The American journal of emergency medicine
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Case Reports
The intractable intra-abdominal hemorrhage with unknown etiology in a patient with severe hemophilia A.
Severe hemophilia patients are more likely to be complicated by intra-articular hemorrhage, subcutaneous hemorrhage, and intra-mascular hemorrhage. Spontaneous intra-abdominal hemorrhage is a rare fatal disease, which is an arterial bleeding of uncertain causes from vessel feeding arteries. In case the spontaneous intra-abdominal hemorrhage is complicated to severe hemophilia patients, the mortality rate increases considerably. We experienced a patient with severe hemophilia A, who made a full recovery from spontaneous intra-abdominal hemorrhagic shock by replacement therapy of coagulation factor VII, a noninvasive procedure.
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Case Reports
Cardiac arrest with anaphylactic shock: a successful resuscitation using extracorporeal membrane oxygenation.
Anaphylactic shock is a serious allergic reaction, setting in rapidly, which may lead to life-threatening circulatory failure and necessitates aggressive support to ensure full recovery. We report the case of a 50-year-old man who developed cardiovascular collapse and cardiac arrest to iodine contrast media, occurring during coronary angiography. He was required temporary mechanical circulatory support with an venoarterial extracorporeal membrane oxygenation system by failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy. He had full recovery of cardiac function and released from the hospital 21 days after admission without a neurologic deficit.
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Case Reports
Thrombolysis after initially unsuccessful cardiopulmonary resuscitation in presumed pulmonary embolism.
The life-saving administration of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation (CPR) in 7 patients with presumed pulmonary embolism (PE) was reported. Seven patients who had cardiac arrest were admitted to our emergency department. ⋯ A 90-day follow-up showed that 2 patients were neurologically intact, and 1 patient was mildly disabled. These results demonstrate that thrombolysis after initially unsuccessful CPR in presumed PE may have beneficial effects.
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Randomized Controlled Trial
A randomized controlled trial of capnography during sedation in a pediatric emergency setting.
Data suggest that capnography is a more sensitive measure of ventilation than standard modalities and detects respiratory depression before hypoxemia occurs. We sought to determine if adding capnography to standard monitoring during sedation of children increased the frequency of interventions for hypoventilation, and whether these interventions would decrease the frequency of oxygen desaturations. ⋯ Hypoventilation is common during sedation of pediatric emergency department patients. This can be difficult to detect by current monitoring methods other than capnography. Providers with access to capnography provided fewer but more timely interventions for hypoventilation. This led to fewer episodes of hypoventilation and of oxygen desaturation.