Cases reported "shock, traumatic"

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1/40. A case of traumatic shock complicated by methamphetamine intoxication.

    A case of a 38-year-old male with traumatic shock complicated by methamphetamine intoxication is presented. The patient was involved in an assault which resulted in cardiac tamponade and right ventricular outflow laceration. pericardiocentesis was immediately performed. However, profound metabolic acidosis greatly in excess of that expected from the short duration of the shock was revealed by arterial blood gas analysis. Another cause of the metabolic acidosis was suspected. The patient subsequently admitted to intravenous use of methamphetamine. Following hemodynamic and metabolic stabilization by continuous pericardial drainage and intravenous administration of sodium bicarbonate, the patient underwent cardiac surgery. His postoperative course was uneventful. There is a substantial association between methamphetamine users and traumatic accidents. In such cases, early identification of drug use is important. Marked metabolic acidosis, which conflicts with the diagnosed cause of shock, may be a clinical clue to methamphetamine intoxication. ( info)

2/40. Differential diagnosis and management of an infant presenting in shock with a history of sickle cell anemia and a recent fall.

    The presentation of shock in an infant can be subtle, yet must be recognized and treated very quickly to prevent decompensation and cardiopulmonary arrest. Treatment must begin as soon as shock is noted and before or along with the evaluation to establish the etiology of the shock. This case report illustrates these principles by describing an infant with sickle cell anemia who presented to the emergency department in shock after sustaining a fall. ( info)

3/40. Traumatic cardiogenic shock due to massive air embolism. A possible role for cardiopulmonary bypass.

    Systemic arterial embolism is a potentially lethal complication of bronchopulmonary venous fistula in trauma patients with blunt chest trauma or isolated penetrating lung injury on positive pressure ventilation. A high index of suspicion, early diagnosis and management in specialized centres are keys to a successful outcome. ( info)

4/40. Shocking abdominal trauma: review of an uncommon disorder of small intestine perfusion.

    'shock bowel' is a rare disorder of gastrointestinal physiology with characteristic radiological features. It usually occurs in the setting of blunt abdominal trauma and hypovolaemia, with complete reversibility of these findings following resuscitation. We present a case demonstrating the classic features of this complex of imaging findings thought to be caused by end-organ hypoperfusion. ( info)

5/40. Black kidney sign: a new computed tomographic finding associated with the hypoperfusion complex in children.

    The authors describe a new CT finding associated with the hypoperfusion complex in children: complete lack of enhancement of both kidneys without renal swelling, without subcapsular cortical rim enhancement, and without peripheral wedge-shaped areas of hypoattenuation. This "black kidney sign" was found in two severely injured children who died within a few hours after the CT examination. It may help to establish a diagnosis of severe hemodynamic instability and may be a negative prognostic factor. ( info)

6/40. 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. ( info)

7/40. Acute adrenal insufficiency presenting as shock after trauma and surgery: three cases and review of the literature.

    Profound nonhemorrhagic shock developed in one postoperative and two trauma patients. Cardiovascular collapse was characterized by severe hypotension (systolic blood pressure less than 80 mm Hg), hyperdynamic cardiac indices (CI greater than 4 L/min/m2), low systemic vascular resistance (SVR less than 500 dyne.sec/cm5.m2), and multiple organ failure. sepsis was not found by culturing of specimens or visual inspection at laparotomy. Screening cortisol levels were low (less than 2 micrograms/dL in two patients) and did not respond appropriately to synthetic ACTH (cosyntropin) challenge. Administration of exogenous glucocorticoids promptly and dramatically reversed shock and organ failure in two patients. Oral glucocorticoid and mineralocorticoid supplementation were required at hospital discharge. Acute adrenal insufficiency is rare after trauma, but may produce life-threatening cardiovascular collapse, mimicking the "septic" shock state. cosyntropin stimulation testing confirms the diagnosis and is accurate in traumatized patients. Outcome is dependent upon early recognition and exogenous glucocorticoid administration. Appropriate endocrine evaluation prevents unnecessary use of steroids in a population of trauma patients who are already in a state of immunosuppression. ( info)

8/40. forecasting of the course and outcome of shock in severe mechanical traumas.

    The ability to forecast the course and outcome of severe mechanical trauma would aid clinicians in making decisions concerning the treatment of patients. Multifactorial regression models, developed from data obtained from 933 patients with polytrauma and shock, have a high predictive value. A two-part data sheet was developed to give a rating system that predicts the duration of shock in patients that survive and the life span in patients that eventually die. Factors considered in developing the rating system include systemic hemodynamics, hematocrit number, blood density, arteriovenous difference in oxygen saturation, and rectocutaneous temperature gradient, among others. ( info)

9/40. Inadequate bicarbonate resuscitation in trauma patients requiring crossclamping of the aorta.

    The use of bicarbonate in the management of metabolic acidosis is controversial. We present three patients who required crossclamping of the aorta for control of shock and whose metabolic acidosis was inadequately treated with bicarbonate. Within minutes of aortic declamping, all became hypotensive and two went into refractory ventricular fibrillation and died. Arguments supporting the role of adequate bicarbonate resuscitation in this setting are discussed. ( info)

10/40. Postpartum shock and uterine inversion.

    A 21-year-old woman, para 1 0, developed profound postpartum shock secondary to acute inversion of the uterus. Fundal re-inversion was achieved by prompt manual replacement of the uterus from below. An aggressive approach to uterine inversion is the keystone of success. ( info)
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