Polyunsaturated fatty acids such as omega-3 eicosapentaenoic acid and omega-6 docosahexaenoic acid, found in over-the-counter fish oil supplements, are often consumed for their beneficial, prophylactic, anti-inflammatory effects. Although the mechanisms of action are not fully known, a diet rich in polyunsaturated fats may reduce the risk of hyperlipidemia, atherosclerosis, high low-density lipoprotein cholesterol levels, hypertension, and inflammatory diseases. Masked by its many benefits, the risks of omega-3 fatty acid supplementation are often underappreciated, particularly its ability to inhibit platelet aggregation and promote bleeding in patients taking anticoagulant medications. The following details the clinical case of an elderly patient taking warfarin and fish oil supplementation whose warfarin-induced coagulopathy could not be reversed after suffering blunt head trauma.

Background: Dysphagia is a common complication after cervical spine trauma with spinal cord injury. We sought to characterize the prevalence of dysphagia within a total cervical spinal injury (CSI) population, considering the implications of spinal cord injury status and age on dysphagia development. We hypothesized that while greater rates of dysphagia would be found in geriatric and spinal cord-injured subgroups, all patients presenting with CSI would be at heightened risk for swallowing dysfunction.Methods: All trauma admissions to a level II trauma center from January 2010 to April 2014 with CSI were retrospectively reviewed. CSI was classified as any ligamentous or cervical spinous fracture with or without cord injury. Patients failing a formal swallow evaluation were considered dysphagic. The implications of dysphagia development on age and spinal cord injury status were assessed in univariate and multivariate analyses.Results: A total of 481 patients met study inclusion criteria, of which 123 (26%) developed dysphagia. Within the dysphagic subpopulation, 90 patients (73%) were geriatric, and 23 (19%) sustained spinal cord injury. The dysphagic subpopulation was predominantly free from spinal cord injury (81%). Multivariate analyses found age (adjusted odds ratio: 1.06; 95% confidence interval 1.04-1.07; P < 0.001) and spinal cord injury (adjusted odds ratio: 2.69; 95% confidence interval 1.30-5.56; P = 0.008) to be significant predictors of dysphagia development.Conclusions: Despite spinal cord-injured patients being at increased risk for dysphagia, most of the dysphagic subpopulation was free from spinal cord injury. Geriatric and CSI patients with or without cord injury should be at heightened suspicion for dysphagia development. (C) 2016 Elsevier Inc. All rights reserved.

Crit Care Med 2015 • Volume 43 • Number 12 (Suppl.) Marfan syndrome on ECMO. Methods: Pediatric patients ≤18 yr of age with MFS in the Extracorporeal Life Support Organization (ELSO) Registry were included. The primary outcome of interest was death before hospital discharge. Between group comparisons (non Marfan patients (nonMFS) and Marfan patients) were performed using chi-square, t-test and fisher’s exact test. Results: Included were 19 patients with Marfan syndrome. ECMO use in patients with MFS has increased with all cases occurring after 1994. Compared to all pediatric ECMO patients (nonMFS, n=50,884 in ELSO registry) MFS patients had worse survival (MFS 21% vs. nonMFS 63%, p=0.001). More MFS patients were likely to be placed on ECMO for cardiac (74%) vs. respiratory failure (10%). In MFS patients no risk factors for mortality were identified. The most common complication was cardiovascular in 53% of patients. Conclusions: Marfan syndrome is an uncommon indication for ECMO survival with worse outcome than the overall ECMO population. Although limited by the small sample size these results should be factored in to decision making when considering ECMO for pediatric Marfan patients.