1/535. Ultrasound detection of ventricular fibrillation disguised as asystole.ultrasonography in the emergency department is being used for many purposes, including the evaluation of patients with cardiac arrest. Ultrasound testing has been shown to be useful in such patients in determining the presence of true electromechanical dissociation and pericardial effusions. We report a case of ventricular fibrillation identified by ultrasonography that appeared as asystole on ECG monitoring. Recognition of this ultrasound application can aid in the prompt diagnosis of occult ventricular fibrillation and allow for proper treatment with defibrillation.- - - - - - - - - - ranking = 1keywords = cardiac (Clic here for more details about this article) |
2/535. Emergency cardiopulmonary bypass for cardiac arrest refractory to pediatric advanced life support.We report the application of emergent cardiopulmonary bypass (CPB) for three pediatric patients in the cardiac catheterization laboratory with cardiac arrest who did not respond to conventional resuscitation efforts. All three patients had return of baseline prearrest rhythms within minutes of the initiation of artificial cardiopulmonary support and the return of spontaneous circulation upon weaning CPB. Two patients had normal neurologic outcomes despite an interval of over 30 minutes from arrest to CPB. The continued judicious application and study of this technology in a small subpopulation of pediatric cardiac arrest patients is warranted.- - - - - - - - - - ranking = 7keywords = cardiac (Clic here for more details about this article) |
3/535. Pericardial drainage prior to operation contributes to surgical repair of traumatic cardiac injury.We report on two cases of successful surgical repair of cardiac injury: one involving a left ventricular stab injury and the other a blunt rupture of the right atrium. Each patient underwent emergency surgical repair, the former via left anterolateral thoracotomy and the latter via median sternotomy, following pericardial drainage tube insertion from the subxiphoid area. The operative approach was chosen according to the color of drained blood, i.e., arterial bleeding indicated left anterolateral thoracotomy, while venous bleeding indicated median sternotomy. We conclude that pericardial drainage via the subxiphoid approach prior to induction of anesthesia is an easy and useful technique to perform, not only to release cardiac tamponade but to determine the operative approach in patients suffering from cardiac tamponade following cardiac injury.- - - - - - - - - - ranking = 27.854833490907keywords = rupture, injury, cardiac (Clic here for more details about this article) |
4/535. Transient peroneal nerve palsies from injuries placed in traction splints.Two patients thought to have distal femur fractures presented to the emergency department (ED) of a level 1 trauma center with traction splints applied to their lower extremities. Both patients had varying degrees of peroneal nerve palsies. Neither patient sustained a fracture, but both had a lateral collateral ligament injury and one an associated anterior cruciate ligament tear. One patient had a sensory and motor block, while the other had loss of sensation on the dorsum of his foot. After removal of the traction splint both regained peroneal nerve function within 6 hours. Although assessment of ligamentous knee injuries are not a priority in the trauma setting, clinicians should be aware of this possible complication in a patient with a lateral soft tissue injury to the knee who is placed in a traction splint that is not indicated for immobilization of this type of injury.- - - - - - - - - - ranking = 3.3785098269269keywords = injury (Clic here for more details about this article) |
5/535. Small ruptured abdominal aneurysm diagnosed by emergency physician ultrasound.Ruptured abdominal aortic aneurysms currently have a high rate of both mortality and misdiagnosis. Aneurysms smaller than 4 cm are not commonly considered for surgical repair. This report describes the case of a ruptured abdominal aneurysm measuring less than 4 cm diagnosed by the emergency physician utilizing bedside ultrasound. Within 30 minutes of arrival at the emergency department the patient's abdominal pain resolved spontaneously after defecation. If the bedside ultrasound had not been performed it is possible the patient would have been discharged from the hospital without surgical intervention. Bedside ultrasound by emergency physicians may improve the diagnosis of ruptured aortic aneurysms, particularly if the presentation is atypical.- - - - - - - - - - ranking = 71.829863368462keywords = rupture (Clic here for more details about this article) |
6/535. hypothyroidism presenting as acute cardiac tamponade with viral pericarditis.This report describes the case of a young woman who presented to an emergency department with severe abdominal pain and shock. The patient was found to have pericardial tamponade due to a massive pericardial effusion. On further evaluation, the etiology of this effusion was considered to be secondary to hypothyroidism with concominant acute viral pericarditis leading to a fulminant tamponade. The presentation, differential diagnosis, and management of pericardial effusion and tamponade secondary to hypothyroidism and viral pericarditis are discussed. The diagnosis of hypothyroidism in conjunction with acute viral pericarditis should be considered in patients presenting with unexplained pericardial effusion and tamponade.- - - - - - - - - - ranking = 4keywords = cardiac (Clic here for more details about this article) |
7/535. The electrocardiographic diagnosis of acute myocardial infarction in patients with ventricular paced rhythms.The electrocardiographic diagnosis of ischemic heart disease is more difficult in the setting of ventricular-paced rhythms (VPR). ST segment/T wave configurations are changed by the altered intraventricular conduction associated with ventricular pacing. The anticipated, or expected, morphology in patients with VPR is one of QRS complex-ST segment/T wave discordance. An awareness of the anticipated ST segment morphologies of VPR is mandatory for the emergency physician. This knowledge is not dependent on additional diagnostic testing, medical records, or expertise in pacemaker function. Two cases are presented in which an analysis of the electrocardiogram in the setting of VPR assisted the treating physicians in establishing the correct diagnosis of acute myocardial infarction and arranging for urgent revascularization.- - - - - - - - - - ranking = 0.43034931567547keywords = heart (Clic here for more details about this article) |
8/535. Intraoperative echocardiography in cardiac emergencies.echocardiography has brought about a new modality of surgical decision making in open heart surgery. Especially in urgent and emergency surgery, echocardiography can provide decisive insight into the underlying pathophysiological processes, improved monitoring of cardiac function, as well as immediate quality control after the procedure. The importance of intraoperative echocardiography for the cardiac surgeon is illustrated in a number of selected case reports.- - - - - - - - - - ranking = 6.4303493156755keywords = cardiac, heart (Clic here for more details about this article) |
9/535. The portable Doppler: practical applications in EMS care.The practical application of a new, commercially available, portable Doppler ultrasound device to the operation of a busy city-county emergency department and ambulance service was investigated. An initial evaluation using healthy volunteers confirmed accuracy and reproducibility of the Doppler blood pressure readings comparable to that of auscultatory and palpatory measurement. In selected patients, the Doppler readings correlated well with readings from patients who had intra-arterial lines. When used in several low flow states, such as testing adequacy of cardiopulmonary resuscitation (CPR) and verification of electromechanical dissociation, the Doppler aided the clinical evaluation and treatment in many cases where traditional methods were useless. The Doppler was also helpful in the evaluation of local arterial injury but this unit was not found sensitive enough for venous disease. Finally, the Doppler enhanced the obtaining of vital signs in the noisy environment of our ambulances.- - - - - - - - - - ranking = 1.126169942309keywords = injury (Clic here for more details about this article) |
10/535. Spontaneous bladder rupture: rare cause of peritonitis.Spontaneous rupture of the urinary bladder is an uncommon, but important, cause of generalized peritonitis. It is a surgical emergency which may be rapidly fatal if diagnosis and treatment are delayed. Bladder disease or obstruction, coupled with a sudden increase in intra-abdominal pressure usually accounts for the rupture. Characteristic symptoms are acute lower abdominal pain followed by generalized peritonitis. In most cases, the rupture is intra-peritoneal.- - - - - - - - - - ranking = 83.801507263206keywords = rupture (Clic here for more details about this article) |
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