2011, Hot Cases 1

Liverpool Hospital
  • Right basal ganglia bleed as a complication of warfarin therapy with ARDS and difficulty weaning.
  • Male with neutropenic sepsis, likely catheter related, 2 weeks after stem cell transplant for mantle cell lymphoma. Clinical findings include hyperdynamic shock, systolic murmur, ventilated on minimal oxygen
  • Male polytrauma secondary to MVA, car versus tree, bilateral SAH, facial fractures, chest injuries, fractured thoracic and lumbar vertebrae. Failed intubation secondary to facial injuries requiring urgent tracheostomy.
  • Male polytrauma secondary to MVA, fractured ribs, splenic rupture, long bone injuries and open book pelvic fracture awaiting fixation.
  • Male polytrauma, pedestrian versus car, unstable cervical and thoracic spine fractures, splenectomy and open book pelvic fractures with external fixation.
  • Female with grade IV SAH from PCOM aneurysm treated by coiling and complicated by temporal infarct and recurrent hydrocephalus. Current status unresponsive with right hemispheric infarct, some absent brain stem reflexes and likely to progress to brain death.
  • Female with traumatic SAH and cerebral contusion. History of alcohol abuse. Re-intubated for agitation and confusion, currently has aspiration pneumonia.
  • Female with right MCA SAH awaiting coiling. Intubated on minimal support, left hemiparesis, agitated.
Westmead Hospital
  • 39-year-old female, with background of atypical dermatomyositis and immunosuppression, readmitted to ICU with worsening respiratory failure and new onset sepsis. Recent discharge from ICU following PJP for which she required ECMO and prolonged mechanical ventilation. Current issues include neuromuscular weakness and prolonged hospital stay.
  • 77-year-old female admitted to ICU from the ward with decreased level of consciousness and respiratory distress requiring intubation. In hospital for one month following fall at home and subsequent problems with swallowing, confusion and delirium. Uncertain underlying diagnosis.
  • 63-year-old female admitted with respiratory failure and septic shock secondary to severe community acquired pneumonia. Co-morbidities include diabetes, NHL in remission, COPD with prolonged steroid therapy and psoriatic arthropathy. ICU course complicated by ischaemic hepatitis and SVT. Slow to wean due to haemodynamic instability, respiratory failure and obesity.
  • 56-year-old male post CABG x 5 with ischaemic cardiomyopathy and acute on chronic renal failure, now dialysis dependent.
  • 44-year-old male, intubated and ventilated in ICU for 16 days, post elective Ivor-Lewis oesophagectomy for distal oesophageal cancer complicated by anastamotic breakdown. Current issues included persistent fevers and poor nutritional state.
  • 67-year-old male, one day post AVR for aortic valve endocarditis following MSSA bacteraemia also resulting in cerebral emboli and multiple infarcts; splenic abscess requiring splenectomy; and septic arthritis. Physical signs included embolic phenomena, signs of lateral medullary syndrome, swollen left knee, laparotomy scar and signs of recent cardiac surgery.
  • 31-year-old female admitted to ICU with SAH secondary to ACOM aneurysm, treated by coiling. Background history included coarctation of the aorta repaired in 1994 and congenital bicuspid aortic valve.
  • 35-year-old male with out of hospital VF arrest admitted to ICU with cardiogenic shock following emergency coronary angiography and failed PTCA. Current issues included hypoxia, cardiogenic shock, sepsis, acute kidney injury and uncertain neurological recovery.
  • 58-year-old male one week post VF arrest secondary to blocked LAD with some neurological recovery but recent deterioration with acute pulmonary oedema. Other issues included acute kidney injury.
  • 43-year-old female with intra-abdominal sepsis and multi-organ failure, including acute on chronic renal failure. Co-morbidities include COPD, T2DM and severe chronic pain with multiple analgesic use
  • 49-year-old male with ongoing sepsis and multi-organ failure due to left lower lobe community-acquired pneumonia. Complications include left sided empyema and septic right knee.
  • 44-year-old female post resection of left lobe liver for hepatocellular carcinoma with background of partially corrected congenital heart disease.
  • 64-year-old male with background of CLL and recent chemotherapy, who presented with severe septic shock
  • 29-year-old lady with severe hypoxaemic respiratory failure secondary to aspiration following an elective laparascopic cholecystectomy.

[Submit a comment or correction]