Letter to Editor
Surgery
Mirko Barone; Massimo Ippoliti; Felice Mucilli
Volume 9, Issue 2 , July 2023, Pages 79-80
Abstract
Intra-abdominal infections still represent a challenge for surgeons. The systemic physiopathological effects of infection rapidly progress, leading to sepsis and multiorgan failure, whose prognosis is often dramatic. Mortality risk stratification using scoring systems would unequivocally aid the early ...
Read More
Intra-abdominal infections still represent a challenge for surgeons. The systemic physiopathological effects of infection rapidly progress, leading to sepsis and multiorgan failure, whose prognosis is often dramatic. Mortality risk stratification using scoring systems would unequivocally aid the early identification of patients at risk of disease progression.
Review Article
Clinical Toxicology
Rouhullah Dehghani; Shahrad Tajaddini; masoomeh varzandeh
Volume 9, Issue 2 , July 2023, Pages 81-86
Abstract
Objective: Arthropod bites and stings have always been of interest to humans; therefore, researchers have always been interested in their prevention and timely treatment. Considering the brilliance of ancient Iranian physicians, especially Avicenna, this study was conducted based on their views on diagnosing ...
Read More
Objective: Arthropod bites and stings have always been of interest to humans; therefore, researchers have always been interested in their prevention and timely treatment. Considering the brilliance of ancient Iranian physicians, especially Avicenna, this study was conducted based on their views on diagnosing and treating venomous arthropod bites and stings.Methods: This study is a narrative review conducted by surveying sources, especially The Canon of Medicine, and searching for the keywords “bites,” “stings,” “poisonous,” “venomous arachnids,” and“insects” as well as the diagnosis and treatment of bites and stings .The study was conducted in 2022 and in Kashan and Kerman universities of medical sciences. Sampling method was based onthe study objective.The collected data was then summarized.Results: To diagnose the bite or sting, the clinical manifestations of the patient, local symptoms in the bite or sting site, and the classification of the venomous arthropods, such as spiders, wasps, scorpions, etc., are used. Venom suction and using medicinal plants and ointments of mineral compounds were proposed as treatment methods.Conclusion: Therapeutic methods and the use of herbal and mineral compounds are widely mentioned in The Canon. There are a lot of connections and harmony between modern and conventional medicine, in the clinical description of bites and stings as well as their diagnosis, but more research is suggested on treatment methods
Original Article
Critical Care
Moloud Balafar; Mahboub Pouraghaei; Mahnaz Ranjkesh; Mahshid Dehghan; Ali Delkhorrami; Samad Shams Vahdati
Volume 9, Issue 2 , July 2023, Pages 87-91
Abstract
Objective: According to the most recent guidelines, the recommended imaging approaches for the diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However, there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attention in intensive care units ...
Read More
Objective: According to the most recent guidelines, the recommended imaging approaches for the diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However, there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attention in intensive care units (ICUs) and emergency departments. Considering the importance of the timely diagnosis and proper treatment of pneumonia, this study aimed to determine the diagnostic value of bedside LUS in comparison to chest CT scans in patients with suspected pneumonia or unspecified CXR findings in the emergency department.Methods: This prospective descriptive-analytic study was conducted in the emergency department of Imam Reza hospital. Patients aged 3 years and older with early diagnosis of pneumonia or any unspecified CXR findings with an indication of CT scan were included in the study. LUS was performed with a deep curved and linear surface probe. The results obtained from the chest ultrasound were compared with the results obtained by CT scan as the diagnostic gold standard.Results: A total of 175 patients were included in this study. According to the results, the sensitivity and specificity of LUS in the diagnosis of subpleural consolidation were 94.1% and 100%, respectively, and the positive predictive value and the negative predictive value were 100% and 33.3%, respectively. The sensitivity and specificity of LUS in diagnosing pleural effusion were 69.2% and 100%, respectively, and the positive predictive value and the negative predictive value were 100% and 90.7%, respectively. Furthermore, the sensitivity of LUS in diagnosing dynamic airbronchogram was 98%.Conclusion: According to the findings of the present study, in patients suspected of pneumonia, LUS is more sensitive and specific in the diagnosis of pneumonia and is less time-intensive and costly. Additionally, the ultrasound device is easily portable and accessible. It can be widely used and does not have the secondary side effects of ionizing radiation in patients. However, the technician’s skill in performing ultrasound is a matter of importance.
Original Article
Clinical Toxicology
Nastaran Eizadi-mood; laaya mokhtar; shiva samsamshariat; Gholamali dorooshi; arman otroshi; mohammad naghizadeh; Ali Mohammad Sabzghabaee
Volume 9, Issue 2 , July 2023, Pages 92-96
Abstract
Objective: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning.Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients who had ...
Read More
Objective: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning.Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients who had attempted suicide by poisoning and were admitted from 2013 to 2023 were included in this study. Different variables, including age, gender, hematological index on admission, hospital stay, and outcome (mortality), were recorded in a data-gathering form. ANOVA and chi-square or Fisher’s exact tests were used for analysis.Results: This study was conducted on 48186 patients, 53.4% of whom were male. The average age of the patients was 34.92 (±13.23). Of all patients, 6% had anemia, 15.1% leukocytosis, 15% higher than average hemoglobin, and 9.1% lower than average platelet count. White blood cell (WBC) count was higher (mean difference=3741.85, SD=151.35, 95% CI=3445.21–4038.5) in deceased patients, while platelet count was significantly lower in deceased patients (mean difference=17.19, SD=2.57, 95% CI=12.14–22.24) (P<0.001). Anemia correlated with more extended hospital stayby an average of 1.61 days (SD=0.27, 95% CI=0.98–2.24) compared to patients with normal hemoglobin. Thrombocytopenia also correlated with more extended hospital stays by an average of 1.38 days (SD=0.21, 95% CI=0.88–1.89).Conclusion: The frequency of abnormal hematological indices was not high in patients with acute poisoning. Deceased patients had higher WBC and lower platelet counts compared to surviving patients. Patients with anemia and thrombocytopenia had more extended hospital stays
Original Article
Anesthesiology
Behzad Nazemroaya; Azim Honarmand; Golshan Mazaheri Tehrani
Volume 9, Issue 2 , July 2023, Pages 97-103
Abstract
Objective: Etomidate is mentioned as one of the rapid intravenous anesthetic drugs whose unique characteristics include hemodynamic stability, negligible respiratory depression, and brain protection. The most common complication of etomidate is intravenous pain during injection. The purpose of this study ...
Read More
Objective: Etomidate is mentioned as one of the rapid intravenous anesthetic drugs whose unique characteristics include hemodynamic stability, negligible respiratory depression, and brain protection. The most common complication of etomidate is intravenous pain during injection. The purpose of this study was to compare the effectiveness of the Valsalva maneuver and fentanyl in reducing the pain caused by etomidate injection for anesthesia induction.Methods: This clinical trial was performed on 96 patients at Alzahra hospital, affiliated with the Isfahan University of Medical Sciences, from January to June 2021. Patients were divided into two groups of 48 people: the Valsalva maneuver group (group 1) and the fentanyl group (group 2). Blood pressure, heart rate (HR), oxygen saturation, and pain of etomidate injection using the withdrawal response score were graded on a four-point scale (no pain = zero, mild pain = 1, average pain = 2, and severe pain = 3). The collected information was entered into SPSS software version 24. Then, the pain score in the two groups was compared using the chi-square test. The significance level in the present study was P < 0.05.Results: The mean HR (P = 0.07), mean arterial pressure (MAP) (P = 0.33), systolic pressure (P = 0.90), diastolic pressure (P = 0.67), and oxygen saturation level (P = 0.27) at different times between the two groups showed no significant difference (P > 0.05). However, during the etomidate injection, the HR increased and after the injection, the HR decreased in both groups (P = 0.042). The two groups had no significant difference regarding pain frequency.Conclusion: There was no difference in the effect of the Valsalva maneuver and fentanyl on reducing the pain caused by etomidate injection.
Original Article
Emergency medicine
Shiva Salmasi; Sadaf Dilmaqani; Hanieh Ebrahimi Bakhtavar; Alireza Ala; Farzad Rahmani
Volume 9, Issue 2 , July 2023, Pages 104-108
Abstract
Objective: This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients.Methods: In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical ...
Read More
Objective: This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients.Methods: In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical Sciences were selected between August 2019 and September 2021. The census sampling method was used until the required sample size was achieved. The following patient information was recorded and studied: mechanism of trauma, age, gender, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), the presence of clavicular fracture, concomitant injuries, hospital outcome, duration ofhospitalization, and severity of trauma. The participants were divided into two groups based on the presence of a clavicular fracture. Data were analyzed using SPSS software.Results: Of all 185 patients, 51 had clavicular fractures. The mean age of the patients was 34.72±12.99. Of all patients, 27.6% had clavicular fractures. There was no statistically significant difference in GCS scores between the two groups (P=0.927). The highest percentage of injuries associated with clavicular traumas was traumatic brain injuries, with rates of 22.4% and 19.6% in the study and control groups, respectively. There were statistically significant differences inconcomitant injuries between the two groups (P
Original Article
Pediatrics
Sangeetha Shenoy; Shruti Patil
Volume 9, Issue 2 , July 2023, Pages 109-113
Abstract
Objective: Organ dysfunction is an important factor determining the severity and outcome of critical illness in children. Organ dysfunction scores are based on the number of organs involved and the severity of dysfunction in each. This study aimed to evaluate organ dysfunction using PELOD-2 in critically ...
Read More
Objective: Organ dysfunction is an important factor determining the severity and outcome of critical illness in children. Organ dysfunction scores are based on the number of organs involved and the severity of dysfunction in each. This study aimed to evaluate organ dysfunction using PELOD-2 in critically ill children.Methods: This prospective observational study included all consecutive critically ill children with organ dysfunction aged one month to 15 years admitted to pediatric intensive care unit of a Ramaiah Medical College Hospital, Bangalore between January 2018 and December 2020. The severity of organ dysfunction was scored using Pediatric logistic organ dysfunction-2 (PELOD-2) and evaluated based on the outcome using SPSS and PASW statistics for Windows version 18.0. The sample size required for the study with 95% confidence level and 10% relative precision was 149 critically ill children. The children were classified based on the presence of single and multiple organ dysfunction. Demographics and laboratory parameters were compared between the two groups using non parametric tests. The factors affecting mortality among children with multiple organ dysfunction were assessed using univariate and multivariate analysis.Results: Of the 550 children admitted with critical illness during the study period, organ dysfunction was present in 84% of the patients. Of these, 43% had multiple-organ dysfunction. The median (interquartile range) of the patients was 5.5 (1, 11) years with a male-to-female ratio of 1.7:1. The mortality rate was 14.4%. The PELOD-2 score and mortality steadily increased with the number of organs involved. The presence of more than two organ dysfunctions had an odd ratio (OR) of 45.7 for mortality (95% CI: 18.9–110.6, P value<0.001). The area under the receiver operating curve(ROC) for predicting mortality using the number of organs affected was 0.96 (95% CI: 0.94–0.97, P value<0.001). Dysfunction in more than two organs had a sensitivity of 92.5% and a specificity of 91% in predicting mortality. The presence of cardiovascular dysfunction and the need for ventilation were found to be independent predictors of mortality.Conclusion: The presence of more than two organ dysfunctions in PELOD-2 increased the risk of mortality; the need for ventilation and the presence of cardiovascular dysfunction were independent predictors of mortality.
Original Article
Infectious disease
Farhad Heydari; Majid Zamani; Mohammad Nasr-Esfahani; Fatemehsadat Mirmohammad Sadeghi; Faezeh Hedayati
Volume 9, Issue 2 , July 2023, Pages 114-119
Abstract
Objective: Recently, high-flow nasal cannula (HFNC) oxygen therapy has been implicated in the treatment of patients with acute respiratory failure. In this study, the effect of this treatment on COVID-19 patients was investigated.Methods : This was a prospective, randomized, single-blind clinical trial ...
Read More
Objective: Recently, high-flow nasal cannula (HFNC) oxygen therapy has been implicated in the treatment of patients with acute respiratory failure. In this study, the effect of this treatment on COVID-19 patients was investigated.Methods : This was a prospective, randomized, single-blind clinical trial on patients with COVID-19 referred to the emergency department. COVID-19 patients who had peripheral oxygen saturation (SpO2) ≤90% despite receiving nasal oxygen (up to 6 L/min) were included in the study and randomized to HFNC or conventional oxygen therapy (COT). Then the patients were compared in terms of vital signs, SpO2, need for endotracheal intubation, and need for intensive care unit admission. The sample size was calculated at 35 patients in each group. Variables were compared using the chi-square test, Student’s t-test, or the Mann-Whitney U test.Results: 87 patients with a mean age of 65.3±14.8 (62.1% male) were included. The two groups were similar in terms of age, sex, time interval from onset to diagnosis, and underlying diseases (hypertension, diabetes, coronary artery disease, etc.) (P<0.05). No statistically significant difference was reported between SpO2 and PaO2/FiO2 vital signs at the beginning of treatment between the two groups. One hour after treatment, respiratory rate, SpO2, and PaO2/FiO2 were better in the HFNC group compared to the COT group (P<0.05). Also, there was no significant difference between the two groups in terms of the need for endotracheal intubation, the need for ICU admission, and in-hospital mortality.Conclusion: Early use of HFNC oxygen therapy in patients with COVID-19 can improve SpO2, respiratory rate, and PaO2/FiO2 levels. Therefore, it has high clinical value.
Original Article
Trauma
Hashem AlKotaifan; Raghad H Abdelkader; Mohammad Alshloul; Shaher H. Hamaideh; Mohammed S. ALBashtawy; Nazzal M Alshloul; Doha M Alshloul
Volume 9, Issue 2 , July 2023, Pages 120-126
Abstract
Objective: Trauma-informed care (TIC) is an innovative concept that recognizes the lasting impactof psychological trauma. Critical care nurses’ attitude toward TIC plays an essential role in assessing,monitoring, and addressing trauma experienced by patients. This study aimed to describe criticalcare ...
Read More
Objective: Trauma-informed care (TIC) is an innovative concept that recognizes the lasting impactof psychological trauma. Critical care nurses’ attitude toward TIC plays an essential role in assessing,monitoring, and addressing trauma experienced by patients. This study aimed to describe criticalcare nurses’ attitudes toward TIC in critical care units at Jordanian military hospitals.Methods: This descriptive-analytical cross-sectional study was performed on 315 critical care nursesat seven military hospitals (two from the north, three from the center, and two from the south) in2022. The data collection tool was the Attitudes Related to Trauma-Informed Care-35 (ARTIC-35)scale. Multi-stage sampling approach was used to recruit critical care nurses. Statistical Package forSocial Science (IBM-SPSS) V. 23 was used to analyze data.Results: In the sample of 315 nurses, gender was significantly associated with the reactions subscale(P=0.001). Also, there were statistical differences between nurses working in the emergencydepartment and those working in intensive care units regarding the responses and behaviorssubscales, with emergency department nurses scoring higher on the scale (P=0.003). Regardingin-service training in trauma-related care, the causes subscale was significantly different based onthe number of training sessions with higher scores among nurses with higher training (P=0.02).Conclusion: Critical care nurses had an unfavorable attitude toward TIC. Health organizations, nursemanagers, universities, and other stakeholders should collaborate to achieve a national strategyto raise awareness about TIC. Much research is needed to explore nurses’ attitudes toward TIC indiverse health sectors
Case Report
OB/GYN
Jessica Ann Nathan; Valerie Sze Yen Chew; Nur Fazlin Ab Manan
Volume 9, Issue 2 , July 2023, Pages 127-129
Abstract
Objective: Spontaneous uterine artery rupture in a non-pregnant woman is an extremely uncommon event. To date, there have only been a few cases. Patients often present with acute abdomen and are hemodynamically unstable.Case Presentation: A 42-year-old female presented with multiple episodes of syncopal ...
Read More
Objective: Spontaneous uterine artery rupture in a non-pregnant woman is an extremely uncommon event. To date, there have only been a few cases. Patients often present with acute abdomen and are hemodynamically unstable.Case Presentation: A 42-year-old female presented with multiple episodes of syncopal attack associated with vomiting and generalized abdominal pain. Upon arrival, she was hypotensive which required aggressive fluid resuscitation with crystalloids and blood products. Urine pregnancy test was negative. In addition, ultrasound scan showed free fluid in the abdomen mainly at the splenorenal area and organized clots around the uterus. Computed tomography of the Abdomen revealed a moderate amount of hemoperitoneum with hypodense clots at the left para-colic gutter and pelvis. She underwent an exploratory laparotomy and intraoperatively noted bleeding from left uterine artery with 1.2 L of hemoperitoneum with no other abnormalities detected. Intraoperatively, there was an estimated 5 L blood loss which required packed cell and disseminated intravascular coagulation transfusion. Subsequently, the patient was sent to intensive care unit where she recovered well and was discharged home 5 days later.Conclusion: Spontaneous uterine artery rupture is an extremely rare occurrence with high mortality if there is failure to detect and intervene early.
Case Report
Trauma
Mamatha Siddalingappa Nanjappa; Anjan kumar shah; Susheen Dutt; Narahari Ranganath
Volume 9, Issue 2 , July 2023, Pages 130-133
Abstract
Objective: Penetrating injuries in the maxillofacial region pose a great challenge due to the anatomical complexity inherent to the area compounded with vital functions such as vision and airway. This paper highlights the importance of meticulous preoperative planning and a concerted effort of a multidisciplinary ...
Read More
Objective: Penetrating injuries in the maxillofacial region pose a great challenge due to the anatomical complexity inherent to the area compounded with vital functions such as vision and airway. This paper highlights the importance of meticulous preoperative planning and a concerted effort of a multidisciplinary team in managing penetrating maxillofacial injuries.Case Presentation: A 38-year -old man reported to the emergency department with a knife impacted in the medial wall of the orbit, travelling up to the base of the cranium. A CT scan aided in evaluating the site, depth, and relation of the foreign body to the adjacent structures. A team of oral and maxillofacial surgeons, ENT and neurosurgeon successfully retrieved the knife and the patient recovered with no morbidities.Conclusions: Penetrating injuries in the maxillofacial region are rare and there is a dearth of documentation in literature. A quick response with proper preoperative planning and a team approach is paramount in the successful management of these patients.
Case Report
Cardiology
Asghar Mohamadi; Nazanin Davari; Elham Sepahvand; Maryam Aliramezany
Volume 9, Issue 2 , July 2023, Pages 134-137
Abstract
Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history ...
Read More
Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history arrived at our hospitalwith a history of dyspnea and swelling in the lower extremities. She did not complain of pain,arthralgia, trauma, or chest pain but complained of exertional dyspnea and fatigue that had startedone month before and had aggravated two days before. Her laboratory test indicated anemia. Inechocardiography, we saw mild right ventricle enlargement and dysfunction, but the left heart wasnormal with acceptable systolic and diastolic function. In the subcostal view, the inferior vena cava(IVC) was dilated but under compression of a large liver mass. According to our literature review, thisis the first case in which a metastatic liver mass had presented with heart failure.Conclusion: In patients presenting with dyspnea, despite normal echocardiographic findings, theexact evaluation of the IVC should be considered.
Case Report
Emergency medicine
Zainab Mehdi; Daljinderjit Kaur; Parv kamra; Nidhi Arora; Narinder kaur; Shivam Bansal
Volume 9, Issue 2 , July 2023, Pages 138-141
Abstract
Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easy alternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure, predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestion with spontaneous pneumothorax, ...
Read More
Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easy alternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure, predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestion with spontaneous pneumothorax, spontaneous pneumomediastinum, and pneumorrhachis. Aim is to reinforce the importance of a high index of suspicion in early diagnosis when the above findings are present with ARDS in absence of trauma and a history of alleged substance ingestion.Case Presentation: A 35-year-old male presented with loose stool occasionally bloody, oral ulcers, yellow discoloration of eyes with fever, and decreased urine output for three days after consuming some substance with his seafood. On examination, he had yellow discoloration of eyes and oral mucosa along with multiple ulcers on the buccal region as well as the dorsum of the tongue and lateral margins with generalized subcutaneous emphysema. In addition, decreased air entry in the bilateral lung field and muffled heart sounds were present. He had an acute hepatorenal failure and severe metabolic acidosis with respiratory failure. Urine tested positive for myoglobin and muscle enzymes (creatinine kinase and lactate dehydrogenase (LDH)) were raised. He was intubated and shifted to the intensive care unit. Injectable N-acetyl cysteine (NAC) for acute liver failure was started with empirical antibiotics and intravenous fluids. We supplemented thiamine and vitamin K, and hemodialysis was done in view of progressive renal failure. Radiological evaluation showed spontaneous pneumothorax, pneumomediastinum, and pneumorrhachis which were managed conservatively. His respiratory parameters worsened despite maximal ventilatory support. Renal failure and metabolic acidosis worsened in spite of hemodialysis. He succumbed to his illness on day five of admission and seven days after toxin ingestion.Conclusion: We recommend that the sale of paraquat be restricted and regulated to avoid its use for suicidal and homicidal purposes. More research is required to find measures to intervene early and prevent pulmonary fibrosis. We propose that paraquat toxicity be considered early in a patient with the triad in an atraumatic setting with acute respiratory distress syndrome (ARDS).
Case Report
Emergency Medical Services
Albert Hardy Wu; Mariza Fitriati; Disa Edralyn; Adriana Jardine
Volume 9, Issue 2 , July 2023, Pages 142-145
Abstract
Objective: Antepartum hemorrhage (APH) is one of the leading causes of maternal and fetalmortality worldwide, complicating 2–4% of pregnancies. Considering the probability of bloodtransfusion, blood testing and cross-matching are essential for the anesthesiologist duringperioperative management. ...
Read More
Objective: Antepartum hemorrhage (APH) is one of the leading causes of maternal and fetalmortality worldwide, complicating 2–4% of pregnancies. Considering the probability of bloodtransfusion, blood testing and cross-matching are essential for the anesthesiologist duringperioperative management. Rhesus (Rh) is the second most significant blood group systemafter ABO. Hence, this blood type system needs to be taken into consideration. Furthermore, inIndonesia, Rh-negative blood types are rare.Case Presentation: A 39-year-old woman with Gravida IV, three term pregnancies, no pretermpregnancies, no abortions, and three living children (GIVP3003) and gestational age 26 to 27weeks arrived at the hospital with massive bleeding from the birth canal three hours beforeadmission. The bleeding was fresh red, and the patient had changed diapers twice before arrivingat the hospital. She presented hypovolemic shock, a blood pressure of 71/39 mm Hg, andanemic conjunctivas, with a history of B Rh (-) blood type, ongoing HIV therapy, and completedpulmonary tuberculosis (TB) treatment. The hospital’s and PMI’s (Indonesian Red Cross) bloodbank had no Rh (-) bloodstock. An emergency cesarean section under general anesthesia wasperformed, and a 900 g neonate was delivered. The patient received a total of four stored wholeblood (SWB) bags of type B Rh (+) blood products, one SWB bag during surgery, and three SWBbags during recovery in the intensive care unit (ICU).Conclusion: Rh (+) transfusion in patients with Rh (-) should be the last option in an emergency.The transfusion reaction did not occur right away in the initial transfusion. Under promptmanagement, the transfusion response and the life-threatening condition were then successfullymanaged.