Open Access DOI:10.23937/2378-3656/1410306
The Management of an Early COVID-19 Case with Severe Acute Respiratory Distress Syndrome in a Community Hospital in Ontario, Canada
Maham Khalid, BMSc, Han-Oh Chung, MD, MSc HS Ed, Dimitra Fleming, BSc Phm, George Farjou, MD and Jennifer LY Tsang, MD, PhD
Article Type: Case Report | First Published: April 23, 2020
We reported an early COVID-19 case in a young patient in a Canadian community intensive care unit (ICU) with severe acute respiratory syndrome (ARDS). We discussed the management according to the recently published Surviving Sepsis Guidelines on COVID-19. This will provide critical care physicians important and timely information on the management of severe COVID-19 using a real case when critical care physicians are facing a surge in COVID-19 cases. Many of the recommendations regarding ARDS ar...
Open Access DOI:10.23937/2378-3656/1410305
Thoracopagus Conjoined Twins: Early Diagnosis by Ultrasound, A Case Report
Giovanna Rosica, Daniela Bucari, Giovanni Pastore and Angela Musella
Article Type: Case Report | First Published: April 23, 2020
A tempestive diagnosis of conjoined twins pregnancy is highly important to lead to the best the rapeutic option. Thoracopagus conjoined twins account for more than 40% of conjoined twins pregnancies, and the prognosis is very poor because in most of cases a single heart and/ or liver is present. In our case, the premature diagnosis has given the family a chance to choose for pregnancy termination reducing as far as possible the already heavy emotional impact of that condition....
Open Access DOI:10.23937/2378-3656/1410304
Remifentanil: Pharmacokinetics, Pharmacodynamics, and Current Clinical Applications
Marco A Maurtua, MD, Amanda Pursell, MD, Kyle Damron, MD and Patel Sonal, MD
Article Type: Review Article | First Published: April 15, 2020
Remifentanil is a mu-receptor agonist chemically related to fentanyl, alfentanil, and sufentanil that was approved for use in general anesthesia in 1996 by the US Food and Drug Administration. It is a piperidine derivative, a 3-(4-methoxycarbonyl-4-[(L-oxopropyl)- phenylamino]-L-piperidine) propanoic acid, methyl ester. The introduction of the methyl ester group onto the N-acyl side chain of the piperidine ring is what makes remifentanil structurally unique among the currently available opioids....
Open Access DOI:10.23937/2378-3656/1410303
Subnormal Thyroid Makes the Heart Skip a Beat
Supraja Thunuguntla, MD, Rizwan Mohammed, MBBS, Lauren Muenchow, MS and Jose Campo Maldonado, MD, FACP
Article Type: Case Report | First Published: April 11, 2020
A 72-year-old Hispanic male with an unconfirmed history of alcohol-related cirrhosis presented to the hospital for rectal bleeding and dark stool for two days. Vitals included a heart rate of 90-120 bpm, blood pressure 90-140 over 50-60 mmHg. A left thyroid nodule was appreciated on physical exam. His pertinent labs included TSH, free T3 and T4 levels that were 0.033 mU/L (low), 3.33 mU/L and 1.33 mU/L (both within normal limits) respectively. A TSH done 3 days later was low (0.024). Thyroid per...
