general belief, herbal medicines are known to cause serious side effects and toxicities. On the other hand, physicians’ knowledge of herbal medicines and their potential toxicities are generally limited. Neurotoxicity, cardiac toxicity, pulmonary toxicity, hepatotoxicity, and nephrotoxicity are potential severe complications of herbal medicines.

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Sublingual Capnometry: A Non-invasive Measure of Microcirculatory Dysfunction in Sepsis

Sepsis is among the most common reason for admission to intensive care units throughout the world. Sepsis is characterized by a generalized microcirculatory injury, which results in tissue dysoxia. Tissue dysoxia is believed to be the causation of multiorgan dysfunction syndrome (MODS) which commonly complicates the course of sepsis. The expedient detection and correction of tissue dysoxia may limit the development of MODS.

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