Tension pneumothorax managed without immediate needle decompression

Standard medical reference texts state that the immediate life-saving treatment for tension pneumothorax is needle decompression. This article reports a case of an 85-year-old man with tension pneumothorax who was managed without performing immediate needle decompression. Emergency physicians should be aware of the proper management of such cases. There seems to be a growing body of evidence in the literature to suggest that in spontaneously breathing patients with tension pneumothorax, the rate of deterioration of this condition is much less rapid compared to ventilated patients, and the risks of performing needle decompression need to be balanced against the benefits of this procedure. In the absence of hemodynamic instability or severe respiratory insufficiency, the proper approach to managing such cases may be to carefully monitor the patient, promptly obtain portable chest radiography, and immediately perform chest tube drainage once the diagnosis is confirmed.     

Subclavian and pulmonary artery steal phenomenon in a patient with isolated left subclavian artery and right aortic arch

We describe a patient with an isolated left subclavian artery associated with right aortic arch, patent ductus arteriosus, and ventricular septal defect. As the isolated left subclavian artery is supplied by the left vertebral artery in which blood flows in the retrograde direction, this anomaly is usually responsible for a congenital subclavian steal phenomenon. Atrophy of the left cerebral hemisphere and inverted left vertebral arterial flow were clearly depicted by echoencephalography in this patient, whose subclavian artery was connected to the main pulmonary artery by a patent ductus arteriosus. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013.     

切割式活检针用于腰椎间盘突出症患者减压的效果观察及护理

目的探讨切割式活检针用于腰椎间盘突出症患者减压的临床效果及护理措施。方法对120例腰椎间盘突出症患者,进行椎间盘减压术,并做好围手术期护理。结果 120例腰椎间盘突出症患者,术后1～2d疼痛明显减轻。随访3个月～1年,有效率达96.7%,优良率达89.2%。无1例发生并发症。结论切割式活检针减压术,具有操作简单、患者痛苦小、不良反应少和并发症发生率低等优点。围手术期护理和康复指导,对提高手术疗效、避免疾病复发具有重要意义。     

新型一次性胸腔抽液针的制作与临床应用研究

目的 探讨自制的新型一次性胸腔抽液针的临床应用效果.方法 根据Y形静脉留置针的制作材料和形状,设计制作成带有刻度和侧孔的新型一次性胸腔抽液针并应用于临床.选择68例胸腔积液的病人,随机分为观察组和对照组.对照组采用传统的胸腔穿刺针进行穿刺抽液,观察组采用新型的一次性胸腔抽液针进行穿刺抽液.观察两种穿刺针在疼痛程度、患者满意度、医生满意度及并发症发生率等方面有无差异性.结果 两种穿刺针在疼痛程度、患者满意度、医生满意度方面差异有统计学意义(P＜0.01).并发症发生率比较发现,观察组抽吸顺利无反应,无医源性损伤和胸膜反应出现;34例患者留置套管5～8 d,无1例感染发生.对照组有3例发生胸膜反应.结论 新型一次性胸腔抽液针可以在治疗期间内保留在患者的身体上,减少了因反复多次抽液带来的痛苦,安全可靠,医务人员操作方便;易掌握穿刺深浅,可避免意外损伤的发生,并且制作简单、价格低廉,适合基层医院推广应用.     

无名动脉与右锁骨下动脉扩张的超声表现

目的分析探讨老年动脉硬化导致无名动脉与右锁骨下动脉改变的超声声像图与临床意义。方法经二维超声和彩色多普勒检查26例无名动脉与右锁骨下内径及血流速度、血管走行、有无斑块形成。并设立36例正常对照组,测量无名动脉与右锁骨下动脉内径。结果老年动脉硬化,可导致无名动脉及右锁骨下动脉延长、扩张,使右锁骨下动脉分叉点抬高,血管扭曲,由无名动脉向右锁骨下动脉的血流角度发生改变,血液运行不畅,局部斑块形成。结论超声可以通过测量血管内径、观察有无斑块形成、对血管走行及血流动力学观测而对老年性右颈部搏动性包块性质做出判别。     

迷走右锁骨下动脉起始部狭窄伴右椎动脉发育不良致锁骨下动脉盗血综合征1例

<正>患者女，51岁，因阴道不规则出血2天就诊，追溯病史发现偶感头晕1年，外院超声提示“右锁骨下动脉及右椎动脉(vertebral artery, VA)异常”。查体：左上肢血压125/76 mmHg, 右上肢血压95/67 mmHg, 右上肢脉搏减弱。实验室检查及心电图检查未见异常。颈部血管及上肢血管彩色多普勒超声：右锁骨下动脉远心段血流频谱呈小慢波，     

胎儿双侧锁骨下动脉切面在迷走右锁骨下动脉诊断中的应用价值

目的 探究胎儿双侧锁骨下动脉切面在迷走右锁骨下动脉(ARSA)诊断中的应用价值.方法 选择2018年4月至2019年4月入院接受胎儿心脏超声检查的978例孕妇为研究对象,采用彩色多普勒超声诊断仪观察胎儿三血管气管切面(3-VT)和双侧锁骨下动脉切面.统计孕妇产前超声检查结果中的ARSA检出情况.结果 978例胎儿中3-...     

右锁骨下动脉狭窄和闭塞的腔内治疗

目的:探讨腔内治疗右锁骨下动脉狭窄和闭塞的手术指征、特点和疗效。方法:选择2009年3月—2013年3月复旦大学附属中山医院诊治的右锁骨下动脉狭窄和闭塞患者21例,局麻下腔内治疗后1个月、3个月时门诊随访,此后每隔半年门诊随访,行踝肱指数(ankle-brachial index,ABI)、彩超检查或CT血管成像(CT angiography,CTA)检查。结果:21例患者中右锁骨下动脉闭塞性病变7例,狭窄性病变14例。2例右锁骨下动脉闭塞患者因导丝无法通过闭塞段病变而仅行造影,其余19例均成功行腔内治疗,总成功率为90.5%。19例行腔内治疗的患者术后平均随访19.3个月,通畅率为89.5%(17/19),中度再狭窄率为10.5%(2/19),无支架断裂和打折,无病死病例。结论:右锁骨下动脉狭窄和闭塞有其特殊的解剖学特点,腔内治疗是一种有效的治疗方法。     

左锁骨下动脉急性闭塞与动脉夹层

目的通过对46例左锁骨下动脉急性闭塞患者的造影诊断和经皮腔内血管成形术治疗,探讨动脉夹层与左锁骨下动脉急性闭塞的关系、病理特点及经股动脉-肱动脉逆行双路径腔内血管支架植入术的治疗方法、疗效、适应证及并发症。方法对46例锁骨下动脉急性闭塞的患者采用经股动脉-肱动脉双路径诊断动脉夹层,采用经股动脉-肱动脉双路径腔内血管支架植入技术治疗左锁骨下动脉急性闭塞患者46例。结果造影证实左锁骨下动脉近端动脉夹层并左锁骨下动脉急性闭塞38例,降主动脉内膜下出血(DebackeyⅢ)不典型型并发左锁骨下动脉急性闭塞8例,植入支架46枚,全部成功,仅4例发生短暂左上肢缺血;支架植入后,造影证实左锁骨下动脉血流方向恢复正常、左椎动脉血流方向恢复正常;术后采用彩色多普勒超声、经颅多普勒超声(TCD)和(或)数字减影血管造影(DSA)复查随访2周至12个月,证实支架位置恒定、血流方向正常、无再狭窄。结论左锁骨下动脉近端动脉夹层、主动脉内膜下出血可引起左锁骨下动脉急性闭塞,而导致锁骨下动脉窃血综合征,经股动脉-肱动脉双路径腔内支架植入术治疗效果可靠、操作方法简单安全。     

锁骨下动脉瘤1例

患者女,59岁,甲状腺癌术后1年余,高血压病史15年,头晕、头痛10年.颈部超声:于横切面见左锁骨下动脉前壁瘤样结构向外突起,约8 mm×6 mm,距椎动脉开口约13 mm(图1).CDFI于瘤体内见丰富血流信号(图2).超声诊断:左锁骨下动脉瘤.CTA:左锁骨下动脉胸廓内动脉起始段局限性隆起,约0.7 cm×0.5 cm,边界清晰,距离椎动脉开口约14 mm(图3);锁骨下动脉其余部分及其分支未见明显异常.CTA诊断与超声一致.     

动脉留置针在老年呼吸衰竭患者抢救中的应用

为赢得老年呼吸衰竭患者的抢救时机,为42例老年呼吸衰竭患者应用静脉留置针行动脉留置,阐述了穿刺部位、留置针型号的选择,穿刺方法,封管液的选择及注意事项,并重点强调并发症的预防如感染、静脉炎、套管内凝血、导管脱落及阻塞。认为应用静脉留置针行动脉留置既可保护患者的血管,减轻痛苦又保证了有效的采血通道赢得抢救的宝贵时机。     

经皮左锁骨下动脉植入药盒治疗中晚期肝癌

目的：探讨经左锁骨下动脉留置导管药盒治疗肝癌的操作方法和临床价值。方法：对15例晚期原发性肝癌、4例多发转移性肝癌采用seldinger技术经左锁骨下动脉植入药盒，留置管头端深置靶动脉内，药盒埋植在穿刺点外下方皮下，作肿瘤靶动脉内长期灌注治疗。结果：19例导管药盒系统均1次植入成功，术中无明显并发症；随访1～12个月，死亡2例、导管脱出1例、导管阻塞1例，术后病人生活质量和临床指标均有较明显改善。结论：经皮左锁骨下动脉植入式药盒操作简单易行、成功率高且创伤小；药盒的植入给以后肿瘤靶动脉内长期灌往治疗提供了方便、有效的新途径。     

Acute diffuse thyroid swelling: A rare complication of fine‐needle aspiration

We present a case illustrating the rare complication of acute generalized thyroid swelling shortly after sonographic‐guided fine needle aspiration of a thyroid nodule. Ultrasound revealed the presence of characteristic linear hypoechoic avascular areas interspersed throughout the gland suggestive of edema. The patient was treated conservatively, with near complete normalization of the thyroid within 24 hours. Recognition of this potential complication is important, as the rapid onset of diffuse thyroid enlargement is often alarming but typically has a transient and self‐limiting course. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45 :426–429, 2017     

Fluoroscopic Technique of Subclavian Venous Puncture for Permanent Pacing: A Safer and Easier Approach

Infraclavicular subclavian puncture may be performed with fluoroscopic observation of the needle trajectory. In 92 patients so implanted between July 1985 and May 1987 uneventful venous access was achieved in 90, one was unsuccessful and one patient had subcutaneous emphysema, a complication rate of 2.2%.     

Pulmonary artery rupture: serious complication associated with pulmonary artery catheters

An analysis of the Manufacturer and User Facility Device Experience database of the Food and Drug Administration was conducted to identify adverse event reports associated with pulmonary artery catheter use between 1993 and 1999. Of 714 adverse event reports, there were 48 deaths of which 42 (88%) were related to pulmonary artery rupture. A further analysis of risk factors was conducted and found "postmenopausal female" was a most significant finding. Further study is recommended to establish a causal relationship.     

头皮针经桡动脉采集血气标本的临床意义

目的探讨头皮针经桡动脉采集血气分析标本的技术方法及临床应用价值。方法回顾分析建设医院内一科2006年1月至2008年11月收治的114例患者资料,其中头皮针经桡动脉采血73例共163次,肝素化注射器经股动脉采血41例共63次,比较两种采血方法对血气分析标本采集的影响。结果头皮针经桡动脉采血法一次穿刺成功率为95.1%(155/163),两次穿刺成功率为4.9%(8/163),无1例误采静脉血,血样标本合格率100%;注射器经股动脉采血法一次穿刺成功率为74.6%(47/63),误采静脉血23.8%(15/63),血样标本合格率65.1%(41/63);两组间穿刺成功率、误采静脉血、血样标本合格率比较差异均有统计学意义(P0.01)。结论经桡动脉采血具有安全、简便、快捷、采血量少、标本不易混入空气及出现血凝块等优点,该技术方法明显优于肝素化注射器经股动脉采血,应作为临床血气标本采集的首选技术方法而推广应用。     

Clinical challenges and serious vascular complications in neurofibromatosis

Although generally regarded as a benign and chronic condition, neurofibromatosis can be associated with acute vascular and neurological complications. We report the case of a patient with neurofibromatosis who developed massive haemothorax as a result of spontaneous rupture of the left vertebral artery and left subclavian artery. The case was a diagnostic and management challenge.