1/24. Myocardial contusion presented as acute myocardial infarction after chest trauma.A 46-year-old male patient developed an acute myocardial infarction and congestive heart failure following blunt chest trauma. Electrocardiogram (ECG) revealed acute anterior myocardial infarction. echocardiography showed akinesis of interventricular septum, dyskinesis in apical anterior wall, and severe impairment of left ventricular overall systolic function. coronary angiography revealed normal coronary arteries. The patient followed a low-intensity physical medicine rehabilitation program. Follow-up was without new complications or deterioration of congestive heart failure. Five months later the patient presented with fulminant acute pulmonary edema and cardiogenic shock. cardiopulmonary resuscitation was unsuccessful.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/24. Nonocclusive ischemic colitis in a 12-year-old girl: value of unenhanced spiral computed tomography.A 12-year-old girl was hit by a car and arrived in the emergency room in hemorrhagic shock. Contrast-enhanced computed tomography of the abdomen showed traumatic rupture of the liver and large amounts of intraperitoneal hemorrhage. Unenhanced computed tomography showed a hyperdense thickening of the wall of the descending colon. This finding was consistent with a nonocclusive ischemic colitis, which was confirmed some days later by endoscopy, at a time when the patient had already developed Gram-negative bacteremia. We discuss the pathogenesis of nonocclusive ischemic colitis, computed tomography findings, and the value of unenhanced computed tomography.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
3/24. Circumferential pelvic antishock sheeting: a temporary resuscitation aid.Acute traumatic pelvic ring instability causes severe pain and associated hemorrhage. Circumferential pelvic sheeting provides patient comfort and noninvasive, rapid, and temporary pelvic ring stability. A bed sheet is readily available, inexpensive, easily applied around the pelvis, and disposable.- - - - - - - - - - ranking = 4keywords = shock (Clic here for more details about this article) |
4/24. Sonographic intraperitoneal fluid in patients with pelvic fracture: two cases of traumatic intraperitoneal bladder rupture.Two patients who presented to the Emergency Department (ED) in shock with severe pelvic fractures were evaluated for intra-abdominal injury with a focused assessment with sonography in trauma (FAST) examination. Free intraperitoneal fluid was identified in the hepato-renal recess of both patients. At laparotomy both patients were found to have extensive uroperitoneum resulting from intraperitoneal bladder rupture and no other intra-abdominal injuries. The source of shock in both cases was ultimately determined to be arterial hemorrhage from pelvic vessels. The utility of FAST examinations in the setting of major pelvic injury is relatively unstudied. Coincident injuries make the evaluation for source of hemorrhage in this subset of patients challenging. This is a report of sonographic intraperitoneal fluid in the setting of major pelvic injury and hemodynamic instability found to be uroperitoneum and not hemoperitoneum.- - - - - - - - - - ranking = 2keywords = shock (Clic here for more details about this article) |
5/24. Multiple heart and pericardial lacerations due to blunt trauma from assault.A case of 80-year-old woman who died of hemorrhagic shock as a consequence of multiple heart and pericardial lacerations as well as myocardial contusion due to blunt trauma from assault is reported. At postmortem examination, fractures of the body of the sternum and bilateral ribs were detected. A laceration of the anterior left-sided pericardium, a 2.8-cm linear tear in the right venous sinus from the origin of the inferior to the origin of the superior vena cava, a 3-cm laceration between the venous sinus and the right auricle, and a 2-cm tear in the anterior wall of the left atrium, behind the aortic trunk, were visible. Multiple heart and pericardial lacerations were thought to be caused by compression of the heart between sternum and vertebrae, together with multiple rib fractures and extensive movements of the sternum toward the spine as a result of kicking.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
6/24. First military use of activated factor vii in an APC-III pelvic fracture.A male soldier in shock with an APC-III pelvic fracture was flown to an air Assault Surgical Group (AASG) of 16 Close Support Medical Regiment at Al Amarah in iraq. A pelvic external fixator was applied and his condition stabilized. Ultrasound scanning (FAST) showed an absent bladder, and a spreading retroperitoneal haematoma combined with intra-abdominal, free blood. Unfortunately he continued to bleed and required transfusion with the unit's entire stock of type-specific blood. At emergency laparotomy, uncontrollable pelvic bleeding was encountered and the abdominal aorta required clamping above the iliac bifurcation. Branches of the right internal iliac artery were the source and this was ligated. Some bleeding continued post-operatively: administration of activated factor vii was associated with a marked reduction in the oozing from his fixator pin-sites and an improvement in his pH from 7.1 to 7.3. In total, 25 units of blood were transfused, 8 of which were fresh whole blood donated by individual members of the AASG. The patient survived, returned to the UK, had his injuries reconstructed, and is currently undergoing rehabilitation. This case illustrates the benefits of forward resuscitation surgery in wartime and the need for a multidisciplinary approach to trauma care.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
7/24. Acute adrenal insufficiency: hemodynamic and echocardiographic characteristics.A patient with high output circulatory failure due to acute secondary adrenal insufficiency is described. The hemodynamic similarities and echocardiographic differences between volume expanded cortisol deficiency and septic shock are identified.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
8/24. An unusual case of early fulminant post-traumatic fat embolism syndrome.A multiple-injured patient developed a very early onset fulminant fat embolism syndrome that was partially masked by haemorrhagic shock. Despite early diagnosis by transoesophageal echocardiography and aggressive symptomatic treatment, there was a rapid evolution to death. Post mortem examination revealed the presence of both pulmonary and systemic fat emboli. This case highlights the ever present risk of masked fat embolism syndrome shortly after trauma.- - - - - - - - - - ranking = 103.12432526069keywords = haemorrhagic shock, shock (Clic here for more details about this article) |
9/24. Multiple organ dysfunction syndrome after multiple trauma.Multiple organ dysfunction syndrome (MODS) is a serious, often fatal, sequel to multiple trauma. Prolonged shock states, severe sepsis, acute pancreatitis, acute renal failure, severe burns, ischemic conditions, and acute respiratory distress syndrome have been implicated in the development of MODS. Despite advances in critical care therapies and infection control practices, severe sepsis remains a major health problem, with an estimated mortality rate of 30-50% (Ely, Kleinpell, & Goyett, 2003). The purposes of this article are to describe the pathophysiologic changes that lead to the development of MODS and discuss strategies to prevent the development of MODS and to treat MODS if it develops.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
10/24. Definitive management of acute cardiac tamponade secondary to blunt trauma.Blunt cardiac injuries are a leading cause of fatalities following motor-vehicle accidents. Injury to the heart is involved in 20% of road traffic deaths. Structural cardiac injuries (i.e. chamber rupture or perforation) carry a high mortality rate and patients rarely survive long enough to reach hospital. Chamber rupture is present at autopsy in 36-65% of death from blunt cardiac trauma, whereas in clinical series it is present in 0.3-0.9% of cases and is an uncommon clinical finding. patients with large ruptures or perforations usually die at the scene or in transit--the rupture of a cardiac cavity, coronary artery or intrapericardial portion of a major vein or artery is usually instantly fatal because of acute tamponade. The small, rare, remaining group of patients who survive to hospital presentation usually have tears in a cavity under low pressure and prompt diagnosis and surgery can now lead to a survival rate of 70-80% in experienced trauma centres. As regional trauma systems evolve, patients with severe, but potentially survivable cardiac injury are surviving to ED. Two distinct syndromes are apparent--haemorrhagic shock and cardiac tamponade. Any patient with severe chest trauma, hypotension disproportionate to estimated loss of blood or with an inadequate response to fluid administration should be suspected of having a cardiac cause of shock. For patients with severe hypotension or in extremis, the treatment of choice is resuscitative thoracotomy with pericardotomy. Closed chest cardiopulmonary resuscitation is ineffective in these circumstances. Blunt traumatic cardiac injury presenting with shock is associated with a poor prognosis. The majority of survivors of blunt or penetrating cardiac injury present to the ED/trauma centre with vital signs. The main pathophysiologic determinant for most survivors is acute pericardial tamponade. The presence of normal clinical signs or normal ECG studies does not exclude tamponade. In recent years the widespread availability and use of ultrasound for the initial assessment of severely injured patients has facilitated the early diagnosis of cardiac tamponade and associated cardiac injuries. Two cases of survival from blunt traumatic cardiac trauma are described in the present paper to demonstrate survivability in the context of rapid assessment and intervention.- - - - - - - - - - ranking = 105.12432526069keywords = haemorrhagic shock, shock (Clic here for more details about this article) |
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