FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4386584377> ?p ?o ?g. }

• W4386584377 abstract "Figure 1.: A chest x-ray prior to left chest tube placement showing moderate-sized left pneumothorax with bilateral infiltrates.FigureFigureFigureFigureFigureA 54-year-old woman presented with increasing fatigue and decreased appetite. She had a dry cough that was improving but no significant medical history, medications, tobacco use, or ethanol use. She also had no chest pain, shortness of breath, fever, or chills. The patient had had a positive COVID-19 test two weeks before her initial ED visit. Her ED vital signs were a temperature of 37°C, a blood pressure of 133/74 mm Hg, a respiratory rate of 19 bpm, a pulse oximetry of 88% on room air, and a body mass index of 30 kg/m2. The patient was started on 6L oxygen via nasal cannula. A portable chest x-ray showed airspace opacities throughout the lungs bilaterally, most pronounced in the lung bases. A computed tomography angiogram of the chest showed no pulmonary embolism and diffuse bilateral interstitial and alveolar opacities. The patient's laboratory evaluation was significant for an elevated blood glucose of 315 U/L, a ferritin of 540.3 ng/mL, a C-reactive protein of 21 mg/dL, and a D-dimer of 10,550 ng/mL. The patient had no history of diabetes. She was admitted for hypoxia and COVID-19 with superimposed pneumonia. During her hospital stay, she completed a course of remdesivir and a 10-day course of dexamethasone. Her pneumonia was treated with vancomycin and pipercillian/tazobactam. The patient was also diagnosed with an acute DVT in her left lower leg, and was treated with apixaban. She was discharged after a 12-day hospital stay on 3L of oxygen via nasal cannula, metformin ER, glimepiride, insulin glargine, and insulin lispro. Eleven days after she was discharged, a chest x-ray showed a small left apical lateral pneumothorax. A repeat chest x-ray the following day showed her left pneumothorax had increased in size. (Fig. 1.) She was advised to return to the ED for evaluation. Her vital signs were a temperature of 36.6°C, a blood pressure of 129/78 mm Hg, a respiratory rate of 18 bpm, and a pulse oximetry of 98% on her home 3L of oxygen. Thoracic surgery was consulted for the left-sided pneumothorax. Interventional radiology placed a 10.2 French Cook Heimlich drain. A follow-up chest x-ray showed resolution of the pneumothorax. The following day, there was a trace left apicolateral pneumothorax after the removal of the chest tube. The patient was monitored for two more days and discharged with continued 3L of home oxygen. Risk Factors and Mechanisms Pneumothorax is considered a medical emergency, and prompt identification and management are important. The typical risk factors for primary spontaneous pneumothorax include tall, thin body habitus, male sex, and being between the ages of 10 and 30. (Am J Med. 1962;32:361.) Chest pain and dyspnea are the most common presenting symptoms. (N Engl J Med. 2000;342[12]:868; Asian Cardiovasc Thorac Ann. 2014;22[8]:997.)Figure 2.: Point-of-care ultrasound utilizing a high-frequency linear transducer in M-mode showing the “stratosphere sign.” Note the absence of lung sliding motion shown as relatively static appearance across the M-mode image.Secondary spontaneous pneumothorax is a complication of processes such as infection, bullous diseases, and trauma. The majority of patients with bullae have histories of cigarette or marijuana smoking, pulmonary sarcoidosis, alpha-1 antitrypsin deficiency, Marfan syndrome, Ehlers-Danlos syndrome, or inhaled fiberglass exposure. (Am J Med. 1962;32:361; Thorax. 2000;55[4]:340; https://bit.ly/2WVO7SS; West J Emerg Med. 2013;14[5]:450; https://bit.ly/3n7GHH7.) A proposed mechanism for pneumothorax in COVID-19 patients is that injured fibrotic alveoli are prone to rupture during resolution of consolidations and ground glass opacities. (Korean J Radiol. 2020;21[5]:541; https://bit.ly/3yN75sg.) Rupture can lead directly to pneumothorax or bullae formation. This along with peribronchial abscess formation leaves an opportunity for interstitial pulmonary emphysema to develop, which can track back along the bronchovascular sheath, causing pneumomediastinum or pneumothorax. (Korean J Radiol. 2020;21[5]:541; https://bit.ly/3yN75sg; AJR Am J Roentgenol. 2003;181[6]:1525; https://bit.ly/3jUBktb; Korean J Radiol. 2020;21[7]:929; https://bit.ly/3DOqNYp.) Intubation is a well-known risk factor for iatrogenic pneumothorax. The patient in this case was not intubated during her hospital course. It has been suggested that, even after extubation, intubated patients have a higher risk of developing complications. (Am J Trop Med Hyg. 2020;103[3]:1166; https://bit.ly/3zPhdSp.) A review of the literature showed few reports depicting spontaneous pneumothorax in non-intubated COVID-19 patients. Of the found reports, eight patients were treated conservatively, and the other 10 required chest tube insertion. The mortality rate for COVID-19 patients with pneumothorax was 33 percent. (Korean J Radiol. 2020;21[5]:541; https://bit.ly/3yN75sg; Ann Thorac Surg. 2020;110[5]:e413; https://bit.ly/3l1ZnWa; CMAJ. 2020;192[19]:E510; https://bit.ly/3kSyZxO; J Infect Public Health. 2020;13[6]:887; https://bit.ly/3haKvnh; J Travel Med. 2020;27[5]:taaa062; https://bit.ly/3l16cqV; Eur J Case Rep Intern Med. 2020;7[7]:001742; https://bit.ly/2WY7V8k; BMJ Case Rep. 2020;13[5]:e235861; https://bit.ly/3yQ5P7q; Korean J Radiol. 2020;21[5]:627; https://bit.ly/3yKtxC5; Emerg Radiol. 2020;27[6]:727; https://bit.ly/3ndSDYd; IDCases. 2020;21:e00806; https://bit.ly/3kZ0CFD; BMJ Case Rep. 2020;13[5]:e236519; https://bit.ly/3zPrbn3; Medicine [Baltimore]. 2020;99[20]:e20208; https://bit.ly/3zKZs6R.) This was the first reported case in the United States of a delayed spontaneous pneumothorax in a female patient without other risk factors. Important causes of sudden respiratory compromise related to COVID-19 patients include pulmonary embolism, secondary bacterial pneumonia, acute respiratory distress syndrome, and pneumothorax; all require prompt intervention. In addition to standard emergent evaluation, POCUS can be used to differentiate these entities rapidly. (J Emerg Trauma Shock. 2012;5[1]:76; https://bit.ly/3zTw26K; Crit Care. 2020;24[1]:702; https://bit.ly/3kWH0SI; Ann Intensive Care. 2014;4[1]:1; https://bit.ly/3BL8u4n.) POCUS can detect pneumothorax showing the absence of lung sliding, “the stratosphere sign” on M-mode (Fig. 2), and the lung point sign. (J Emerg Trauma Shock. 2012;5[1]:76; https://bit.ly/3zTw26K; Ann Intensive Care. 2014;4[1]:1; https://bit.ly/3BL8u4n.) Emergency physicians should be aware of the possibility of delayed pneumothorax in COVID-19 patients who do not have other risk factors and have not been ventilated. Imaging should be obtained if patients have a change in their clinical respiratory symptoms or if they develop hypoxia." @default.
• W4386584377 created "2023-09-11" @default.
• W4386584377 creator A5004701867 @default.
• W4386584377 creator A5050505383 @default.
• W4386584377 creator A5053279517 @default.
• W4386584377 creator A5054546569 @default.
• W4386584377 creator A5089944948 @default.
• W4386584377 date "2021-10-12" @default.
• W4386584377 modified "2023-09-29" @default.
• W4386584377 title "The Case Files" @default.
• W4386584377 doi "https://doi.org/10.1097/01.eem.0000794748.67208.33" @default.
• W4386584377 hasPublicationYear "2021" @default.
• W4386584377 type Work @default.
• W4386584377 citedByCount "0" @default.
• W4386584377 crossrefType "journal-article" @default.
• W4386584377 hasAuthorship W4386584377A5004701867 @default.
• W4386584377 hasAuthorship W4386584377A5050505383 @default.
• W4386584377 hasAuthorship W4386584377A5053279517 @default.
• W4386584377 hasAuthorship W4386584377A5054546569 @default.
• W4386584377 hasAuthorship W4386584377A5089944948 @default.
• W4386584377 hasConcept C126322002 @default.
• W4386584377 hasConcept C141071460 @default.
• W4386584377 hasConcept C2777063151 @default.
• W4386584377 hasConcept C2777914695 @default.
• W4386584377 hasConcept C2778074680 @default.
• W4386584377 hasConcept C2778329176 @default.
• W4386584377 hasConcept C2778594517 @default.
• W4386584377 hasConcept C2779634585 @default.
• W4386584377 hasConcept C2780124106 @default.
• W4386584377 hasConcept C2780334268 @default.
• W4386584377 hasConcept C2780505380 @default.
• W4386584377 hasConcept C42219234 @default.
• W4386584377 hasConcept C71924100 @default.
• W4386584377 hasConceptScore W4386584377C126322002 @default.
• W4386584377 hasConceptScore W4386584377C141071460 @default.
• W4386584377 hasConceptScore W4386584377C2777063151 @default.
• W4386584377 hasConceptScore W4386584377C2777914695 @default.
• W4386584377 hasConceptScore W4386584377C2778074680 @default.
• W4386584377 hasConceptScore W4386584377C2778329176 @default.
• W4386584377 hasConceptScore W4386584377C2778594517 @default.
• W4386584377 hasConceptScore W4386584377C2779634585 @default.
• W4386584377 hasConceptScore W4386584377C2780124106 @default.
• W4386584377 hasConceptScore W4386584377C2780334268 @default.
• W4386584377 hasConceptScore W4386584377C2780505380 @default.
• W4386584377 hasConceptScore W4386584377C42219234 @default.
• W4386584377 hasConceptScore W4386584377C71924100 @default.
• W4386584377 hasIssue "10A" @default.
• W4386584377 hasLocation W43865843771 @default.
• W4386584377 hasOpenAccess W4386584377 @default.
• W4386584377 hasPrimaryLocation W43865843771 @default.
• W4386584377 hasRelatedWork W2011177479 @default.
• W4386584377 hasRelatedWork W2211336242 @default.
• W4386584377 hasRelatedWork W2283945086 @default.
• W4386584377 hasRelatedWork W2355800467 @default.
• W4386584377 hasRelatedWork W2370758048 @default.
• W4386584377 hasRelatedWork W2383337405 @default.
• W4386584377 hasRelatedWork W2413385427 @default.
• W4386584377 hasRelatedWork W2419456819 @default.
• W4386584377 hasRelatedWork W2471039675 @default.
• W4386584377 hasRelatedWork W2891318755 @default.
• W4386584377 hasVolume "43" @default.
• W4386584377 isParatext "false" @default.
• W4386584377 isRetracted "false" @default.
• W4386584377 workType "article" @default.