1/4. Prehospital rounds. Beyond SVT.This patient had a complex presentation, with many potential causes for his shock status. He was obviously in shock, with many signs of poor perfusion. He presented with very rapid heart and respiratory rates, and poor skin perfusion and oxygenation. The clinical presentation of the patient prompted the EMS crew to consider electrical cardioversion in hopes of addressing the unstable tachycardic rate. However, the crew opted to consider the patient's past medical history--i.e., the diarrhea, vomiting and lack of fluid intake--and instead treat the patient for hypovolemia. The picture had not improved by arrival at the ED, and had not been corrected with a fluid bolus.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/4. hypovolemia-induced reversible severe mitral regurgitation due to left ventricular outflow tract obstruction.We describe a hypertensive patient who developed profound cardiogenic shock after treatment with nitrates and diuretics. echocardiography revealed a marked left ventricular outflow tract obstruction with severe mitral regurgitation that were reversible after aggressive fluid therapy.- - - - - - - - - - ranking = 0.5keywords = shock (Clic here for more details about this article) |
3/4. Ruptured heterotopic pregnancy presenting with relative bradycardia in a woman not receiving reproductive assistance.We report a case of heterotopic pregnancy in a woman who had not undergone in vitro fertilization or any other reproductive assistance. The patient failed to mount a tachycardic response to hemorrhagic shock. bradycardia is a well-established phenomenon in the setting of hemoperitoneum and particularly with ruptured ectopic pregnancy. This is a case of heterotopic pregnancy with relative bradycardia in a woman without predisposing factors for heterotopic pregnancy. We make suggestions on avoiding common pitfalls in the emergency department diagnosis of heterotopic pregnancy. We also address the similar clinical presentations of heterotopic pregnancy and intrauterine pregnancy with ruptured corpus luteum cyst.- - - - - - - - - - ranking = 0.5keywords = shock (Clic here for more details about this article) |
4/4. Vasopressin in hemorrhagic shock.We describe the treatment of two patients with hemorrhagic shock unresponsive to volume replacement and catecholamines. Both patients responded to a small-dose infusion of vasopressin, which allowed tapering off of the catecholamines. The possible role of small-dose infusions of vasopressin in fluid- and catecholamine-resistant hemorrhagic shock is discussed.- - - - - - - - - - ranking = 3keywords = shock (Clic here for more details about this article) |