Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/EQDtTCBSFOI Aim: In addition to its respiratory impact of SARS-CoV2, skin lesions of probable vascular origin have been described. This study intends to quantify the incidence of acro-ischemic lesions in COVID-19 infected adult subjects in our population, describing clinical patterns and associated findings. Methods: All adult confirmed cases of COVID-19 infection who presented with acroischemic lesions and received care in our institution were prospectively enrolled up to May 15th, 2020. The variables included demographics, comorbidities, analytical parameters, clinical presentations and COVID-19 treatment. Results: We enrolled 24 patients. The overall rate of acro-ischemic findings in COVID-19 patients was 1.2% [0.6% for outpatients and 2.9% for hospitalized (ICU and non-ICU patients)], but the observed incidence for acro-ischemia in ICU patients was remarkably higher (23.0%, p<0.001). We have described four different clinical patterns of acroischemia: atypical Raynaud´s phenomenon (ARP), (4); pseudo-pernio (PP), (5); severe microcirculatory ischemia with preserved pulse (SMI), (6); and dry gangrene with arteriosclerosis obliterans (AO), (9). Kendall´s τ correlation with lung disease severity was 0.877 (95% CI, 0.756 to 0.968); p<0.01). ARP individuals were predominantly female, while SMI appeared lately in elderly hospitalized subjects with better prognosis. AO occurred in patients with more comorbidity and younger than those with SMI. We observed other associated lesions of suggestive ischemic nature in other organs in all groups (15 patients of total sample). Plasma procalcitonin was significantly higher in patients who developed SMI (median and interquartile range: 9.99 (4.2, 12.3) mg/mL vs 0.26 (0.11, 0.89) mg/mL; p<0.001), and D-dimer level at hospital admission was significantly higher in AO patients (median and interquartile range: 1166 (1050, 2111) mg/L vs 502 (448, 777) mg/L; p<0.001). Conclusion: The observed risk for acroischemia in COVID-19 is high in ICU patients (23%). We have described four different clinical patterns of acroischemia (ARP, PP, SMI and AO) associated with lung disease severity. Authors have communicated various lesions of suggestive ischemic nature in other organs. Raynaud-like pattern is reported as a "novelty".
El catéter venoso central yugular interno es un dispositivo invasivo que se introduce en una vena central progresándolo hasta que la luz distal resida en la aurícula. Se describió por primera vez en 1929 y desde entonces, se han desarrollado múltiples técnicas y dispositivos. Es un procedimiento que se lleva a cabo rutinariamente en quirófano y en las unidades de cuidados intensivos para monitorización y soporte hemodinámico, nutrición parenteral, hemodiálisis, aporte de fluidos y drogas vasoactivas. A continuación, se describe un caso de iatrogenia en la canalización de una vía venosa central, el desarrollo de los acontecimientos y la importancia en la rapidez de actuación del equipo, que fue decisiva para el desenlace del caso. Se expone con el objetivo de recordar la gravedad de las consecuencias posibles de una técnica con la que los anestesiólogos estamos muy familiarizados en nuestra práctica clínica diaria, que no está exenta de riesgos.
The need for non-obstetric surgery during pregnancy is relatively frequent and can occur at any time during pregnancy. In this chapter, we will develop the anesthetic implications of changes in maternal physiology, and the repercussions of anesthesia on the fetus, and we will delve into the peculiarities of anesthetic management of these patients. Urgent/emergent procedures should not be postponed in these patients due to their pregnancy conditions. However, elective surgeries should be delayed whenever possible, taking into account the maternal-fetal risk-benefit.
El uso de las emulsiones lipídicas como antídotos para la intoxicación sistémica por anestésicos locales (ISAL) ha aumentado en las últimas décadas. El síndrome de sobrecarga grasa (FOS) es una de sus complicaciones. Presentamos el caso de una gestante que para cesárea recibió bolo de lidocaína 2% a través de catéter epidural normofuncionante. Ante la sospecha de una ISAL por alteraciones neurológicas, recibió una carga de Intralipid®. En el postoperatorio debutó con ictericia, hipertermia, taquicardia y acidosis láctica. Una vez descartadas otras complicaciones, se sospechó FOS por la presencia de plasma lechoso. Se decidió tratamiento con fluidoterapia intensiva y antitérmicos. Si bien el FOS es una complicación rara, debe sospecharse ante pacientes que hayan recibido altas dosis de emulsiones lipídicas. No existen estudios sobre este síndrome en población obstétrica y hay opiniones encontradas respecto a su tratamiento, aunque el eje central es la fluidoterapia para disminuir la viscosidad plasmática.
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