M. Elie-Turenne, R. Seethala, I. Aisiku, A. Bihorac, T. Ozrazgat-Baslanti, K. Mark, N. George, B. Allen, S. Bozorgmehri, D. Meurer, Hasan Rasheed, C. Tzeng, P. Hou
{"title":"A large multicenter evaluation of quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) performance among hospitalized US Emergency Department patients with suspected infection","authors":"M. Elie-Turenne, R. Seethala, I. Aisiku, A. Bihorac, T. Ozrazgat-Baslanti, K. Mark, N. George, B. Allen, S. Bozorgmehri, D. Meurer, Hasan Rasheed, C. Tzeng, P. Hou","doi":"10.21037/jeccm-21-56","DOIUrl":"https://doi.org/10.21037/jeccm-21-56","url":null,"abstract":"","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46525045","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}
Thyroid storm is a rare endocrine emergency that requires prompt recognition and treatment to reduce the high morbidity and mortality associated with the disease. A subset of patients with thyroid storm develop the grave complication of thyrotoxicosis-induced low-output heart failure, the severity of which ranges from subclinical to life-threatening. These patients present a therapeutic challenge because the initiation of beta-adrenergic blockade, a cornerstone of therapy in thyroid storm, disrupts the hyperadrenergic state that plays a compensatory role in maintaining cardiac output and may lead to cardiogenic shock. We present a case of a young healthy man who presented to the emergency department in thyroid storm, which was his first clinical presentation of Graves’ disease. He was treated with beta-blockers prior to recognition of his subclinical low-output heart failure and he decompensated into cardiogenic shock necessitating inotropic and vasopressor support. He was ultimately treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock which enabled him to recover normal left ventricular function while his thyroid hormone levels normalized. Screening for underlying thyrocardiac disease and cautious administration of rate controlling agents can prevent treatment-induced cardiogenic shock. Early intervention with VA-ECMO may provide the best clinical outcome for patients presenting with thyrotoxicosis-induced low-output heart failure.
{"title":"The perils of beta-blockade and the promise of venoarterial extracorporeal membrane oxygenation in managing low-output heart failure in thyroid storm: a case report","authors":"Jennifer Zacharia, T. May","doi":"10.21037/JECCM-20-133","DOIUrl":"https://doi.org/10.21037/JECCM-20-133","url":null,"abstract":"Thyroid storm is a rare endocrine emergency that requires prompt recognition and treatment to reduce the high morbidity and mortality associated with the disease. A subset of patients with thyroid storm develop the grave complication of thyrotoxicosis-induced low-output heart failure, the severity of which ranges from subclinical to life-threatening. These patients present a therapeutic challenge because the initiation of beta-adrenergic blockade, a cornerstone of therapy in thyroid storm, disrupts the hyperadrenergic state that plays a compensatory role in maintaining cardiac output and may lead to cardiogenic shock. We present a case of a young healthy man who presented to the emergency department in thyroid storm, which was his first clinical presentation of Graves’ disease. He was treated with beta-blockers prior to recognition of his subclinical low-output heart failure and he decompensated into cardiogenic shock necessitating inotropic and vasopressor support. He was ultimately treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock which enabled him to recover normal left ventricular function while his thyroid hormone levels normalized. Screening for underlying thyrocardiac disease and cautious administration of rate controlling agents can prevent treatment-induced cardiogenic shock. Early intervention with VA-ECMO may provide the best clinical outcome for patients presenting with thyrotoxicosis-induced low-output heart failure.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48378694","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}
Benjamin O. Lawson, Peter Fahim, Jenny I. Shen, E. Lum
{"title":"False blood leak alarm from dialysate discoloration following vitamin B12 infusion: case report","authors":"Benjamin O. Lawson, Peter Fahim, Jenny I. Shen, E. Lum","doi":"10.21037/jeccm-22-1","DOIUrl":"https://doi.org/10.21037/jeccm-22-1","url":null,"abstract":"","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49658596","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}
: Extracorporeal cardiopulmonary resuscitation (ECPR) is the initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during resuscitation. As a clinical emergency, ECPR is often initiated with limited background information, especially for those with out of hospital cardiac arrest. The underlying cause of cardiac arrest is often revealed after the VA-ECMO is established. If the original culprit turns out to be aortic dissection, in which peripheral VA-ECMO is relatively contra-indicated, the first question to answer is whether the arterial return catheter is perfusing the true lumen. If not, the high retrograde flow to the false lumen can otherwise result in further progression of the aortic dissection. While aortogram by computer tomography is still considered one of the gold standards to confirm the catheter position, the transport risk for an unstable patient immediately after ECPR is still high. This article suggests a novel bedside method of using microbubble contrast transesophageal echocardiography, injected through the return cannula, to check if the blood flow is directed towards the true or the false lumen. The test result allows the clinicians prompt decision making on whether to change the VA-ECMO configuration or for early VA-ECMO withdrawal. The image of such a diagnostic contrast echocardiography technique is presented in this case report.
{"title":"Case report of contrast transesophageal echocardiography to confirm extracorporeal membrane oxygenation (ECMO) catheter position in aortic dissection","authors":"S. Au, K. Fong, Sai Kwong Yung, G. Ng","doi":"10.21037/JECCM-20-166","DOIUrl":"https://doi.org/10.21037/JECCM-20-166","url":null,"abstract":": Extracorporeal cardiopulmonary resuscitation (ECPR) is the initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during resuscitation. As a clinical emergency, ECPR is often initiated with limited background information, especially for those with out of hospital cardiac arrest. The underlying cause of cardiac arrest is often revealed after the VA-ECMO is established. If the original culprit turns out to be aortic dissection, in which peripheral VA-ECMO is relatively contra-indicated, the first question to answer is whether the arterial return catheter is perfusing the true lumen. If not, the high retrograde flow to the false lumen can otherwise result in further progression of the aortic dissection. While aortogram by computer tomography is still considered one of the gold standards to confirm the catheter position, the transport risk for an unstable patient immediately after ECPR is still high. This article suggests a novel bedside method of using microbubble contrast transesophageal echocardiography, injected through the return cannula, to check if the blood flow is directed towards the true or the false lumen. The test result allows the clinicians prompt decision making on whether to change the VA-ECMO configuration or for early VA-ECMO withdrawal. The image of such a diagnostic contrast echocardiography technique is presented in this case report.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":"41 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41292132","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}
Alyssa J. Melo, J. Vadhan, Melanie Miller, Jose B. Melo
: Corpus luteum cyst rupture is a common cause of spontaneous hemoperitoneum discovered within the emergency department (ED) setting. It is extremely uncommon, however, to discover a rare underlying hematologic disorder such as acquired hemophilia in these cases. Early recognition of the condition is essential given the substantial risk of severe morbidity and mortality associated with increased time to diagnosis. We report a case of a 25-year-old female who presented to the ED with lower abdominal pain and a syncopal event, who was found to have spontaneous hemoperitoneum due to a ruptured corpus luteum cyst and was subsequently discovered to have acquired hemophilia A (AHA). Patients with AHA can present to the ED with a wide spectrum of symptoms, most commonly related to the inciting bleeding event. AHA should be considered in all patients who present with profound and prolonged bleeding episodes devoid of immediately identifiable causes within the emergency setting. A high index of suspicion for this condition is critical because surgical intervention in the absence of appropriate hemostatic and immunosuppressive treatment can result in catastrophic consequences.
{"title":"Acquired hemophilia A presenting as spontaneous hemorrhage following corpus luteum cyst rupture: a case report and review of the literature","authors":"Alyssa J. Melo, J. Vadhan, Melanie Miller, Jose B. Melo","doi":"10.21037/JECCM-20-144","DOIUrl":"https://doi.org/10.21037/JECCM-20-144","url":null,"abstract":": Corpus luteum cyst rupture is a common cause of spontaneous hemoperitoneum discovered within the emergency department (ED) setting. It is extremely uncommon, however, to discover a rare underlying hematologic disorder such as acquired hemophilia in these cases. Early recognition of the condition is essential given the substantial risk of severe morbidity and mortality associated with increased time to diagnosis. We report a case of a 25-year-old female who presented to the ED with lower abdominal pain and a syncopal event, who was found to have spontaneous hemoperitoneum due to a ruptured corpus luteum cyst and was subsequently discovered to have acquired hemophilia A (AHA). Patients with AHA can present to the ED with a wide spectrum of symptoms, most commonly related to the inciting bleeding event. AHA should be considered in all patients who present with profound and prolonged bleeding episodes devoid of immediately identifiable causes within the emergency setting. A high index of suspicion for this condition is critical because surgical intervention in the absence of appropriate hemostatic and immunosuppressive treatment can result in catastrophic consequences.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47167233","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}
Department of Neuroscience & The Carney Institute, Brown University, Providence, RI, USA; Department of Neurosurgery, Brown University Alpert Medical School & Rhode Island Hospital, Providence, RI, USA; The Warren Alpert Medical School of Brown University, Providence, RI, USA; Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA Contributions: (I) Conception and design: Both authors; (II) Administrative support: WF Asaad; (III) Provision of study materials or patients: WF Asaad; (IV) Collection and assembly of data: AR Kimata; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Anna R. Kimata. Department of Neuroscience, Brown University, Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA. Email: anna_kimata@brown.edu.
{"title":"Characterizing the burden of complications in traumatic brain injury: a retrospective study","authors":"Anna R. Kimata, Wael Asaad","doi":"10.21037/jeccm-21-53","DOIUrl":"https://doi.org/10.21037/jeccm-21-53","url":null,"abstract":"Department of Neuroscience & The Carney Institute, Brown University, Providence, RI, USA; Department of Neurosurgery, Brown University Alpert Medical School & Rhode Island Hospital, Providence, RI, USA; The Warren Alpert Medical School of Brown University, Providence, RI, USA; Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA Contributions: (I) Conception and design: Both authors; (II) Administrative support: WF Asaad; (III) Provision of study materials or patients: WF Asaad; (IV) Collection and assembly of data: AR Kimata; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Anna R. Kimata. Department of Neuroscience, Brown University, Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA. Email: anna_kimata@brown.edu.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41694116","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}
C. Browne, A. Mujitaba, R. Pilkington, G. Putnam, L. Barberis
: Jael Syndrome is defined as an intentional craniofacial stab injury. There are few cases in the medical literature describing such facial impalements with the presence of the instrument in the face. Such cases present a complex challenge, involving many specialities, and in particular requires cautious considerations in the immediate preoperative management and intubation of such patients. The use of High Flow Oxygen (HFO) has an increasingly popular role in anaesthetic and intensive care practices, with numerous studies supporting its efficacy in preoxygenation and increasing the safe apnoea time prior to intubation. We report the case of a 20 years old man who presented with facial impalement with a kitchen knife following an altercation. Imaging confirmed that the knife passed through the nasopharynx and was embedded in his right occipital condyle. He was transferred to theatre, where prior to the removal of the implement and haemostasis control, he was preoxygenated using (HFO) and his airway secured with video laryngoscopy. Post operatively, he was kept sedated and ventilation in the Intensive Care Unit (ICU) prior to being successfully extubated and transferred to the ward. He was subsequently discharged form hospital with only mild sensory loss secondary to the injury. This case highlights the technical difficulties associated with the preoxygenation and intubation in patients presenting with facial impalement, and in particular use of HFO in providing for an extended safe apnoea time prior to securing a difficult airway in the context of maxillofacial trauma.
{"title":"Use of high flow oxygen (HFO) for difficult airway management in Jael syndrome: a case report","authors":"C. Browne, A. Mujitaba, R. Pilkington, G. Putnam, L. Barberis","doi":"10.21037/JECCM-20-47","DOIUrl":"https://doi.org/10.21037/JECCM-20-47","url":null,"abstract":": Jael Syndrome is defined as an intentional craniofacial stab injury. There are few cases in the medical literature describing such facial impalements with the presence of the instrument in the face. Such cases present a complex challenge, involving many specialities, and in particular requires cautious considerations in the immediate preoperative management and intubation of such patients. The use of High Flow Oxygen (HFO) has an increasingly popular role in anaesthetic and intensive care practices, with numerous studies supporting its efficacy in preoxygenation and increasing the safe apnoea time prior to intubation. We report the case of a 20 years old man who presented with facial impalement with a kitchen knife following an altercation. Imaging confirmed that the knife passed through the nasopharynx and was embedded in his right occipital condyle. He was transferred to theatre, where prior to the removal of the implement and haemostasis control, he was preoxygenated using (HFO) and his airway secured with video laryngoscopy. Post operatively, he was kept sedated and ventilation in the Intensive Care Unit (ICU) prior to being successfully extubated and transferred to the ward. He was subsequently discharged form hospital with only mild sensory loss secondary to the injury. This case highlights the technical difficulties associated with the preoxygenation and intubation in patients presenting with facial impalement, and in particular use of HFO in providing for an extended safe apnoea time prior to securing a difficult airway in the context of maxillofacial trauma.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44115198","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}
{"title":"Trends of emergency department visits for gunshot victims in the United States","authors":"Ateequr Rahman, Monica Yanni, Lejla Cukovic, Liam Herrebout, Kirstin Krzyzewski, Yelena Sahakian","doi":"10.21037/jeccm-21-114","DOIUrl":"https://doi.org/10.21037/jeccm-21-114","url":null,"abstract":"","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41466138","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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