Complications

Question 1

SAH

Answer 1

• Rebleeding: Risk highest in the first 24 hours.
• Vasospasm: Leading to delayed cerebral ischemia, typically 4-14 days post-hemorrhage.
• Hydrocephalus: Acute or chronic, due to impaired CSF circulation.
• Seizures: Especially in the acute phase.
• Cardiac Complications: Stress cardiomyopathy, ECG changes, arrhythmias.
• Electrolyte Disturbances: Particularly hyponatremia from SIADH, cerebral salt wasting, or cranial DI
• Neurogenic Pulmonary Edema: Secondary to severe brain injury.
• Infection: Meningitis, ventriculitis, especially in cases involving external ventricular drains.

Question 2

Thyroid storm management

Answer 2

• Hypotension (from aggressive beta-blocker therapy)
• Hepatotoxicity (from antithyroid medications, especially PTU)
• Agranulocytosis (from antithyroid medications)
• Allergic reactions (to antithyroid medications)
• PTU-induced vasculitis
• Gastrointestinal disturbances (from iodine therapy)
• Arrhythmias (secondary to aggressive treatment or underlying disease)
• Thyroid crisis exacerbation (if iodine given before antithyroid agents)
• Adrenal insufficiency (from abrupt withdrawal or high dose of glucocorticoids)
• Osteoporosis and immune suppression (long-term glucocorticoid use)

Question 3

MV in asthma

Answer 3

• Air Trapping (Auto PEEP) and Dynamic Hyperinflation:
  
  • Disconnect MV for a few seconds.
  • Reduce tidal volume and respiratory rate to allow more time for exhalation.
  • Shorten inspiratory time.
  • Consider sedation and paralysis to reduce patient-ventilator dyssynchrony.
• Pneumothorax:
  
  • Immediate bedside ultrasound or chest X-ray to confirm diagnosis.
  • Emergency needle decompression (4th or 5th intercostal space anterior to mid-axillary line) followed by chest tube insertion.

Question 4

ECMO

Answer 4

• Inadequate ECMO Flow: (Increase flow rate)
• Inadequate Sweep Gas Flow: (Increase sweep gas flow)
• Oxygenator Dysfunction: (Assess and possibly replace oxygenator)
• Patient-ECMO Circuit Mismatch: (Adjust ECMO settings to patient’s needs)
• Re-circulation: (Adjust cannula positioning, ECMO flow)
• Kink in Tubing: (Straighten kinks in ECMO tubing)
• Thrombus in Circuit: (Anticoagulation management, circuit change if needed)
• Air in Circuit: (De-air circuit, check for air entrainment sources)
• Pump Failure: (Check pump, prepare for replacement)
• Heat Exchange Failure: (Adjust heat exchanger).

Question 5

CVT and it’s treatment

Answer 5

• Propagation of thrombus
• Venous infarction
• Hemorrhagic transformation of venous infarctions
• Brainstem compression from an enlarging hematoma
• Cerebral edema
• Raised intracranial pressure
• Seizures (convulsive or nonconvulsive)
• Pulmonary emboli

Question 5

TB menengitis

Answer 5

• Neurological Complications: Hydrocephalus (communicating or obstructive), vasculitis leading to infarcts, cranial nerve palsies, seizures, tuberculomas.
• Systemic Complications: Disseminated tuberculosis (miliary TB), tuberculosis involvement in other organs (e.g., lungs, lymph nodes).
• Complications from Long-term Therapy: Hepatotoxicity from antituberculous drugs, peripheral neuropathy (isoniazid-induced), adrenal insufficiency (secondary to rifampicin).
• Immune Reconstitution Inflammatory Syndrome (IRIS): In patients receiving ART for HIV, worsening symptoms due to immune system recovery.
• Mortality and Morbidity: High risk of death, long-term neurological deficits in survivors.

Question 6

Protamine

Answer 6

• Hypotension: Rapid infusion causing significant blood pressure drop.
• Anaphylaxis: Severe allergic reaction, though rare.
• Bradycardia: Heart rate decrease.
• Coagulopathy: Potential impairment of coagulation.
• Thrombocytopenia: Reduced platelet count.
• Pulmonary Hypertension: Acute rise in pulmonary arterial pressure.
• Systemic Vasodilation: Decrease in systemic vascular resistance.

Question 7

VA ECMO

Answer 7

Complications specifically associated with VA (Venoarterial) ECMO:

• Differential Hypoxemia (Harlequin Syndrome): Occurs when oxygenated blood from ECMO doesn’t mix well with the native cardiac output, causing upper body hypoxia and lower body hyperoxia.
• Limb Ischemia: Arising from arterial cannulation, particularly in the femoral artery, leading to compromised blood flow and potential ischemic damage to the limb.
• Systemic Embolization: Increased risk of thromboembolic events such as stroke or myocardial infarction, especially pertinent in patients with aortic atheroma or intracardiac thrombus.
• Vascular Injury: Risk of trauma to vessels during cannulation, including arterial dissection or perforation, a significant concern with arterial access.
• Cardiac Complications: Includes increased afterload on the left ventricle due to retrograde blood flow from aortic cannulation, potentially leading to left ventricular distension, especially in cases of poor cardiac function.
• Harlequin Syndrome Management: This unique complication requires careful balancing of ECMO flow and native cardiac output, sometimes necessitating additional interventions like intra-aortic balloon pump or left ventricular venting.

Question 8

Aortic Aneurysm

Answer 8

• Aortic Rupture
• Myocardial Ischemia/Infarction
• Neurological Deficits: Stroke, Coma, Altered Conscious Level, Syncope, Paraplegia
• Malperfusion: Coronary, Mesenteric, Limb, Spinal Cord, Renal, hepatic
• Hypotension
• Hemothorax
• Cardiac Tamponade
• Acute Aortic Regurgitation
• Congestive Cardiac Failure
• Subsequent Aneurysm Formation