Saudi Critical Care Journal

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Krait (elapid snake) bite may be painless, without evidence of flange marks, and the patient is many times unaware of the bite. This may present as unexplained neuroparalysis and deep coma with absent brainstem reflexes, and it may look like brain death. We present a case of such unexplained neuroparalysis who was diagnosed on clinical ground, and the patient was completely recovered with anti-snake venom (ASV) and supportive treatment. A high index of suspicious, background history of the patient and timely empirical ASV therapy can save the patient from a coma with unexplained neuroparalysis from definite death.

Hypophosphatemia is a common electrolyte abnormality in our day-to-day practice in Intensive Care Unit. Severe hypophosphatemia is usually multifactorial and can lead to devastating consequences such as cardiac arrest. Phosphate replacement can be considered in severe symptomatic hypophosphatemia. We describe a patient of chronic alcoholic and diabetic who presented with diabetic ketoacidosis, right-lung pneumonia, and septic shock. Subsequently, the patient developed recurrent cardiac arrest. Both hypophosphatemia and phosphate-induced hypocalcemia were attributed to be the cause of this recurrent cardiac arrest.

Tetanus, also known as lockjaw, is an infection characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. These spasms usually last a few minutes each time and occur frequently for three to four weeks. Tetanus is a disease caused by the toxin produced by the ubiquitous bacterium, Clostridium tetani. C tetani infection can be acquired through surgery, intravenous drug abuse, the neonate's umbilicus, bites, burns, body piercing, puncture wounds, and ear infections. This organism can enter through any break in the integrity of the body. We hereby describe the successful management, including critical care challenges of a case of Tetanus in a young male patient following a minor toe injury. Timely airway management followed by early tracheostomy with effective control of muscle spasms and other supportive therapy is highlighted. Tetanus continues to be a menacing infectious disease with high fatality in the developing world.

This study aimed to show the spontaneous rupture of the stomach in a 3-year-old girl. The patient was admitted to the pediatric clinic due to poor general condition that occurred suddenly with severe abdominal pain, vomiting, and the development of hypovolemic shock (blood pressure was unmeasurable, in acidosis), and after the ultrasound and abdominal X-ray, she was operated by the pediatric surgeon within 6 h of admission. During surgery, multiple defects of stomach mucosa with transmural bleeding without pathohistological changes in the muscle layer were found in the large stomach blood vessels. Treatment was continued in the pediatric intensive care unit with the development of life-limiting complications: peritonitis, sepsis, intracranial hemorrhage, and outcome of death. Rupture of the stomach caused by acute distension is rarely seen outside the neonatal period with fast clinical course and high mortality rate. Early diagnosis and rapid surgical procedures are a prerequisite to avoid the development of life-limiting complications that lead to a fatal outcome.

Introduction: Ventilator-associated pneumonia (VAP) is subtype of healthcare acquired pneumonia. With high mortality rate (46%), especially in contused lungs due to trauma. Antibiotics are important in treatment of VAP. Aim of Work: The aim is to evaluate and compare the effect of the use of tazocin (piperacillin + tazobactam)/vancomycin combination versus the use of tazocin/linezolid in the treatment of VAP and weaning from the ventilator in traumatized lungs in patients with severe chest trauma complicated with VAP. Patients and Methods: Prospective double-blind study conducted on 200 patients from King Abdul-Aziz Specialized Hospital. Patients were allocated into two groups as follows: Group A included 100 patients who received piperacillin-tazobactam with vancomycin with the five points of bundle of VAP prevention while Group B included another 100 patients who received piperacillin-tazobactam but with linezolid and with the five points of bundle of VAP prevention. In this study, diagnosis of lung contusion was made by computerized axial tomography of the chest while VAP was diagnosed by modified clinical pulmonary infection score (CPIS). Any patient who had score of 6 or more was considered to have VAP. Results: 15, 38, and 46 patients in Group A showing controlled tracheal secretion, respectively, in three studied period compared to 28, 75, and 83 in Group B, less parenchymatous lung infiltration in the chest X-ray 12, 40, and 48 patients in Group A compared to 24, 88, and 91 patients in Group B, improvement of the hypoxic index 48, 76, and 85 patients in Group A compared to 66, 90, and 98 patients in B, normalization of temperature 16, 36, and 54 patients in Group A while 40, 76, and 90 patients in B and reduction of total leukocytic count 18, 35, and 57 patients in Group A while 38,70, and 87 patients in Group B, there was 15 out of 98 patients in Group A not weaned while only 5 out of 100 patients in Group B cases failed to be weaned from mechanical ventilation within the studied period (2 weeks). Conclusion: The use of tazocin/linezolid provided a rapid response in treatment and less morbidity by shortening the duration of ventilation than tazocin/vancomycin in VAP that occurred in traumatized lungs.

Online since 15^th Dec, 2016