1/2. Acute fatal haemorrhage during percutaneous dilatational tracheostomy.Percutaneous dilatational tracheostomy (PDT) is associated with a number of life-threatening complications. We present a case of massive and fatal arterial haemorrhage that occurred in the intensive care unit during an elective PDT on an 86-year-old woman following earlier evacuation of a traumatic subdural haematoma. An avulsed right subclavian artery was found at post mortem. Previous thyroid surgery and aberrant arterial anatomy contributed to the fatal outcome.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
2/2. Intracerebral haematoma masquerading as ventricular standstill.An 82 year old man was referred to the emergency room by his general practitioner for a right frontoparietal headache. The preceding day he had tripped and fallen, hitting the back of his head on the floor. Computed tomography showed a cortical contre coup haematoma. In view of ventricular standstill noted on ECG, a temporary pacing wire was inserted and a dual chamber permanent pacemaker was subsequently implanted. Intracerebral bleeding was treated conservatively and the patient made a good recovery. All patients admitted with head injury and sinus bradycardia or sinus arrest should be nursed at 15 degrees to 30 degrees with instructions to avoid the head up and supine positions. Furthermore, brain CT should be promptly recorded to assess for intracerebral haematoma and raised intracranial pressure and, if they are confirmed, these patients with cardiovascular compromise should benefit from close collaboration between neurosurgeon and cardiologist. Urgent pacing should be considered for all patients with head injury who experience symptomatic bradycardia or ventricular standstill.- - - - - - - - - - ranking = 6keywords = haematoma (Clic here for more details about this article) |