Journal of Emergencies, Trauma, and Shock最新文献

Aluminum phosphide (ALP) is one of the most commonly used pesticides worldwide with high mortality rates primarily due to the production of phosphene gas which causes severe mitochondrial damage leading to refractory myocardial depression, refractory hypotension, severe metabolic acidosis, and acute respiratory distress syndrome.[1] There is no antidote for ALP poisoning and treatment remains mainly supportive. The available literature shows a favorable outcome with extracorporeal membrane oxygenation (ECMO) in severely intoxicated patients presenting early with cardiovascular collapse. In this study, we describe an adult male who presented to us with ALP poisoning following deliberate self-harm, was put on ECMO in the emergency room and had a good prognosis.

The patient was an 80-year-old woman with chronic atrial fibrillation, chronic heart failure, cerebellar infarction, hyperlipidemia, and hypertension, who suddenly collapsed while playing gateball outdoors. The doctor at a nearby clinic doctor found her in a state of cardiopulmonary arrest and started basic life support. Twelve minutes after discovery, spontaneous circulation returned. On arrival, she was in a deep coma state with atrial fibrillation-related tachycardia. A physical examination revealed pulseless right radial and left popliteal arteries with cyanosis. Whole-body-enhanced computed tomography and head magnetic resonance imaging demonstrated multiple ischemic organs. Taken together, it was considered that a massive-free thrombus from the left atrium, which was caused by atrial fibrillation, had first obstructed the left ventricular outflow tract, resulting in cardiac arrest. Then, the thrombus had been scattered throughout the body by chest compression. Her condition was judged to be irreversible and she died on day 3. This is the first reported case of multiple systemic embolization associated with chest compression in a patient with cardiac arrest. This unique case adds one more cause to the list of the documented etiologies of complications caused by chest compression.

Introduction: Selective nonoperative management (NOM) is the standard of care for blunt solid organ injury (SOI). Hemodynamic instability is a contraindication for NOM, but it is unclear whether the need for blood transfusion should be a criterion for instability. This study looks at the outcome of blood-transfused SOI patients to determine whether NOM is safe for this group.

Methods: This is a retrospective cohort study using the National Trauma Data Bank years 2017 through 2019. We selected patients with blunt liver, spleen, and kidney injuries. Within this group, we compared the mortality for those managed with NOM versus the hemostatic procedures of laparotomy and angioembolization. Significance for univariate analysis is tested with Chi-square for categorical variables. Multivariate analysis is performed with Cox proportional hazards regression with time-dependent covariate.

Results: 108,718 (3.5%) patients for the years 2017 through 2019 had a SOI. 20,569 (18.9%) of these received at least one unit of packed red blood cells (PRBCs) within the first 4 h. Of the SOI patients who received blood, 8264 (40.2%) underwent laparotomy only, 2924 (14.2%) underwent embolization only, and 1119 (5.4%) underwent both procedures. The adjusted odds ratios (ORs) of death for transfused SOI patients who underwent laparotomy only, embolization only, and both procedures are 0.93 (P = not significant), 0.27 (P < 0.001), and 0.48 (P < 0.001), respectively. The ORs of death with laparotomy for patients receiving >1 through 4 units are 0.87, 0.78, 0.75, and 0.72, respectively (P ≤ 0.01 for all). For embolization, the ORs are 0.27, 0.30, 0.30, and 0.30, respectively (P < 0.001 for all).

Conclusion: Laparotomy is independently associated with survival for patients who receive >1 unit of PRBCs. Angioembolization is independently associated with survival for the entire cohort, including transfused patients. Given the protective association of laparotomy in the blood-transfused SOI group, need for blood transfusion should be considered a meaningful index of instability and a relative indication for laparotomy. The protective association with angioembolization supports current practices for angioembolization of high-risk patients in the transfused and nontransfused groups.

Hypercalcemia is generally caused by primary hyperparathyroidism, malignancies, and drugs. Herein, we report a case of severe hypercalcemia due to drowning in hot springs. A 55-year-old woman was found floating in a public bath at a hotel and was admitted to a nearby hospital. The patient was intubated because of hypoxia and shock, and noradrenaline was titrated. Computed tomography revealed bilateral aspiration pneumonia. Blood tests revealed hypercalcemia (serum total calcium [Ca]: 18.7 mg/dL). Hyperparathyroidism, malignancy, and drug-related factors were ruled out as the causes of hypercalcemia. In addition, the public bath in which the patient drowned contained high concentrations of Ca. We concluded that the reason for hypercalcemia was accidental ingestion of the hot spring water containing a high concentration of Ca through the gastrointestinal tract. In the case of drowning and hypercalcemia, the cause may be clarified by examining the components that were accidentally swallowed.