The American journal of emergency medicine
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Case Reports
Successful use of intra-arrest thrombolysis for electrical storm due to acute myocardial infarction.
Acute vascular thrombotic disease, including acute myocardial infarction and pulmonary embolism, accounts for 70% of sudden outpatient cardiac arrest. The role of intra-arrest thrombolytic administration aimed at reversing the underlying cause of cardiac arrest remains an area of debate with recent guidelines advising against routine use. ⋯ Return of spontaneous circulation was rapidly achieved after rescue intra-arrest bolus thrombolysis. Highlights of this case are discussed in the context of the current evidence for thrombolytic therapy in cardiac arrest with specific attention to the issue of patient selection.
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Case Reports
Urgent interscalene brachial plexus block for management of traumatic luxatio erecta in the ED.
Trauma in the emergency department may present providers with amyriad of unforeseen clinical scenarios. We present an example of how an urgent nerve block facilitated rapid management of a luxatio erecta shoulder fracture-dislocation without sedation. A 20-year-old female pedestrian presented to our level II trauma center after being stuck bya motor vehicle. ⋯ Regional anesthesia presents a viable option in this scenario for rapid-onset analgesia available urgently at the bedside. In our experience, using a stay-away technique in conjunction with short-acting, low-toxicity chloroprocaine provides safe, quick, and effective anesthesia. This allowed for prompt reduction of the dislocated joint and timely evaluation for potential life-threatening injuries while avoiding the risks associated with conscious sedation.
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Case Reports
Acute myocardial infarction with concomitant pulmonary embolism as a result of patent foramen ovale.
Acute myocardial infarction (MI) and pulmonary embolism canal one lead to life-threatening conditions such as sudden cardiac death and congestive heart failure. We discuss a case of a 74-year-old man presented to the emergency department with acute dyspnea and chest pain. Acute anterior MI and pulmonary embolism concomitantly were diagnosed. ⋯ Transthoracic echocardiography revealed a thrombus that was stuck into the patent foramen ovale with parts in right and left atria. Anticoagulation therapy was started; neither fibrinolytic therapy nor operation was performed because of low survey expectations of the patient's recently diagnosed primary disease stage IV lung cancer. Patient was discharged on his 20th day with oral anticoagulation and antiagregant therapy.
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Aortic dissection is a life-threatening emergency. Well-established risk factors include systemic hypertension, hereditary connective tissue diseases (Marfan syndrome and Ehlers-Danlos syndrome), coarctation of the aorta, bicuspid aortic valve, aortitis, and arch hypoplasia. ⋯ We report a rare case of symptomatic ischemia of the lower extremities due to aortic dissection. This case demonstrates that the treating physician needs to be vigilant for ischemia reperfusion injuries such as osteofascial compartment syndrome and acute renal failure in aortic dissection.
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Visceral injury from cardiac arrest resuscitation is a rare but potentially life-threatening complication. We describe and review 2 cases of hepatic laceration complicated by major abdominal hemorrhage manifested as delayed shock following cardiopulmonary resuscitation after cardiac arrest. Two patients enrolled in our institutional post cardiac arrest resuscitation clinical pathway had evidence of major liver laceration presenting as delayed shock due to massive hemoperitoneum. ⋯ Both cases were successfully managed via hepatic artery embolization. Visceral abdominal injuries are an uncommon but important complication of cardiopulmonary resuscitation. Coagulopathy, including therapeutic systemic anticoagulation, is a risk factor for clinically significant hemorrhage.