The presentation of clinical symptoms due to decompression during diving, varies significantly, as mainly minor disturbances for the gastrointestinal tract in particular have been reported. The following case debates ...The presentation of clinical symptoms due to decompression during diving, varies significantly, as mainly minor disturbances for the gastrointestinal tract in particular have been reported. The following case debates whether diving can cause severe symptoms from the gastrointestinal system. We describe a clinical case of ischemic colitis presented in a 27-year-old male, who manifested abdominal pain while in the process of scuba diving 20 meters undersea, followed by bloody diarrhoea as soon as he ascended to sea level. Taking into account his past medical history, the thorough, impeccable clinical and laboratory examinations and presence of no other factors predisposing to ischemia of the colon, we assume that a possible relationship between diving conditions and the pathogenesis of ischemic colitis may exist. This unusual case might represent a hematologic manifestation of decompression sickness, due to increased coagulability and/or transient air emboli, occurring during a routine scuba diving ascent to sea level.展开更多
Rationale:Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries.Such enormous pressure into the rectum can ...Rationale:Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries.Such enormous pressure into the rectum can lead to devastating injuries.Patient's concern:A 35-year-old male was referred to our emergency department with an alleged history of directing high pressure compressed air jet towards the anus.There was diffuse subcutaneous emphysema over the neck,chest,abdomen,and extremities,and he presented with hemodynamic instability and respiratory failure.Diagnosis:Rectosigmoid perforation due to exposure to high-pressure air jet causing tension pneumoperitoneum,pneumomediastinum,pneumothorax,and extensive subcutaneous emphysema.Intervention:In view of tension pneumoperitoneum,urgent percutaneous needle decompression was performed using 16 G needle,5 cm superomedial to the anterior superior iliac spine.The gush of air was released along with reduction in abdominal distension and improvement in hemodynamics.Outcome:The patient succumbed two days later due to septic shock.Lessons:This case highlighted the importance of promoting education about work safety among industrial workers especially in developing countries like India.展开更多
Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intub...Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilatorrelated pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation. The diagnosis of pneumothorax in critical illness is established from the patients' history, physical examination and radiological investigation, although the appearances of a pneumothorax on a supine radiograph may be different from the classic appearance on an erect radiograph. For this reason, ultrasonography is beneficial for excluding the diagnosis of pneumothorax. Respiration-dependent movement of the visceral pleura and lung surface with respect to the parietal pleura and chest wall can be easily visualized with transthoracic sonography given that the presence of air in the pleural space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation Ⅱ score or Pa O2/Fi O2 < 200 mm Hg were found to have higher mortality.展开更多
文摘The presentation of clinical symptoms due to decompression during diving, varies significantly, as mainly minor disturbances for the gastrointestinal tract in particular have been reported. The following case debates whether diving can cause severe symptoms from the gastrointestinal system. We describe a clinical case of ischemic colitis presented in a 27-year-old male, who manifested abdominal pain while in the process of scuba diving 20 meters undersea, followed by bloody diarrhoea as soon as he ascended to sea level. Taking into account his past medical history, the thorough, impeccable clinical and laboratory examinations and presence of no other factors predisposing to ischemia of the colon, we assume that a possible relationship between diving conditions and the pathogenesis of ischemic colitis may exist. This unusual case might represent a hematologic manifestation of decompression sickness, due to increased coagulability and/or transient air emboli, occurring during a routine scuba diving ascent to sea level.
文摘Rationale:Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries.Such enormous pressure into the rectum can lead to devastating injuries.Patient's concern:A 35-year-old male was referred to our emergency department with an alleged history of directing high pressure compressed air jet towards the anus.There was diffuse subcutaneous emphysema over the neck,chest,abdomen,and extremities,and he presented with hemodynamic instability and respiratory failure.Diagnosis:Rectosigmoid perforation due to exposure to high-pressure air jet causing tension pneumoperitoneum,pneumomediastinum,pneumothorax,and extensive subcutaneous emphysema.Intervention:In view of tension pneumoperitoneum,urgent percutaneous needle decompression was performed using 16 G needle,5 cm superomedial to the anterior superior iliac spine.The gush of air was released along with reduction in abdominal distension and improvement in hemodynamics.Outcome:The patient succumbed two days later due to septic shock.Lessons:This case highlighted the importance of promoting education about work safety among industrial workers especially in developing countries like India.
文摘Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilatorrelated pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation. The diagnosis of pneumothorax in critical illness is established from the patients' history, physical examination and radiological investigation, although the appearances of a pneumothorax on a supine radiograph may be different from the classic appearance on an erect radiograph. For this reason, ultrasonography is beneficial for excluding the diagnosis of pneumothorax. Respiration-dependent movement of the visceral pleura and lung surface with respect to the parietal pleura and chest wall can be easily visualized with transthoracic sonography given that the presence of air in the pleural space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation Ⅱ score or Pa O2/Fi O2 < 200 mm Hg were found to have higher mortality.
