Avery Smith

Deaths associated with insertion of nasogastric tubes for enteral nutrition in the medical intensive care unit: Clinical and autopsy findings

ABSTRACT It is generally assumed that blind insertion of nasogastric tubes for enteral nutrition in patients admitted to medical intensive care units is safe; that is, does not result in life-threatening injury. If death occurs in temporal association with insertion of a nasogastric tube, caregivers typically attribute it to underlying diseases, with little or no consideration of iatrogenic death due to tube insertion. The clinical and autopsy results in three recent cases at Baylor University Medical Center challenge the validity of these notions.

PH Grand Rounds: When Pulmonary Arterial Hypertension Is Complicated by Pericardial Disease

Patients with pulmonary hypertension whose case is complicated by a pericardial effusion pose a management dilemma. These patients are more complex given their unique set of hemodynamics, and the decision to proceed with a pericardial fluid drainage is not straightforward and mortality is potentially high. The current medical literature does not provide strict guidelines or a formal consensus regarding this clinical presentation. It appears management should be tailored to individual cases. We present a case of a patient in whom medical management spared the risk posed by drainage.

Abdominal Apoplexy Resulting in Small Bowel Obstruction

Abdominal apoplexy is a rare hemorrhagic condition involving the small arteries or veins within the abdominal cavity. A high degree of clinical suspicion, followed by appropriate diagnostic workup and therapeutic intervention, is critical, as nonoperative mortality approaches 100%. Contrary to most previously reported cases, which were associated with hemoperitoneum, we present a patient in which gastroduodenal artery dissection resulted in an organized retroperitoneal hematoma with local compression of the duodenum and subsequent bowel obstruction, resulting in vomiting, aspiration, and death.