A 29-year-old patient with normal preanesthetic evaluation was planned for percutaneous nephrolithotomy (PCNL) for right nephrolithiasis with right pyelolithiasis. Surgery was performed under general anesthesia with endotracheal intubation with muscle relaxation. At the conclusion of surgery, when the patient was turned over to supine position, tense abdomen was noted. Immediately extended focu...

Petroleum is an important strategic material which is connected with the vitals and safety of the national economy, and the supplier selections are related to the safety of petroleum production and supply. However, the traditional approaches for supplier selections are limited in subjective evaluation of weights, inaccurate assessing rules, and inefficient decision-making. Although most of the ...

Spontaneous liver bleeding is often reported in preeclampsia. It is otherwise rare and has been linked to gross anatomical lesions and coagulopathy. We report a case of subcapsular hematoma of the liver without any apparent lesion and in the absence of coagulopathy. A 41-year-old male, paraplegic for 16 years, presented to the emergency department 3 days after sudden onset of right upper quadra...

OBJECTIVE Use of low-dose ketamine infusions in the emergency department (ED) has not previously been described, despite routine use in perioperative and other settings. Our hypothesis was that a low-dose ketamine bolus followed by continuous infusion would 1) provide clinically significant and sustained pain relief; 2) be well tolerated; and 3) be feasible in the ED. METHODS We prospectively...

A 57-year-old female presented to the emergency department with left sided facial rash with associated pain, blurred vision and oral discomfort. Past medical history included hypertension, and remote scleroderma (untreated). There was no history of neck stiffness, ear pain, environmental exposures, trauma, or immunosuppressive medications. Her facial pain was sharp in quality and extended to he...

Bilateral subclavian stenosis is a rare clinical condition. An interbrachial pressure difference of 15 mm Hg can raise suspicion for unilateral subclavian artery stenosis, but the diagnosis of bilateral subclavian artery stenosis can be challenging. We present a case of a 75-year-old woman who presented with refractory hypotension after surgery. Initial vitals revealed blood pressure in the 60s...

A 32-year-old Spanish man presented to hospital after a second episode of syncope immediately following exercise. On admission, his vitals signs were stable and he had a regular heart rate of 60 bpm. ECG and transthoracic echocardiogram were normal. He completed 15 min of a BRUCE protocol exercise test. One minute and ten seconds into recovery, he lost consciousness. His ECG demonstrated sinus ...

We present a 62-year-old patient with COVID-19 pneumonia on Veno-venous (VV) Extracorporeal Membrane Oxygenation (ECMO) unique perturbations to pre and post oxygenator pressures due fibrin deposition in despite being Heparin/Bivalirudin infusion activated Partial Thromboplastin Time (aPTT) within therapeutic range of 60–80 seconds. On Day 8 ECMO support, it was noticed that flows steadily decre...

Managing the risks arising from actions and conditions of various elements that make up an operating room is a major concern during surgical procedure. One main challenges to define alert thresholds in non-deterministic context where unpredictable adverse events occur. In response this problematic, paper presents architecture couples Multi-Agent System (MAS) with Case-Based Reasoning (CBR). The...

The concept of wellness has yet to be formally adopted in Parkinson’s disease (PD) management despite its potential improve quality life. Currently, PD treatment is usually focused on symptomatic therapies for motor symptom relief using medications or devices. While the focus non-motor symptoms increased last decade, it remains suboptimal. Future clinical practice should strive incorporate more...