The American journal of emergency medicine
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Case Reports
A life-threatening complication of warfarin therapy in ED: diffuse alveolar hemorrhage.
Warfarin have some serious adverse effects, and bleeding is one of the most serious and frequent of them. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin.
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Heatstroke is one of the most common clinical emergencies. Heatstroke that occurred in a dry-heat environment such as desert is usually more seriously effective and often leads to death. However, the report of the pathophysiologic mechanisms about heatstroke in dry-heat environment of desert has not been seen. ⋯ We have successfully established the rat heatstroke model of dry-heat environment of desert. We have identified heatstroke rats that presented changing characteristics on physiological indicators and varying degrees of organ damage, which are aggravated by the evolution of heatstroke in dry-heat environment of desert. We have preliminarily discussed the mechanism of heatstroke in dry-heat environment of desert.
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We encountered a case of severe acute respiratory distress syndrome in late pregnancy due to influenza (H1N1) with refractory hypoxemia to conventional mechanical ventilation. Ventilation in prone position rescued this patient by maintaining oxygenation and sustaining improvement thereafter. ⋯ It requires frequent monitoring of possible complications due to prone position and highly dedicated supporting staffs. More data are required on safety of proning in the late pregnancy.
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Case Reports
Spontaneous hepatic rupture caused by hemolysis, elevated liver enzymes, and low platelet count syndrome.
The causes of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome or hepatic hemorrhage as a serious complication of HELLP are not known. Although spontaneous hepatic rupture associated with HELLP syndrome is a rare complication of pregnancy, hepatic rupture results in life-threatening complications. ⋯ Hepatic rupture in HELLP syndrome should be considered a differential diagnosis in pregnant patients with sudden onset of abdominal pain or hypotension. We report a case of 30-year-old primigravida female with spontaneous hepatic rupture caused by HELLP syndrome as a presenting symptom of right upper quadrant abdominal pain.
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Pericardial effusion is commonly detected in patients with severe hypothyroidism and is typically mild; rarely, it may lead to cardiac tamponade. Cardiac tamponade with myxedema coma as initial presenting feature of previously unrecognized hypothyroidism is rare. This case highlights that previously undiagnosed hypothyroidism can manifest as myxedema coma with shock due to pericardial tamponade particularly in winters because a cold environment can precipitate myxedema. ⋯ Cardiac tamponade and myxedema coma as presenting features of previously unrecognized primary hypothyroidism are extremely rare. Urgent bedside echocardiography with pericardiocentesis along with thyroxine therapy is the treatment of choice. It is important to include hypothyroidism as the differential diagnosis in patients with cardiac tamponade and altered level of consciousness especially in winter months.