lunes, 10 de julio de 2017

The Hidden Harms of Hand Sanitizer

The Case

A 57-year-old woman with a history of alcohol abuse and severe depression was admitted to the hospital for community-acquired pneumonia. After 2 days on the medical ward, she was found unconscious. Oxygen was administered, and the patient was intubated and placed on a ventilator. As part of the workup for her altered mental status, a toxicology panel was drawn, and her blood alcohol level returned elevated at 530 mg/dL. A search of the ward revealed several empty containers of alcoholic foam hand sanitizer. The patient required mechanical ventilatory support for over 12 hours, after which she was successfully extubated. Upon interview, the patient confessed to ingesting the alcoholic foam hand sanitizer on the ward to satisfy her strong alcohol craving. VER CASO COMPLETO AQUI

Delayed Recognition of a Positive Blood Culture

The Case

A 58-year-old woman with metastatic breast cancer recently treated with immunosuppressive therapy presented to the hospital for evaluation of diarrhea. As part of the infectious workup performed in the emergency department (ED), blood cultures and stool studies were sent to the laboratory. The following morning, her stool test returned positive for Clostridium difficile (C. difficile), a potent bacteria that can cause serious infections, especially in immunocompromised hosts. At that time, one out of the two blood cultures drawn in the ED was positive for gram-positive rods, but the speciation (type of bacteria) and sensitivity profile (which suggests which antibiotics are best to use) were not yet available. The medical team ordered appropriate antibiotic treatment for C. difficile but did not initiate treatment for the preliminarily positive blood culture. VER CASO COMPLETO AQUI

Pseudo-obstruction But a Real Perforation

Case & Commentary—Part 1

A 77-year-old healthy man with a history of long-standing gastroesophageal reflux disease, refractory to medical management, was admitted to the hospital for surgical treatment (a laparoscopic Nissen fundoplication). The surgery was uncomplicated, and he was slowly recovering in the hospital. VER CASO COMPLETO AQUI: