Resuscitation
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Case Reports
Intra-aortic balloon counterpulsation for cardiogenic shock due to cardiac contusion in an elderly trauma patient.
Blunt thoracic trauma may cause cardiac contusion and cardiogenic shock resistant to inotropic support. The use of intra-aortic balloon counterpulsation (IABCP) as a mechanical means of augmenting cardiac function following cardiac contusion is rare with case reports largely limited to its use in young trauma patients. ⋯ She was successfully managed with invasive monitoring, inotropic support and IABCP. This case provides support for aggressive resuscitation even in the very elderly as recovery from severe cardiac contusion may be possible.
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This study examined (1) the defibrillation efficacy of using a minimally invasive direct cardiac massage (MID-CM) device as one electrode of the defibrillation electrical circuit and (2) the effect on external defibrillation of defibrillating when the MID-CM device is in place and a pneumothorax is present. ⋯ Using the MID-CM device as one electrode of the defibrillation circuit markedly lowers the DFT compared with that for standard transthoracic defibrillation for both a monophasic and biphasic waveform. Defibrillation with the device in place and the chest opened elevates the DFT for external defibrillation much more during end-expiration than during end-inspiration.
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Case Reports
Transient Brugada-type electrocardiographic abnormalities in renal failure reversed by dialysis.
The Brugada syndrome (BRS) is a hereditary cardiac condition (characteristically with a gene mutation affecting sodium channel function) identified by an elevated terminal portion of the QRS complex (prominent J wave) followed by a descending ST-segment elevation ending in a negative T wave in the right precordial leads, and malignant tachyarrhythmias in patients without demonstrable structural heart disease. We report a patient with a previous history of epilepsy treated with psychotropic drugs (with a sodium channel blocking effect) and chronic renal failure on haemodialysis who developed hyperkalaemia (6.6 mmol/l) and ECG findings resembling BRS. ⋯ Subsequently, a flecainide test did not reproduce ST-segment elevation. We conclude that hyperkalaemia associated with cardiac membrane active drugs may cause ECG changes mimicking the Brugada syndrome.
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The treatment of massive pulmonary embolus remains controversial. We describe the first report of the successful use of the thrombolytic agent, tenecteplase, in treating a hypotensive elderly patient with a saddle embolus. A brief review of the current literature concerning thrombolysis for massive pulmonary embolus is given.