An unusual presentation of massive pulmonary embolism mimicking septal acute myocardial infarction treated with tenecteplase

A 31-year-old man (175 cm, 82 kg) was referred to the emergency department 2 h after the sudden onset of acute dyspnea. Immediate ECG showed sinus tachycardia with ST elevations from V1 through V2 and a diagnosis of septal acute myocardial infarction was made. ECG on admission to the cardiology department showed the same results plus the S1–Q3–T3 pattern. Echocardiogram revealed a normally contracting left ventricle, a distended right ventricle with free wall hypokinesia and displacement of the interventricular septum towards the left ventricle. Thrombolytic therapy with tenecteplase 8000 IU and heparin 5000 IU was administered 5–10 min after hospitalisation and the patient was haemodynamically stable 30 min later. Echocardiogram performed 12 h after thrombolysis showed a normal left ventricle and a less distended right ventricle. Lung spiral computed tomography (CT) and lower abdominal CT on the fourth day showed large emboli in the inferior pulmonary arteries of the right and left lung. Rarely, massive pulmonary embolism may mimic anteroseptal acute myocardial infarction on ECG and this case demonstrates the utility of echocardiography for a differential diagnosis, as well as the efficacy of tenecteplase for thrombolytic therapy.     

Blood and coagulation support in trauma

Injury is the leading cause of death in young people and a major cause of loss of years of productive life world wide. Acute surgical care can prevent injury from turning into disability or death but requires prompt access to safe blood products to support resuscitation and restorative surgical procedures. Speed in delivering blood products is critical in resuscitation. Achieving prompt blood product support requires advanced planning and an informed balancing of risks to insure the availability of red cells and coagulation products at the time and place where they are needed. Safety and diagnostic support are critical in the post-resuscitative period where transfusion complications can delay reconstructive surgery and prolong intensive care unit stays. This paper reviews the epidemiology of injury and modern patterns of trauma care against the background of developing knowledge about the coagulopathies of trauma and blood safety.     

依达拉奉治疗急性脑出血的临床疗效评价

目的 评价依达拉奉治疗急性脑出血的临床疗效.方法 将86例急性脑出血患者随机分为观察组(n=46)和对照组(n=40).两组均给予常规治疗,观察组加用依达拉奉静脉滴注,治疗4周.观察神经功能缺损评分和日常生活活动能力评分及脑血肿和水肿体积变化.结果 治疗4周后观察组神经功能缺损评分的降低和治疗2、4周后日常生活活动能力评分的提高与对照组比较差异均有显著性(P<0.05);治疗4周后观察组血肿体积、治疗2周和4周后观察组水肿体积与对照组比较差异有显著性(P<0.05);治疗后4周观察组的总有效率高于对照组(P<0.05);两组不良事件的发生率无明显差异.结论 依达拉奉能改善急性脑出血患者的神经功能缺损和日常生活活动能力水平,促进血肿吸收和抑制水肿形成,是治疗急性脑出血安全有效的药物.     

原发性脑室出血手术治疗

目的提出有效手术治疗原发性脑室出血的方法.方法对7例原发性脑室出血的临床资料进行回顾性分析研究.所有病例都采用侧脑室穿刺+重组链激酶血肿纤溶引流术.结果6例恢复良好(84%),1例死于多器官衰竭(14%).引流管放置在血肿侧容易堵塞,放置在非血肿侧效果较好.结论侧脑室穿刺+重组链激酶血肿纤溶引流术治疗原发性脑室出血是一种有效的治疗方法.     

Low dose nitrite enhances perfusion after fluid resuscitation from hemorrhagic shock

This study determines the systemic and microvascular hemodynamic consequences of administering a low dose sodium nitrite after fluid resuscitation from hemorrhagic shock. Hemodynamic responses to hemorrhagic shock and resuscitation were studied in the hamster window chamber model. Moderated hemorrhage was induced by arterial controlled bleeding of 50% of the blood volume (BV) and the hypovolemic state was maintained for 1 h. Volume restitution was performed by infusion of 25% of BV using Hextend^® (6% Hetastarch 670 kDa in lactated electrolyte solution) 10 min after fluid resuscitation 100 μl of specific concentrations of sodium nitrite were infused. The experimental groups were named based on the nitrite concentration used, namely: 0 μM, 10 μM and 50 μM. Systemic parameters, microvascular hemodynamics and capillary perfusion (functional capillary density, FCD) were followed during entire protocol. Exogenous 10 μM nitrite maintained systemic and microhemodynamic conditions post fluid resuscitation from hemorrhagic shock, compared to 50 μM or no nitrite. A moderated increase in plasma nitrite during the early phase of resuscitation reversed arteriolar vasoconstriction and increased capillary perfusion and venous return, improving central cardiac function. Nitrite effects on resistance vessels, directly influenced intravascular pressure redistribution, sustained blood flow, and prevented tissue ischemia. In conclusion, increasing nitrite plasma bioavailability after fluid resuscitation from hemorrhagic shock can be a potential therapy to enhance microvascular perfusion and to improve overall outcome.     

Experimental pathophysiology of systemic alterations induced by Bothrops asper snake venom

Moderate and severe envenomations by the snake Bothrops asper provoke systemic alterations, such as systemic bleeding, coagulopathy, hypovolemia, hemodynamic instability and shock, and acute renal failure. Systemic hemorrhage is a typical finding of these envenomations, and is primarily caused by the action of P-III snake venom metalloproteinases (SVMPs). This venom also contains a thrombin-like serine proteinase and a prothrombin-activating P-III SVMP, both of which cause defibrin(ogen)ation. Thrombocytopenia, predominantly induced by a C-type lectin-like protein, and platelet hypoaggregation, caused by the two defibrin(ogen)ating enzymes, also contribute to hemostatic disturbances, which potentiate the systemic bleeding induced by hemorrhagic SVMPs. Cardiovascular disturbances leading to shock are due to the combined effects of hemorrhagic toxins, other venom components that increase vascular permeability, the action of hypotensive agents in the venom and of endogenous mediators, and the potential cardiotoxic effect of some toxins. Renal alterations are likely to be caused by direct cytotoxicity of venom components in the kidney, and by renal ischemia resultant from hypovolemia and hypoperfusion. Lethality induced by B. asper venom is the consequence of several combined effects among which the action of P-III SVMPs is especially relevant.     

产后出血的原因与护理个案分析

胎儿娩出后24小时内出血量超过500毫升者为产后出血。产后出血来势汹涌，如抢救不及时，可直接危及产妇的生命，是导致产妇死亡的四大原因之一，所以防治产后出血是产科医护工作者的重要任务。本文以我科住院产妇岑起美的临床资料进行分析，总结我们对产后出血的预防、监测、护理的对策、方法和体会，以便更好地贯彻实施“降消”项目、畅通“绿色通道”。     

创伤患者大量输血的策略及新理念

如何对严重创伤患者更加科学、有效地实施大量输血以提高患者生存率和改善患者长期的生存状态,一直是备受全球医学界关注的焦点问题。理想的输血比例和输血模式在不断发展,并在许多方面存在争论,需要大规模的随机对照研究来解决。当前对严重创伤复苏的较为一致的认识是:创伤患者大量出血有其显著特点,应当重视早期改善凝血功能障碍,并按循证医学所能提供的目前最好的证据进行创伤复苏。