Every day on Figure 1, healthcare professionals gather to learn from one another. To mark the end of the year, here are a few of the cases that the community found the most engaging in 2020.
Subcutaneous emphysema in a ventilated patient with COVID-19
“A 65-year-old male who has been in the ICU for 18 days now. COVID-19 clinically confirmed, negative PCR. On day 7 of his ICU admission, he was diagnosed with a pulmonary embolism of the right main pulmonary artery and other lobar arteries, and was started on anticoagulation. On day 15, he developed subcutaneous emphysema. Although he had been improving clinically up until then..."
"Two X-rays that demonstrate the—often unpredictable—harm that comes from novel adjuncts"
“One of the refrains I have heard a lot is that novel therapies don’t hurt, also known as the “what have you got to lose” strategy.
This patient was admitted to the ICU with COVID pneumonia a few weeks ago and, due to a very high D-dimer level, empiric anticoagulation was initiated. The night prior to extubation, the patient's oxygen saturation plummeted, fresh blood appeared in the ventilator tubing, and the second X-ray was obtained.”
"He discontinued his medications and has no medical follow-up"
“A 61-year-old male presents with a history of stroke and right hemiplegia. Smoker, pulmonary emphysema. Right lower limb: edema, erythema, nodules, painless, bleeding areas, and mild localized heat for more than 9 months. Left lower limb: mild edema, erythema, painless, and mild localized heat for more than 9 months. What's your differential?”