Anesthesia Monitoring and Management
Michele Barletta, Jane Quandt, Rachel Reed in Equine Anesthesia and Pain Management, 2023
One hour into procedure. No eye movement, normal mucous membrane color and CRT.RR 5 breaths/minute.EtCO2 55 mmHg.SpO2 95%.Normal sinus rhythm, HR 32 beats/minutes.Blood pressure 120/55 (80) mmHg.This patient is currently hypoventilating, and this could be what has caused the saturation to be low.
Case 37: Dizziness
Iqbal Khan in Medical Histories for the MRCP and Final MB, 2018
You are reviewing patients in the medical outpatient clinic. Your next patient has been referred by her general practitioner with the following letter. Please read the letter and then review the patient.Dear Doctor,Re: Mrs Mary HarbottleAge: 77 yearsI would appreciate your advice on this elderly lady. She has developed dizzy spells on a number of occasions and has only just managed to avoid falling and doing herself serious injury. Clinical examination is unremarkable except for a soft systolic murmur. An ECG shows normal sinus rhythm and blood tests have also proved to be normal. I am at a loss as to where to go from here and hence am turning to your good self for guidance.Yours sincerely
Questions
Neel Sharma, Tiago Villanueva in SBAs and EMQs in Psychiatry for Medical Students, 2019
A 26-year-old city worker presents to A&E complaining of central crushing chest pain. Chest examination reveals normal heart sounds with no tenderness on chest wall palpation. An ECG demonstrates normal sinus rhythm. A troponin taken 12 hours post-onset is 0.09 μg/L. What is the most likely aetiological cause? Cocaine misuseDiazepam overdoseAlcohol intoxicationCannabis misuseNone of the above
Aerococcus urinae tricuspid valve infective endocarditis
Published in Baylor University Medical Center Proceedings, 2022
Sanchari Banerjee, Sindhubarathi Murali, Atika Azhar, Anojan Pathmanathan, Debanik Chaudhuri
Her erythrocyte sedimentation rate was 113 mm/h, and the C-reactive protein level was 309.5 mg/dL. A complete blood count did not show leukocytosis, and troponin was negative. An electrocardiogram showed normal sinus rhythm. Blood cultures grew gram-positive cocci in clusters significant for A. urinae. Urine cultures were negative. Transthoracic echocardiography showed a markedly thickened tricuspid valve involving the posterior and septal leaflets with minimal regurgitation. Follow-up transesophageal echocardiography showed an ejection fraction of 60% with normal segmental wall motion, a dilated right atrium, and vegetations involving septal and posterior leaflets of the tricuspid valve with moderate tricuspid insufficiency. The larger vegetation on the septal leaflet measured approximately 1.2 × 0.9 cm (Figure 1). Pulmonary artery systolic pressure was elevated to 50 to 55 mm Hg. The mitral, aortic, and pulmonary valves were structurally normal.
Group A streptococcal brain abscess in children: two case reports and a review of the literature
Published in Infectious Diseases, 2018
Guy Hazan, Eyal Kristal, Michael Gideon, Vadim Tzudikov, Yuval Cavari, Yariv Fruchtman, Shalom Ben-Shimol, Eugene Leibovitz, Isaac Lazar, Rimma Melamed
In the emergency department, irregular breathing, bradycardia (around 45 beats/minute) and a blood pressure of 110/75 (90th percentile adjusted to age, gender and height) were observed, raising the suspicion of Cushing's triad indicative of impending brain herniation. She was afebrile. The physical examination revealed a normal pharynx, no skin rash, no signs of meningeal irritation and no heart murmurs. The lungs were clear. On neurologic examination dysarthria and an abnormal cerebellar neurologic examination (finger-nose test) were observed. Ophthalmologic examination (performed by an ophthalmologist) was normal. A complete blood count showed 14,000 WBC/mm3 with 76% neutrophils and 16% lymphocytes. Renal and liver function tests were normal. C-reactive protein was elevated (10 mg/dL, normal up to 5 mg/dL) and blood gases demonstrated pH 7.46, pCO2 41 mmHg, HCO3 29 mmol/L and lactate 0.5 mmol/L. The electrocardiogram showed sinus rhythm of 50 beats/minute, with normal cardiac axis. Chest X-ray was normal. Due to suspicion of brain herniation (based on clinical picture of irregular breathing, bradycardia, hypertension and impaired consciousness), she was treated with intravenous mannitol 2 g/kg. A brain computerized tomography with contrast material performed under general anaesthesia revealed a large abscess (3.5 cm × 4.0 cm) in the left hemisphere of the cerebellum with mass effect on related brain parenchyma, 4th brain ventricle and brain stem (Figure 1).
Acute Enophthalmos After Lumbar Puncture in a Patient with Type 1 Neurofibromatosis Related Sphenoid Wing Dysplasia
Published in Neuro-Ophthalmology, 2022
Deanna Ingrassia Miano, Gregory Byrd, Rani Kattoula, Aye Thet, Ryan Adkins, Ryan Cosgrove, Samantha S. Johnson
A 19-year-old African American woman with a medical history significant for NF-1 presented to hospital after collapsing while leisurely walking outside. She denied any previous syncopal events, blurred vision, diplopia, dizziness, headache, incontinence, weakness, sensory loss, nor history of drug or alcohol use prior to this incident. She denied taking any medications, including anti-epileptics. She had been diagnosed with NF-1 5 years earlier after a single epileptic event, which led to the discovery of a right-sided sphenoid wing dysplasia on imaging. In addition, her family history was positive for NF-1 in her mother. The evaluation was notable only for mild right ankle pain secondary to the fall. An electrocardiogram demonstrated normal sinus rhythm. Aside from the patient’s previously known NF-1 related sphenoid wing dysplasia, a non-contrast computed tomography (CT) scan of the head was negative for acute abnormality (Figure 1A). She was subsequently admitted to the hospital for a further work-up. An electroencephalogram revealed no epileptiform activity. No acute changes were appreciated on magnetic resonance imaging (MRI) at this time. CT angiography of the brain revealed a 2 mm infundibular dilatation at the origin of the left ophthalmic artery. No vasculitic findings were observed.
Related Knowledge Centers
- Depolarization
- Sinus Arrhythmia
- P Wave
- Sinus Bradycardia
- Heart
- Cardiac Muscle
- Cardiac Conduction System
- Sinoatrial Node
- Electrocardiography
- Sinus Tachycardia