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STANDARDIZATION OF NIGHT ROUNDS IN THE PEDIATRIC INTENSIVE CARE UNIT: A FELLOW-LED QI PROJECT [Meeting Abstract]

Jacobowitz, Rebecca; Levasseur, Julie; Hena, Zachary; Mehrotra, Priyanka; Romano, Juliana; Bergman, Charles; Wilsterman, Eric; Dario, Joseph; Crosby, Kristin; Stock, Arabela; Toal, Megan
ISI:000672597102257
ISSN: 0090-3493
CID: 5352702

Aluminum phosphide poisoning: Successful recovery of multiorgan failure in a pediatric patient [Case Report]

Hena, Zachary; McCabe, Megan E; Perez, Michelle M; Sharma, Madhu; Sutton, Nicole J; Peek, Giles J; Clark, Bradley C
Aluminum phosphide (AlP) is an insecticide and rodenticide that produces phosphine gas when exposed to moisture. Exposure to AIP has been described as through inhalation and ingestion routes and is typically either accidental or a suicidal attempt. The result is potential multiorgan toxicity involving the heart, kidneys, lungs, and liver, with an overall mortality related to exposure reported from 30% to 77%. The initial symptoms are nonspecific and can include epigastric pain, vomiting, diarrhea, dizziness, and dyspnea. Patients rapidly experience multisystem organ failure, cardiovascular collapse, and, finally, death. We report the case of a 3 year old girl with AlP poisoning who developed cardiogenic shock, ventricular arrhythmias, respiratory failure, liver injury, and significant acute kidney injury (AKI). She was successfully supported with veno-arterial extracorporeal membrane oxygenation (ECMO) for 16 days, treated with lidocaine and magnesium sulfate for ventricular arrhythmias, and received continuous renal replacement therapy (CRRT) and hemodialysis for 24 days for metabolic acidosis secondary to AKI. Despite her severe clinical presentation, she had complete normalization of her end-organ dysfunction with no neurological sequelae. This case demonstrates the high index of suspicion required for AlP poisoning given the potential for rapid progression and severe multiorgan toxicity. The authors recommend prompt referral to a tertiary care center with ECMO and CRRT capability in cases of suspected or documented AlP poisoning.
PMCID:6363255
PMID: 30805553
ISSN: 2352-6467
CID: 5352672

Aluminium phosphide poisoning resulting in cardiac arrest, successful treatment with Extracorporeal Cardiopulmonary resuscitation (ECPR): a case report [Case Report]

Lehoux, Juan; Hena, Zachary; McCabe, Megan; Peek, Giles
Aluminium phosphide (AP) is a pesticide used against rodents and insects. Exposure of AP to water releases phosphine gas. Phosphine is a highly toxic mitochondrial poison to which there is no known antidote. We report a case of a 3-year-old female with accidental home exposure to AP, which resulted in cardiac arrest, who was successfully supported with extracorporeal membrane oxygenation (ECMO).
PMID: 29781377
ISSN: 1477-111x
CID: 5352662

Clinical Course of Sarcoidosis in World Trade Center Exposed Firefighters

Hena, Kerry M; Yip, Jennifer; Jaber, Nadia; Goldfarb, David; Fullam, Kelly; Cleven, Krystal; Moir, William; Zeig-Owens, Rachel; Webber, Mayris P; Spevack, Daniel M; Judson, Marc A; Maier, Lisa; Krumerman, Andrew; Aizer, Anthony; Spivack, Simon D; Berman, Jessica; Aldrich, Thomas K; Prezant, David J; Christodoulou, Vasilios; Hena, Zachary; Plotycia, Steven M; Soghier, Israa; Gritz, David; Acuna, Dianne S; Weiden, Michael D; Nolan, Anna; Diaz, Keith; Ortiz, Viola; Kelly, Kerry
BACKGROUND: Sarcoidosis is thought to represent a genetically-primed, abnormal immune response to an antigen exposure or inflammatory trigger, with both genetic and environmental factors playing a role in disease onset and phenotypic expression. In a population of firefighters with post-WTC-9/11/2001 (9/11) sarcoidosis, we have a unique opportunity to describe the clinical course of incident sarcoidosis during the 15-years post-exposure and, on average, 8-years after diagnosis. METHODS: Among the WTC-exposed cohort, 74 firefighters with post-9/11 sarcoidosis were identified through medical records review. 59 were enrolled in follow-up studies. For each participant, the World Association of Sarcoidosis and Other Granulomatous Diseases organ assessment tool was used to categorize sarcoidosis involvement of each organ system at time of diagnosis and at follow-up. RESULTS: The incidence of sarcoidosis post-9/11 was 25/100,000. Radiographic resolution of intrathoracic involvement occurred in 24 (45%). Lung function for nearly all was within normal limits. Extrathoracic involvement increased, most prominently joints (15%) and cardiac (16%). There was no evidence for calcium dysmetabolism. Few had ocular (5%) or skin (2%) involvement. None had beryllium sensitization. Most (76%) did not receive any treatment. CONCLUSIONS: Extrathoracic disease was more prevalent in WTC-related sarcoidosis than reported for sarcoidosis patients without WTC-exposure or for other exposure-related granulomatous diseases (beryllium disease and hypersensitivity pneumonitis). Cardiac involvement would have been missed if evaluation stopped after electrocardiogram, 48-hour recordings and echocardiogram. Our results also support the need for advanced cardiac screening in asymptomatic patients with strenuous, stressful, public safety occupations, given the potential fatality of a missed diagnosis.
PMCID:6026251
PMID: 29066387
ISSN: 1931-3543
CID: 2757372

Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients

Hena, Zachary; Sutton, Nicole J; Gates, Gregory J; Taragin, Benjamin H; Pass, Robert H
BACKGROUND:Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. MATERIALS AND METHODS/METHODS:< 0.05 was statistically significant. RESULTS:= NS). No complications were encountered. CONCLUSIONS:allowed similar angiography to the 4 Fr pigtail catheter, allowing safe and effective transcatheter PDA closure in small children.
PMCID:5594934
PMID: 28928609
ISSN: 0974-2069
CID: 5352652

A Case of Back Pain That Wakes a Child From Sleep [Case Report]

Hotz, Arda; Hena, Zachary; Gross, Elissa
PMID: 27820627
ISSN: 2168-6211
CID: 5352642

IMPACT OF A MULTITIERED POST-RAPID RESPONSE TEAM PROTOCOL: CARE OF THOSE WE LEAVE BEHIND [Meeting Abstract]

Katyal, Chhavi; Shlomovich, Mark; Hena, Zachary; Weingarten-Arams, Jacqueline
ISI:000388910201469
ISSN: 0090-3493
CID: 5352682

Clinical Characteristics of Sarcoidosis in World Trade Center (WTC) Exposed Fire Department of the City of New York (FDNY) Firefighters [Meeting Abstract]

Hena, Kerry; Yip, Jennifer; Jaber, Nadia; Goldfarb, David; Fullam, Kelly; Cleven, Krystal; Moir, Vasilios Christodoulou William; Hena, Zachary; Crosse, Tesha; Zeig-Owens, Rachel; Webber, Mayris; Plotycia, Steven; Gritz, David; Spevack, Daniel; Soghier, Israa; Prezant, David; Aldrich, Thomas
ISI:000400118601227
ISSN: 0012-3692
CID: 5352692