Male patient associated with 10 months of age, product of a 34-week pregnancy due to severe pre-eclampsia, with a history of hypocalcemia during the first month of life, with no history of trauma, hospitalization or other diseases
The patient suddenly started with uncontrollable crying lasting 12 hours after eating, which resolved spontaneously.
The patient had a cardiorespiratory arrest that reverted after 5 minutes to resuscitation maneuvers performed by a primary care physician and was referred to our unit.
In the Emergency Department, the patient was intubated, without sedation, with a respiratory rate of 60/min, heart rate 150/min, temperature 37.5 °C, oxygen saturation 76%.
During the primary evaluation he was diagnosed with chest discomfort secondary to increased volume of left pneumothorax, absence of respiratory sounds and ipsilateral hyper-resonance, cold skin and new capillary refill for more than 5 s.
Chest compression was performed with a needle in the second left intercostal space with recovery of spontaneous circulation.
A catheter was placed with zero drainage, with a decrease in left vesicular murmur and signs of shock persisting.
Chest X-rays suggestive of left diaphragmatic hernia with rise and dyspnoea right to stomach tension, compression and atelectasis of the ipsilateral lung; endotracheal tube in the intermediate bronchus, with secondary atelectasis of the upper lobe and even middle and lower lobes.
Endotracheal tube placement was corrected, nasogastric tube drainage was initiated with low gastric fluid output, fluid shock management and use of dopamine and dobutamine amines.
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Laboratory tests at admission showed leukocytosis and hypoxemia.
Leukocytes 25.9 thousand/μl, erythrocytes 4.18 million/μl, Hb 11.2g/dl, hematocrit 7.20, HCO values 74.3 mmol/L, platelets 464,000/μl; Ex gas
Due to persistent shock and difficulties in mechanical ventilation, it was decided to go to the emergency room.
During surgery, the patient presented a new cardiorespiratory arrest with return to spontaneous circulation.
During surgery, a left diaphragmatic hernia of 5 cm was found, with thoracic incisional hernia of the spleen and colon. Primary closure was performed with Graham's patch.
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The patient was admitted to a tertiary hospital for intensive care management where he died after 5 h.
