ABSTRACT
BACKGROUND: The risk of cardiac injury in blunt thoracic trauma is quite rare, occurring in only 0.1% of patients. The least common cardiac injury is coronary artery dissection. Most cardiac injuries result from high-energy mechanisms such as motor vehicle collisions. Even low-mechanism injuries that have been reported involved rapid deceleration. CASE REPORT: We present a case of traumatic coronary artery dissection that resulted from a low-energy blunt thoracic injury with no rapid deceleration. This patient had no other associated thoracic injuries, such as rib fractures or sternal fracture. Following presentation, our patient twice deteriorated into ventricular fibrillation and was successfully resuscitated each time. The coronary lesion was successfully stented and the patient was eventually discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the importance of maintaining a high level of suspicion for coronary artery dissection even in low-energy mechanisms. An electrocardiogram should be obtained early, even in low-energy mechanisms. While patients with traumatic cardiac injuries will commonly present with other injuries, such as rib fractures, the absence of these injuries does not rule out cardiac injury.
ABSTRACT
Injuries from cactus spines can present challenges to Emergency Medicine providers. When the patient has mental limitations that prevent cooperation with removal, these challenges grow. Traditional removal techniques have several drawbacks including prolonged time for complete removal and incomplete removal. We present the case of a 22-year-old with a history of low-functioning autism and congenital motor dysfunction with a cactus spine injury to a large surface area of her chest, abdomen, and extremities. Conscious sedation utilizing intramuscular ketamine and Operating Room (OR) hair removal mitts were utilized to quickly and effectively remove the cactus spines. The patient had efficient, painless resolution of her injury without need for additional spine removal.
ABSTRACT
BACKGROUND AND OBJECTIVE: Managing respiratory failure (RF) secondary to acute decompensated heart failure (ADHF) with non-invasive positive-pressure ventilation (NIPPV) has been shown to significantly improve morbidity and mortality in patients presenting to the emergency department (ED). This subgroup analysis compares high-velocity nasal insufflation (HVNI), a form of high-flow nasal cannula, with NIPPV in the treatment of RF secondary to ADHF with respect to therapy failure, as indicated by the requirement for intubation or all-cause arm failure including subjective crossover to the alternate therapy. METHODS: The subgroup analysis is from a larger randomized control trial of adults presenting to the ED with RF requiring NIPPV support. Patients were randomly selected to therapy, and subgroup selection was established a priori in the original study as a discharge diagnosis. The primary outcome was therapy failure at 72â¯h after enrolment. RESULTS: Subgroup analysis included a total of 22 HVNI and 20 NIPPV patients which fit discharge diagnosis ADHF. Baseline patient characteristics were not statistically significant. Primary outcomes were not statistically significant: intubation rate (pâ¯=â¯1.000), therapy success (pâ¯=â¯1.000). Repeated measures (vitals, dyspnea, blood gases) showed comparable differences over initial 4â¯h. Physicians scored HVNI superior on patient comfort/tolerance (pâ¯<â¯0.001), ease of use (pâ¯=â¯0.004), and monitoring (pâ¯=â¯0.036). Limitations were technical inability to blind the clinician team and lack of power of the subgroup analysis. CONCLUSION: In conclusion, this subgroup analysis suggests HVNI may be non-inferior to NIPPV in patients with respiratory failure secondary to ADHF that do not need emergent intubation.