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General Critical Care

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Type B dissection!


Noor Ali Shah
Noor Ali Shah
Sep 01

Aortic dissections are classified (Stanford classification) into two types: type B dissection involves a tear in the descending part of the aorta and may extend into the abdomen, whereas type A dissection develops in the ascending part of the aorta just as it branches off the heart.

The best treatment of type B dissection is beta blockers and blood pressure control.

In selected cases, surgical intervention is indicated . In most cases minimal surgical intervention is recommended such as endovascular stent.


People with type A aortic dissection often report shortness of breath and a sudden, severe, sharp pain that feels like a tearing in the chest and upper back. It always confuses like acute myocardial infarction as coronary arteries are involved.


There are 2 possible surgery methods for aortic A dissection repair. The first is standard open-heart surgery ( ARR- Aortic Root Replacement). The second is less-invasive endovascular surgery.


Edited

Livedo reticularis!


Mottling vs livedo reticularis

Reversal of the S wave on the hepatic vein Doppler in a patient with alcoholic cardiomyopathy!

Same patient with dilated IVC without respiratory variation:



@Ibrahim Ameen


There is bilateral surgical emphysema with pneumoperotenium ETT is deep with malpositioned right subclavian CVC. Did the patient underwent any laprsopic procedures ? Emphysema and pnumoperotenium could be a post procedure complications

Edited

Dark purple urine secondary to Hydroxycobolamin!


Noor Ali Shah
Noor Ali Shah
Aug 18

Hydroxocobalamin chelates cyanide and forms the nontoxic, renally excreted cyanocobalamin. A common side effect of hydroxocobalamin is a stunning dark red/purple discoloration of the recipient's skin, mucosal membranes, and body fluids, including plasma and urine.


As smoke inhalation victims often demonstrate concomitant carbon monoxide and cyanide toxicities, initial blood gas measurements should be obtained prior to hydroxocobalamin administration.


Urinary obstruction leading to enlarged urinary bladder and hydroureteronephrosis!

@Ibrahim Ameen

Both central lines were confirmed to be venous by US, waveform, and VBGs

Thank you @Ibrahim Ameen

PLSVC


Plethoric IVC with not much variation between inspiration and expiration indicating venous congestion.


RV dilation and TR associated with PE

LOOKS LIKE AIR BUBBLES MORE THAN SMOOKY FLOW?

IF YOU SCAN THE IVC TO SEE WHER THEY COM FROM




Paraplegic patient secondary to traumatic spinal injury with large amount of right main bronchial secretions causing right lung volume loss. Opened up after clearing all secretions. Required multiple bronchoscopies.

In Disseminated Intravascular Coagulation (DIC), patients may present with both necrotic and hemorrhagic skin lesions, reflecting the complex and severe nature of this condition. The necrotic lesions arise from widespread microthrombi formation in small blood vessels, leading to impaired blood flow and subsequent tissue death, manifesting as purplish, black, or red patches on the skin. Concurrently, hemorrhagic lesions occur due to the significant depletion of platelets and clotting factors, a result of the excessive clotting process, leading to spontaneous bleeding under the skin. These may appear as petechiae, purpura, or ecchymoses, scattered across various parts of the body.

@Everyone



Chest X-ray with right lower/middle lobe infiltrate

Turned out to be effusion in the minor fissure on the CT scan.


Noor Ali Shah
Noor Ali Shah
Oct 18, 2023

Parapneumic effusion?

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