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81.
We report the case of a patient who deteriorated suddenly while undergoing endoluminal coronary artery reconstruction with multiple stents to the left anterior descending coronary artery. With the aid of transthoracic echocardiography, a pericardial effusion was noted; however, dissection of the ventricular wall due to a large myocardial hematoma was also identified. Emergency exploration with evacuation of the pericardial blood with coronary artery bypass graft surgery was successfully accomplished. We discuss the possible factors that could have been associated with this unforeseen complication and the potential benefit of transthoracic echocardiography in early recognition. 相似文献
82.
目的:探讨急性脑出血患者血浆 N 端脑钠肽前体(NT-proBNP)及和肽素与病情严重程度及脑出血量之间的关系。方法选取该院2011年12月至2013年6月期间诊断为急性脑出血患者109例(脑出血组)和同期体检的健康者32例(对照组),对脑出血组患者和对照组健康者血浆 NT-proBNP、和肽素水平与格拉斯哥昏迷评分(GCS)进行比较。结果脑出血组血浆NT-proBNP 及和肽素水平明显高于对照组,随病情严重程度及出血量增加呈显著升高,差异有统计学意义(P <0.05)。血浆 NT-proBNP、和肽素水平与脑出血量呈正相关(r=0.63,r=0.58,P <0.01),与 GCS 呈负相关(r=-0.52,r=-0.46,P <0.01)。结论血浆 NT-proBNP、和肽素水平和急性脑出血关系密切,能反映急性脑出血患者病情严重程度。 相似文献
83.
Dhara P. Amin Michael N. Cooper Kim I. Newton 《The Journal of emergency medicine》2018,54(5):e101-e103
Background
Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction.Case Report
Our case involves a 39-year-old man who presented to the Emergency Department via emergency medical services with an enlarging LH after an unwitnessed fall, suspected to be an alcohol withdrawal seizure. The bleeding was likely exacerbated by previously undiagnosed thrombocytopenia. Airway stabilization was rapidly established via nasotracheal intubation after standard intubation techniques were deemed unfeasible. Despite correction of the coagulopathy, the LH continued to expand, resulting in bilateral tympanomandibular joint (TMJ) dislocations. To our knowledge, this complication has not been previously reported as a complication of LH.Why Should an Emergency Physician Be Aware of This?
Despite being a relatively uncommon condition, LH has the potential to result in life-threatening airway obstruction with limited airway options. Prompt airway stabilization should be the first priority upon diagnosis. A rapidly evolving LH can limit standard orotracheal rapid sequence intubation options, and may require alternative airway procedures. Additionally, ongoing lingual swelling after airway stabilization has now been shown in our case to result in bilateral TMJ dislocations. Concurrent management of reversible coagulopathy may help prevent this complication or reduce its severity. 相似文献84.
Sgouros SN Karamanolis G Papadopoulou E Papageorgiou G Stefanides G Nastos H Mantides A 《Journal of gastroenterology and hepatology》2004,19(10):1217-1219
Intramural duodenal hematoma is a rare complication of endoscopic biopsy. It is usually seen in children with growth failure and in patients with bleeding disorders or who are anticoagulated. It is frequently associated with acute pancreatitis. We present a case of an adult patient with Noonan's syndrome who developed postbiopsy intraduodenal hematoma. Abdominal ultrasound and computed tomography scan established the diagnosis. Conservative treatment was successful. According to a brief review of the literature, patients with Noonan's syndrome may develop hematoma after sampling of the duodenum because they present all the main predisposing factors. Additionally, pulmonic valve stenosis may be another predisposing factor, but this may warrant further investigation. 相似文献
85.
Douglas B. Bogart Martha A Bogart John T. Miller Michael W. Farrar W. Kent Barr Michael A. Montgomery 《Catheterization and cardiovascular interventions》1995,34(1):8-13
This report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids. 相似文献
86.
Juliette A.L. Santing Crispijn L. Van den Brand Korné Jellema 《The Journal of emergency medicine》2021,60(3):285-291
BackgroundEmergency departments (EDs) are faced with a growing number of patients with traumatic brain injury (TBI) using direct oral anticoagulants (DOACs). However, there remains uncertainty about the bleeding risk, rate of hematoma expansion, and the efficacy of reversal strategies in these patients.ObjectiveThis study aims to identify the risk of traumatic hemorrhagic complications in patients with TBI using DOACs.MethodsIn this retrospective study we included patients with TBI. All TBI patients were using DOACs, attended one of the three EDs of our hospital between January 2016 and October 2019, and received a computed tomography (CT) scan of the brain. The primary outcome was any traumatic intracranial hemorrhage on CT. Secondary outcomes were the use of reversal agents, secondary neurological deterioration, a neurosurgical intervention within 30 days after the injury, length of stay (LOS), Glasgow Outcome Scale (GOS) at discharge, and mortality.ResultsOf the included patients (N = 316), 24 patients (7.6%, 95% confidence interval [CI] 4.2–9.8) presented with a traumatic intracranial hematoma (ICH). Seven patients (2.2%, 95% CI 0.6–3.8) received a reversal agent and 1 patient (0.3%, 95% CI ?0.3–0.9) underwent a neurosurgical intervention. Of the 24 patients with a traumatic ICH, progression of the lesion was seen in 6 patients (1.9%, 95% CI 0.4–3.4). The mean LOS was 6.5 days (95% CI 3.0–10.1) and the mean GOS at discharge was 4 (95% CI 3.6–4.6). Death occurred in 1 patient (0.3%, 95% CI ?0.3–0.9) suffering from an ICH.ConclusionBased on the present findings it can be postulated that TBI patients using DOACs have a low risk for ICH. Hematoma progression occurred, however, in a substantial number of patients. Considering the retrospective nature of the present study, future prospective trials are needed to confirm this finding. 相似文献
87.
目的 观察经胸超声心动图诊断A型主动脉壁间血肿的价值。方法 回顾性分析40例经CT血管成像(CTA)确诊的A型主动脉壁间血肿患者的临床资料及超声心动图表现,评价经胸超声心动图诊断A型主动脉壁间血肿的价值。结果 40例A型主动脉壁间血肿患者,男25例(25/40,62.50%),女15例,发病中位年龄55岁;以胸背部疼痛(36/40,90.00%)为主要症状;其中30例有高血压病史、15例有吸烟史。主动脉壁间血肿超声主要表现为主动脉壁内-中膜与外膜间存在厚薄不均匀低回声;主动脉窦部增宽与年龄、高血压病史相关(r=0.51,P=0.01;r=0.34,P=0.03)。25例(25/40,62.50%)合并主动脉瓣反流,其中21例(21/25,84.00%)为轻度反流;12例合并心包积液,其中10例(10/12,83.33%)为少量积液。结论 经胸超声心动图对诊断A型主动脉壁间血肿有一定价值,并可用于患者随访。 相似文献
88.
89.
We herein report two autopsy cases with gastric injury associated with cardiopulmonary resuscitation (CPR). Case 1 was a 36–year–old woman who was found in cardiopulmonary arrest possibly caused by a fall from a height of 8 m. She received continuous manual chest compression with artificial ventilation while being transferred to the hospital. Autopsy revealed bruises on her left upper arm with a fracture to the left humerus and advanced pneumohemothorax that was associated with laceration of the left lung due to fracture of the dorsal left costa. Furthermore, complete rupture of the gastric wall (25 cm) was found without hemorrhage. Case 2 was an 85–year–old man found unconscious on the road. He had a history of oral anticoagulant administration, cognitive impairment, and gait disorder. He also received cardiac massage and manual artificial ventilation during CPR. Autopsy revealed severe head injury, possibly caused by a backward fall. His stomach was markedly dilated by air and a fresh intramural hematoma had extended into all layers of the stomach and adjacent omentum; however, injury of the abdominal wall was not evident. Histopathological investigation of the brain revealed advanced Alzheimer’s disease and Lewy pathology, and the damaged neural tissue, which was positive for the amyloid precursor protein. We determined that the gastric injuries in both cases had been caused by CPR. We conclude that careful investigation is required for gastric injury cases to determine the etiology and correlation between gastric injury and cause of death when the victims receive CPR. 相似文献
90.
BackgroundThe decision to resume antithrombotic therapy after surgical evacuation of chronic subdural hematoma (CSDH) requires judicious weighing of the risk of bleeding against that of thromboembolism. This study aimed to investigate the impact of time to resumption of antithrombotic therapy on outcomes of patients after CSDH drainage.MethodsData were obtained retrospectively from three tertiary hospitals in Singapore from 2010 to 2017. Outcome measures analyzed were CSDH recurrence and any thromboembolic events. Logistic and Cox regression tests were used to identify associations between time to resumption and outcomes.ResultsA total of 621 patients underwent 761 CSDH surgeries. Preoperative antithrombotic therapy was used in 139 patients. 110 (79.1%) were on antiplatelets and 35 (25.2%) were on anticoagulants, with six patients (4.3%) being on both antiplatelet and anticoagulant therapy. Antithrombotic therapy was resumed in 84 patients (60.4%) after the surgery. Median time to resumption was 71 days (IQR 29 – 201). Recurrence requiring reoperation occurred in 15 patients (10.8%), of which 12 had recurrence before and three after resumption. Median time to recurrence was 35 days (IQR 27 – 47, range 4 – 82 days). Recurrence rates were similar between patients that were restarted on antithrombotic therapy before and after 14, 21, 28, 42, 56, 70 and 84 days, respectively. Thromboembolic events occurred in 12 patients (8.6%), of which five had the event prior to restarting antithrombosis.ConclusionsTime to antithrombotic resumption did not significantly affect CSDH recurrence. Early resumption of antithrombotic therapy can be safe for patients with a high thromboembolic risk. 相似文献