Pub Date : 2023-02-16DOI: 10.1097/EC9.0000000000000064
R. Vaidyanathan, P. Dar, D. Bagaria, Amit K Gupta
Abstract Introduction Hemorrhage control is the essence of trauma care. Conventional teaching is 1 on the floor (ie, external bleeding) and 4 more (thoracic cavity, abdomen, retroperitoneum, and long bones). In this case report, we present a unique case with concealed bleeding into the soft tissue compartment leading to shock. This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock. Case presentation We present the case with concealed bleeding into the soft tissue compartment posing a challenge in management. On presentation, he had a pulse rate of 117 beats/min, a blood pressure of 90/60 mmHg, and a Glasgow Coma Scale (GCS) score of 9. During resuscitation, the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15. He was then intubated and reevaluated. Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall, extending up to the right lumbar region. Conclusion We suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients, which should not be overlooked after having ruled out the other 5 sites.
{"title":"Soft tissue compartment bleed—the iceberg phenomenon: a case report","authors":"R. Vaidyanathan, P. Dar, D. Bagaria, Amit K Gupta","doi":"10.1097/EC9.0000000000000064","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000064","url":null,"abstract":"Abstract Introduction Hemorrhage control is the essence of trauma care. Conventional teaching is 1 on the floor (ie, external bleeding) and 4 more (thoracic cavity, abdomen, retroperitoneum, and long bones). In this case report, we present a unique case with concealed bleeding into the soft tissue compartment leading to shock. This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock. Case presentation We present the case with concealed bleeding into the soft tissue compartment posing a challenge in management. On presentation, he had a pulse rate of 117 beats/min, a blood pressure of 90/60 mmHg, and a Glasgow Coma Scale (GCS) score of 9. During resuscitation, the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15. He was then intubated and reevaluated. Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall, extending up to the right lumbar region. Conclusion We suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients, which should not be overlooked after having ruled out the other 5 sites.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"32 - 35"},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45494617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-08DOI: 10.1097/ec9.0000000000000071
S. Pothiawala
{"title":"Occult diaphramatic injury in penetrating trauma: a diagnostic challenge","authors":"S. Pothiawala","doi":"10.1097/ec9.0000000000000071","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000071","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49367146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-08DOI: 10.1097/ec9.0000000000000078
Ahmet Butun, Elif Ece Kafdag, Hilal Gunduz, Vedat Zincir, Mehmet Batibay, Kubra Ciftci, D. Demir, Ramazan Bayram, Elanur Yigit
{"title":"Emergency department overcrowding: causes and solutions","authors":"Ahmet Butun, Elif Ece Kafdag, Hilal Gunduz, Vedat Zincir, Mehmet Batibay, Kubra Ciftci, D. Demir, Ramazan Bayram, Elanur Yigit","doi":"10.1097/ec9.0000000000000078","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000078","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47553159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-05DOI: 10.1097/EC9.0000000000000074
Le An, Zhijiang Qi, Huan Shao, Chunsheng Li
Abstract Background Cardiac arrest (CA) is a terminal event that results in a range of pathophysiological changes in the body, most notably, systemic ischemia-reperfusion injury. The hypothalamic-pituitary-adrenal (HPA) axis is an important neuroendocrine system that modulates adrenocortical hormone release. This study was designed to investigate the changes in HPA-related hormone levels after successful cardiopulmonary resuscitation (CPR) and to explore possible etiologies to provide a basis for relevant clinical research. Methods We collected the clinical data of 96 patients with CA admitted to the Emergency Department of Beijing Chaoyang Hospital, Capital Medical University, between January 2016 and May 2017. Serum samples were collected 6, 24, and 72 hours after restoring spontaneous circulation (ROSC). The data were compared with those of the healthy control group (n = 50). An enzyme-linked immunosorbent assay (ELISA) was performed to measure copeptin, adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), and total cortisol. Demographic data were collected for both groups. For the CPR group, clinical data and the end-of-study cerebral performance category (CPC) were analyzed. Patients were followed up through day 28. Death or survival after day 28 was used as the study endpoint. Simple values were expressed as medians and quartiles or ratios (%) for statistical analysis. Continuous variables are expressed as mean ± standard deviation. Categorical variables were expressed as frequencies and percentages. The mean values of normally distributed measurement data were analyzed using 1-way analysis of variance (ANOVA) for among-group comparisons and the least significant difference (LSD) test for between-group comparisons. SPSS v17 (SPSS, Chicago, IL, USA) was used for statistical analysis, and P < 0.05 was considered statistically significant. Results No significant between-group differences were observed in terms of age or sex. The 28-day mortality rate in the CPR group was 71%. ACTH and CRH levels were significantly lower in the CPR group than in the healthy control group (P < 0.001). Copeptin and cortisol levels 6 hours after ROSC were significantly higher in the CPR group than in the healthy control group (P < 0.001). No significant changes in any indicator were observed over time (6, 24, and 72 hours after ROSC) (P > 0.05). The CPC score was 1–2 (good cerebral performance group) in 13 patients, 3–4 (poor cerebral performance group) in 17 patients, and 5 (brain death or clinical death) in 66 patients. Patients with significantly declining ACTH and CRH levels had higher CPC scores (P < 0.05); however, no significant differences were found in other indicators (P > 0.05). Conclusion After post-CA ROSC, ischemia-reperfusion injury may cause brain damage and HPA axis damage and dysfunction, the severity of which is associated with CPC score.
{"title":"Functional changes in the hypothalamic-pituitary-adrenal axis after successful cardiopulmonary resuscitation","authors":"Le An, Zhijiang Qi, Huan Shao, Chunsheng Li","doi":"10.1097/EC9.0000000000000074","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000074","url":null,"abstract":"Abstract Background Cardiac arrest (CA) is a terminal event that results in a range of pathophysiological changes in the body, most notably, systemic ischemia-reperfusion injury. The hypothalamic-pituitary-adrenal (HPA) axis is an important neuroendocrine system that modulates adrenocortical hormone release. This study was designed to investigate the changes in HPA-related hormone levels after successful cardiopulmonary resuscitation (CPR) and to explore possible etiologies to provide a basis for relevant clinical research. Methods We collected the clinical data of 96 patients with CA admitted to the Emergency Department of Beijing Chaoyang Hospital, Capital Medical University, between January 2016 and May 2017. Serum samples were collected 6, 24, and 72 hours after restoring spontaneous circulation (ROSC). The data were compared with those of the healthy control group (n = 50). An enzyme-linked immunosorbent assay (ELISA) was performed to measure copeptin, adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), and total cortisol. Demographic data were collected for both groups. For the CPR group, clinical data and the end-of-study cerebral performance category (CPC) were analyzed. Patients were followed up through day 28. Death or survival after day 28 was used as the study endpoint. Simple values were expressed as medians and quartiles or ratios (%) for statistical analysis. Continuous variables are expressed as mean ± standard deviation. Categorical variables were expressed as frequencies and percentages. The mean values of normally distributed measurement data were analyzed using 1-way analysis of variance (ANOVA) for among-group comparisons and the least significant difference (LSD) test for between-group comparisons. SPSS v17 (SPSS, Chicago, IL, USA) was used for statistical analysis, and P < 0.05 was considered statistically significant. Results No significant between-group differences were observed in terms of age or sex. The 28-day mortality rate in the CPR group was 71%. ACTH and CRH levels were significantly lower in the CPR group than in the healthy control group (P < 0.001). Copeptin and cortisol levels 6 hours after ROSC were significantly higher in the CPR group than in the healthy control group (P < 0.001). No significant changes in any indicator were observed over time (6, 24, and 72 hours after ROSC) (P > 0.05). The CPC score was 1–2 (good cerebral performance group) in 13 patients, 3–4 (poor cerebral performance group) in 17 patients, and 5 (brain death or clinical death) in 66 patients. Patients with significantly declining ACTH and CRH levels had higher CPC scores (P < 0.05); however, no significant differences were found in other indicators (P > 0.05). Conclusion After post-CA ROSC, ischemia-reperfusion injury may cause brain damage and HPA axis damage and dysfunction, the severity of which is associated with CPC score.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"46 - 50"},"PeriodicalIF":0.0,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49401580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-09DOI: 10.1097/ec9.0000000000000070
S. Zeng, Lei Ma, Lishan Yang, Xiao-hong Hu, Cheng-hong Wang, Y. Gou, Yi Li
{"title":"Role of hemoperfusion combined with hemodialysis in acute severe organophosphorus pesticide poisoning: a meta-analysis","authors":"S. Zeng, Lei Ma, Lishan Yang, Xiao-hong Hu, Cheng-hong Wang, Y. Gou, Yi Li","doi":"10.1097/ec9.0000000000000070","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000070","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45427363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-08DOI: 10.1097/EC9.0000000000000065
Xiaojie Liu, Zhen Hua, He Dong, Ya-Ting Zhuo, Haichen Chu, Tianjun Li
Abstract Background Anesthesia induction is challenging in patients with hemodynamic instability. Esketamine has hypnotic, analgesic, and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension. Therefore, it may be more suitable for patients with hypovolemic shock. Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours. Menstruation of the patient was regular, her self-reported urine pregnancy test was positive half a month earlier, and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test. Gynecological ultrasonography demonstrated no pregnancy sac in utero, confirming ectopic pregnancy. Emergency laparoscopy for ectopic pregnancy should be performed immediately. We administered esketamine for induction. Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.
{"title":"Esketamine use for anesthesia induction in an ectopic pregnancy patient with hemorrhagic shock: a case report","authors":"Xiaojie Liu, Zhen Hua, He Dong, Ya-Ting Zhuo, Haichen Chu, Tianjun Li","doi":"10.1097/EC9.0000000000000065","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000065","url":null,"abstract":"Abstract Background Anesthesia induction is challenging in patients with hemodynamic instability. Esketamine has hypnotic, analgesic, and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension. Therefore, it may be more suitable for patients with hypovolemic shock. Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours. Menstruation of the patient was regular, her self-reported urine pregnancy test was positive half a month earlier, and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test. Gynecological ultrasonography demonstrated no pregnancy sac in utero, confirming ectopic pregnancy. Emergency laparoscopy for ectopic pregnancy should be performed immediately. We administered esketamine for induction. Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"136 - 138"},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47750728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-08DOI: 10.1097/ec9.0000000000000068
S. Malouf, Catherine Henry, L. Pemberton, J. Rotella
{"title":"Treatment of prolonged clonidine-induced autonomic instability with midodrine: a case report about a new approach or a cautionary tale?","authors":"S. Malouf, Catherine Henry, L. Pemberton, J. Rotella","doi":"10.1097/ec9.0000000000000068","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000068","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45838366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-29DOI: 10.1097/ec9.0000000000000069
N. Iwasaki, M. Sekino, T. Hara, A. Soyama, M. Hidaka, Yusuke Kasai, Miki Suzumura, H. Araki, Rintaro Yano, Sojiro Matsumoto, T. Ichinomiya, U. Higashijima, S. Eguchi, T. Hara
{"title":"Heparin-induced thrombocytopenia occurring early after living donor liver transplantation: a case report","authors":"N. Iwasaki, M. Sekino, T. Hara, A. Soyama, M. Hidaka, Yusuke Kasai, Miki Suzumura, H. Araki, Rintaro Yano, Sojiro Matsumoto, T. Ichinomiya, U. Higashijima, S. Eguchi, T. Hara","doi":"10.1097/ec9.0000000000000069","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000069","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45676638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Together with the development of the focused assessment with sonography for trauma protocol for ultrasound in trauma patients, point-of-care ultrasound is widely used in the field of emergency and critical care medicine. Researchers have established several classic operating protocols for different diseases, such as acute respiratory failure, shock, and cardiac arrest, in the emergency department and intensive care unit. With further development in the portability and popularity of ultrasonic equipment, it is expected to be used as a new type of technology for physical examination, including inspection, palpation, percussion, auscultation, and insonation, which will improve the clinical medicine practice in the future.
{"title":"Trends in point-of-care ultrasound protocols in the emergency department and intensive care unit: a review","authors":"Xinhui Fan, Y. Bian, Guoying Wang, Weikang Liu, Luyao Gao, Y. Pan, Shengchuan Cao, Qiu-huan Yuan, Shujian Wei, Feng Xu, Yuguo Chen","doi":"10.1097/EC9.0000000000000066","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000066","url":null,"abstract":"Abstract Together with the development of the focused assessment with sonography for trauma protocol for ultrasound in trauma patients, point-of-care ultrasound is widely used in the field of emergency and critical care medicine. Researchers have established several classic operating protocols for different diseases, such as acute respiratory failure, shock, and cardiac arrest, in the emergency department and intensive care unit. With further development in the portability and popularity of ultrasonic equipment, it is expected to be used as a new type of technology for physical examination, including inspection, palpation, percussion, auscultation, and insonation, which will improve the clinical medicine practice in the future.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"64 - 69"},"PeriodicalIF":0.0,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46010740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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