The American journal of emergency medicine
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A pregnant woman at 22+5/7weeks gestation presented to the emergency department (ED) from an outpatient clinic, hypotensive after experiencing a syncopal episode. On arrival to the ER she was tachycardic, tachypneic and complaining of abdominal pain. A bedside FAST was performed and noted free fluid in the abdomen. Subsequent CT obtained noted the rare but life-threatening diagnosis of ruptured splenic artery aneurysm that resulted in emergent transfer to the operating room with OB/GYN and general surgery. The patient underwent emergent splenectomy and endovascular repair with vascular surgery, as well as massive transfusion and was transferred to the ICU post-operatively. The patient made a complete recovery and was discharged home on day four of her hospital stay. She underwent an uncomplicated cesarean section at 37+1weeks (Figs. 1-4). ⋯ Rare but baring a high mortality rate, splenic artery aneurysm should be on the differential of any pregnant woman with abdominal pain, especially in the setting of hemodynamic instability. Prompt recognition, early involvement of OB/GYN and vascular surgery as well as rapid surgical intervention is needed for stabilization. These patients may require large amounts of blood for transfusion and it is important to acquire labs including a type and cross to avoid delays in resuscitation. Over 100 cases of SAA in pregnancy have been reported, but a minority reported both maternal and fetal survival.
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Multicenter Study
FAST for blunt abdominal trauma: Correlation between positive findings and admission acid-base measurement.
This study aimed to determine any association between positive findings in ultrasonography examination and initial BD value with regard to diagnosis of intra-abdominal bleeding following blunt abdominal trauma. ⋯ This study revealed that arterial BD is an early accessible important marker to identify intra-abdominal bleeding, as well as to predict overall in-hospital mortality in patients with blunt abdominal trauma.
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To assess whether use of Impedance Threshold Device (ITD) during cardiopulmonary resuscitation (CPR) reduces the degree of post-cardiac arrest Acute Kidney Injury (AKI), as a result of improved hemodynamics, in a porcine model of ventricular fibrillation (VF) cardiac arrest. ⋯ Use of ITD during ACD-CPR improved hemodynamic parameters, increased 48 h survival and decreased the degree of post-cardiac arrest AKI in the resuscitated animals.