cASE Reports
Bronchoscopy as Therapy for Mucus Plug Obstruction in a Prone Patient in Mayfield Pins: A Case Report
Sravya Veligandla MD, Ioana F. Pasca MD, Trinith Radhakrishnan BS, Haad Arif BS, Gian Christian T Ignacio MD, Ashish Sinha MD
Abstract: Mucus plug obstruction can be a life-threatening complication during procedures requiring patients in the prone position. We describe a case where the preoperative, preemptive bronchoscopy for copious secretions in a patient with COPD was insufficient to prevent intraoperative airway obstruction. Given limited access to the airway in a prone patient in Mayfield pins, intraoperative flexible bronchoscopy with aggressive suctioning, in the prone position was imperative to evaluate the airway and extract the causative mucus plug. Our experience underscores the need for heightened awareness and preparedness for mucus plug obstruction in prone patients, especially in patients with chronic productive bronchitis.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis During Pregnancy
Haad Arif BS, Sunny Bang MD
Abstract: Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a type of autoimmune encephalitis that preferentially affects young women of reproductive age and is strongly associated with viral infections and ovarian teratomas. Here, we present a case of a 20-year-old patient with autoimmune encephalitis in the setting of an ovarian teratoma. The patient's clinical course and medical decision making was complicated by both altered mental status and pregnancy, requiring thorough consultation with the medical Ethics Board regarding available treatment options.
When the Supraglottic Airway Device is the Problem, Not the Solution!
Ashish Sinha MD, Natalie Garcia Perez BA, Haad Arif BS, Viet Nguyen DO & Jeffrey Thomas DO
Abstract: Since their development, supraglottic airway devices, like Laryngeal Mask Airways (LMA®, Teleflex, Morrisville, NC) have been employed for their reliability and ease of use. Reported cases of LMA® malfunction involved inadvertent damage from either the patient or the physicians, not from loss of structural integrity. We describe a novel case of a disposable LMA® structural failure resulting in difficulties in ventilating the patient. While structural failures of LMA® devices are rare, inspection for this problem should be part of the troubleshooting process.
Removal of a Bent Tibial Intramedullary Nail via Osteotomy and Partial Sectioning: A Case Report
Haad Arif BS, Steven Molina BS, Christopher LeBrun MD
Abstract: An 18-year-old male patient presented with a closed fracture of the left tibia and fibula and a bent intramedullary nail after a repeat motorcycle accident. The patient was 5 weeks postoperative from intramedullary nailing of a closed left tibia fracture. The site of angulation of the tibial nail was noted to be more proximal than the fracture site. Partial sectioning of the nail through an osteotomy permitted the removal of the nail and revision tibial nailing. This is the first reported use of an osteotomy and partial sectioning during the extraction of a bent tibial intramedullary nail.
missed ruptured abdominal aortic aneurysm in a paraplegic patient
Haad Arif BS, Sunny Bang MD
Abstract: Abdominal aortic aneurysms (AAA) classically present with abdominal or flank pain, hypotension or shock, and a pulsatile mass. However, more than half of cases lack one or more of these characteristics, and the first presentation may be the aneurysm rupture itself. Here, we describe the case of a ruptured AAA in a paraplegic patient who presented to the Emergency Department (ED) with fatigue and muscle weakness. This case reinforces the fact that the classic triad of AAA is not always present and emphasizes the potential utility of ultrasound as a fast and effective diagnostic modality in the ED.
Can Tilting of the Operating Room Table Laterally Ease Spinal Anesthesia Placement in an Obese Patient? A Case Report
Ashish Sinha MD, Haad Arif BS, Ioana Pasca MD
Abstract: A morbidly obese body habitus presents a challenging scenario when attempting to administer neuraxial anesthesia. In the operating room, anesthesiologists can take advantage of the tilt function available with most surgical tables to angle the table laterally by approximately 12 to 15 degrees, permitting widening of the intervertebral spaces for enhanced exposure, successful placement of intrathecal or epidural medication, and delivery of neuraxial anesthesia.
Solution to Challenging Ventilation in a Morbidly Obese Patient with a Beard: A Case Report
Ashish Sinha MD, Avrodet Mourkus BS, Haad Arif BS, Jessica Chan DO, Ioana Pasca MD
Abstract: Appropriate mask ventilation continues to be a challenge in the obese, bearded patient. Current methods to address this obstacle are associated with time and financial burdens as well as potential poor patient-specific outcomes including skin irritation or violation of patient desires. We present the use of a Tegaderm™ Transparent Film Dressing as a technique for ensuring an adequate air seal when attempting to ventilate an obese, bearded patient.