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Critical Care and Shock, May 2009, Volume 12, No. 2

Differential Effects of Ventricular Pacing Sites of Contraction Synchrony and Global Cardiac Performance

Authors:
Mohammed Alhammouri, Hyung Kook Kim, Yasser Mokhtar, Maxime Cannesson, Masaki Tanabe, John Gorcsan III, David Schwartzman, Michael R. Pinsky

Purpura Fulminans Due to Staphylococcus Aureus: An Emerging Disease

Authors:
Fernando Pavel González Ibarra, Carlos Hernández Iturbe, Arnoldo Millán Montoya, Luis Armando Ochoa Herrera, José de Jesús Ibarra Meza, Alberto Nieto Villaseñor

Giant Right Atrium Secondary to Mitral Stenosis

Authors:
Salim Surani, Arif Surani, Joseph Varon

A 59-year-old Hispanic lady with history of rheumatic fever and chronic atrial fi brillation presented to the emergency department with severe dyspnea. Seventeen years prior to this presentation, she had undergone re-do mitral valve replacement, and tricuspid annuloplasty. The patient’s chest radiograph revealed massively dilated right chambers of the heart (Figure 1). An electrocardiogram showed right axis deviation, atrial fi brillation with a controlled heart rate of 70 beats per minute.

Portal and Splenic Vein Thrombosis Caused by Acute Pancreatitis

Authors:
Ignacio De Cicco, Joseph Varon

A 30-year-old Hispanic gentleman with past medical history of hypertension and dyslipidemia, presented to the emergency department with complaints of a blunt, constant, epigastric pain radiating to his back for 24 hours. Physical examination revealed a man in severe distress, tachypneic and tachycardic. Laboratory data, as well as the physical exam, were consistent with acute severe pancreatitis. The patient was admitted to the intensive care unit (ICU) and a computed tomography (CT) of his abdomen was obtained revealing a large thrombus in the portal vein (Figure 1).

Respiratory Distress in an Elderly - Delayed Presentation of an Odontoid Fracture

Authors:
Yeow Kwan Teo

An 85-year-old man with history of severe dementia lay down for a nap and was witnessed by his family to immediately lose consciousness, with agonal breathing. He was ventilated by facemask by the paramedics when they attended. His vital signs were stable. On admission to hospital he grimaced to painful stimulus only (Glasgow Coma Score=6/15). His arterial blood gas revealed - pH 7.21, pCO2 70 mmHg and bicarbonate 27 mmol/L. He was intubated.

Venomous Snakebites in Two Children

Authors:
Heda Melinda D. Nataprawira, Enny Harliany Alwi, Lesmana Syahrir, Tubagus Ferdi Fadilah, Tri Wahyu Murni