RESUMO
Foreign bodies in the heart are rare occurrences with a limited evidence base to guide recommendations on management. We report a case of multiple cardioembolic strokes as a result of a self-inflicted sewing needle puncture from the anterior chest through the right ventricle and interventricular septum with its tip in the left ventricle close to the subvalvular apparatus in a 39-year-old psychiatric patient. We discuss issues surrounding decision making and ongoing care and highlight the importance of further follow-up and reporting of cases to form a robust evidence base to guide future recommendations.
Assuntos
Embolia Aérea/complicações , Corpos Estranhos/complicações , Ventrículos do Coração/lesões , Transtornos Mentais/complicações , Comportamento Autodestrutivo/complicações , Septo Interventricular/lesões , Adulto , Ecocardiografia , Embolia Aérea/diagnóstico por imagem , Evolução Fatal , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Agulhas , Punções , Acidente Vascular Cerebral , Tomografia Computadorizada por Raios X , Septo Interventricular/diagnóstico por imagemAssuntos
Dióxido de Carbono/sangue , Ácido Láctico/sangue , Oxigênio/sangue , Choque Séptico/terapia , Feminino , Humanos , MasculinoRESUMO
INTRODUCTION: The aim of this study was to determine the Relative Risk (RR) ratios for common clinical correlates in adult patients with minor head injury in a cohort of patients in which loss of consciousness (LOC) and post-traumatic amnesia (PTA) were not the only entry criteria for CT scanning. METHODS: The computerised CT request notes were reviewed on all patients who underwent a CT head scan with a minor head injury over a 1-year period (January 2009-December 2009). The clinical signs and symptoms at presentation were extracted from the request notes and the RR ratios were calculated for five clinical correlates: LOC, PTA, vomiting, nausea and headache. RESULTS: 456 Glasgow coma scale (GCS) 15 patients underwent CT scanning during the period January 2009-December 2009. 55 of the 456 patients had positive CT findings (12%). 270 patients (59%) of the GCS 15 cohort had neither LOC nor PTA and of this subgroup 27 had positive scans. LOC was the only clinical correlate in which the RR reached statistical significance; RR 2.0930 (95% CI 1.25 to 3.50). However, vomiting accounted for four cases, headache for four cases and nausea for no cases. CONCLUSIONS: Using LOC or PTA as the principal entry criterion for CT scanning may result in a significant number of patients with traumatic intracranial injury being missed. Using a less stringent approach still achieved an acceptable CT abnormality rate.
