BackgroundAluminum phosphide is a very common suicide agent in developing countries like Nepal. Due to the unavailability of a specific antidote, mortality is very high because the phosphine molecule that is formed leads to inhibition of the cytochrome oxidase enzyme system in mitochondria. Extracorporeal membrane oxygenation provides life-saving support to the cardiovascular and respiratory systems until the deadly poison is eliminated from the body.Case presentationWe encountered one case of 67-year-old Asian woman, a known case of major depressive disorder, who presented to our center with suicidal ingestion of aluminum phosphide with cardiovascular and respiratory dysfunction. On presentation in our emergency room, she had an ejection fraction of 20% and had to be immediately intubated for respiratory failure. Based on the evidence of almost 100% mortality with aluminum phosphide poisoning, extracorporeal membrane oxygenation was initiated in our intensive care unit. Her general condition and hemodynamics gradually improved over the course of 2 days and she was weaned from extracorporeal membrane oxygenation and ventilator by post-extracorporeal membrane oxygenation days 3 and 4, respectively. After psychiatric evaluation and establishment of normal vital parameters, she was moved out of intensive care unit on post-extracorporeal membrane oxygenation day 6 and discharged to home on post-extracorporeal membrane oxygenation day 10.ConclusionsAlthough this seems to be a small step in terms of global perspective, it is a giant stride for a developing country. The management of reversible but severe cardiac and respiratory failure certainly opens up newer scopes where we can ensure a quality health care service being made accessible even to the most underprivileged people.

Acute pancreatitis (AP) is a rare complication of Dengue fever with unpredictable progression and outcome. There have been increasing reports of acute pancreatitis due to dengue. Fever, abdominal pain or tenderness are the presenting clinical manifestations on hospital admission. We reported two similar cases of Dengue who presented with the complaints of fever, abdominal pain, and generalized body ache. Acute pancreatitis was diagnosed in both cases following blood investigations, ultrasound and contrast enhanced computed tomography (CECT) of the whole abdomen.

Burkholderiacepacia is a rarely diagnosed infection in Nepal. Most cases of B.cepaciaare reported from South East Asia. It can present with a wide spectrum of clinical manifestations ranging from pneumonia to septicemia. We present a case of a 29-year-old man who had acute pancreatitis and was admitted to the hospital due to sepsis. B.cepaciawas isolated from ascitic fluid and was successfully treated with intravenous antibiotics. Bangladesh Crit Care J September 2022; 10(2): 146-148

Chronic Obstructive Pulmonary Disease (COPD) patients generally present with respiratory acidosis and type 2 respiratory failure. Here we present a case of 65 years old female, who is a known case of COPD and presented in our emergency department with severe metabolic alkalosis (pH 7.730, HCO3- greater than 99.9mmol/l). She was referred from other center after the development of seizure. Urinary sodium was sent which indicated the cause of metabolic alkalosis was contraction alkalosis; we then treated the patient with IV fluids, antibiotics and Mechanical Ventilator. Arterial Blood gas analysis was initially done every 4 hours till the pH was corrected. After pH was corrected the patient was extubated to intermitted Non Invasive Ventilation (NIV) for type 2 respiratory failure. With pulmonary rehabilitation we could discharge the patient with inhalers; without the need for NIV or supplementary oxygen. This is one of the rare cases where the patient presented with a very high bicarbonate level, high partial pressure of carbon dioxide in arterial blood, and high pH. The patient was successfully managed with IV fluids and mechanical ventilation.

Background: The knotting or in vivo entrapment of epidural catheters is an uncommon but challenging issue for anesthesiologists. This study aimed to identify the possible causes behind entrapped epidural catheters and the effective methods for their removal. Methods: A systematic review of relevant case reports and series was conducted using the Patient/population, intervention, comparison and outcome (PICO) framework and keywords such as “epidural,” “catheter,” “knotting,” “stuck,” “entrapped,” and “entrapment.” The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed, and the review was registered with International Prospective Register for Systematic Reviews (PROSPERO) (CRD42021291266). Results: The analysis included 59 cases with a mean depth of catheter insertion from the skin of 11.825 cm and an average duration of 8.17 h for the detection of non-functioning catheters. In 27 cases (45.8%), a radiological knot was found, with an average length of 2.59 cm from the tip. The chi-squared test revealed a significant difference between the initial and final positions of catheter insertion (P = 0.049).Conclusions: Deep insertion was the primary cause of epidural catheter entrapment. To remove the entrapped catheters, the lateral decubitus position should be attempted first, followed by the position used during insertion. Based on these findings, recommendations for the prevention and removal of entrapped catheters have been formulated.