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1.
Acta Med Okayama ; 75(4): 517-521, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34511620

RESUMO

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically mediated cardiomyopathy charac-terized by progressive myocardial loss of the right ventricle and its replacement by fibrofatty tissue, causing dyskinesia, aneurysm, and/or arrhythmia. The prevalence of ARVC is estimated to be 1 in 2,000-5,000, with the condition accounting for up to 20% of sudden cardiac deaths in individuals < 35 years old. This report describes the case of 61-year-old Japanese who was diagnosed with ARVC after cardiac arrest (CA) and successful resusci-tation. After the sudden CA, the restoration of spontaneous circulation was achieved with appropriate resusci-tation, followed by the introduction of target temperature management in the intensive care unit. He was diag-nosed with ARVC based on angiography and histology results. An ICD (implantable cardioverter-defibrillator) was implanted, and he was discharged without neurological sequelae 1 month post-CA. ARVC is an important cause of sudden CA, and successfully resuscitated patients with right ventricular dilation should undergo testing to rule out ARVC.

2.
Acute Med Surg ; 8(1): e641, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33791103

RESUMO

Trauma is a primary cause of death globally, with non-compressible torso hemorrhage constituting an important part of "potentially survivable trauma death." Resuscitative endovascular balloon occlusion of the aorta has become a popular alternative to aortic cross-clamping under emergent thoracotomy for non-compressible torso hemorrhage in recent years, however, it alone does not improve the survival rate of patients with severe shock or traumatic cardiac arrest from non-compressible torso hemorrhage. Development of novel advanced maneuvers is essential to improve these patients' survival, and research on promising methods such as selective aortic arch perfusion and emergency preservation and resuscitation is ongoing. This review aimed to provide physicians in charge of severe trauma cases with a broad understanding of these novel therapeutic approaches to manage patients with severe hemorrhagic trauma, which may allow them to develop lifesaving strategies for exsanguinating trauma patients. Although there are still hurdles to overcome before their clinical application, promising research on these novel strategies is in progress, and ongoing development of synthetic red blood cells and techniques that reduce ischemia-reperfusion injury may further maximize their effects. Both continuous proof-of-concept studies and translational clinical evaluations are necessary to clinically apply these hemostasis approaches to trauma patients.

3.
Acute Med Surg ; 8(1): e720, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34992786

RESUMO

Background: With the introduction of electronic cigarettes, reports of nicotine intoxication due to ingestion of large amounts of liquid nicotine have increased. This report presents a rare case of cardiac arrest due to nicotine intoxication that was successfully treated with appropriate respiratory and circulatory support. Case Presentation: A 55-year-old man ingested 600 mg of liquid nicotine and developed sinus bradycardia followed by asystole. Appropriate and prompt resuscitation led to the return of spontaneous circulation. He was admitted to the intensive care unit and discharged 24 days later without any medical sequelae of nicotine intoxication. Conclusion: Ingestion of a large amount of liquid nicotine, as in this case, can result in lethal bradycardia followed by cardiac arrest. Prompt basic life support by paramedic produced good neurological outcomes. Emergency physicians should be aware of the symptoms and appropriate treatment of severe nicotine intoxication.

4.
Int J Surg Case Rep ; 77: 321-324, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33197777

RESUMO

INTRODUCTION: Blunt neck trauma patients can suffer from an airway emergency and are necessary to careful observation. PRESENTATION OF CASE: A 79-year-old man under anticoagulation therapy presented to our hospital three hours after a fall. Shortly after arrival, he developed dyspnea. Oral intubation was attempted, but with no success; therefore, an emergency tracheotomy was performed. Contrast-enhanced computed tomography (CT) and subsequent angiography revealed active bleeding from a branch of the right ascending cervical artery. Subsequently, the right thyrocervical trunk, which is upstream from the ascending cervical artery, was embolized and hemostasis was achieved. He was discharged 52 days after the emergency admission. DISCUSSION: This is the first case report of an ascending cervical artery injury due to blunt trauma that resulted in an airway emergency. Contrast-enhanced CT and cervical angiography are useful for confirming the area of injury and size of the hematoma. Half of patients with respiratory distress accompanied by a cervical spine injury require definitive airway management within five hours of the injury and all by 24 h. Neck trauma can lead to fatal airway obstruction and careful monitoring is warranted to detect any signs of impeding respiratory obstruction. CONCLUSION: All emergency physicians need to keep their airway management skills updated in order to perform reliably and rapidly in difficult and urgent situations.

5.
Int J Surg Case Rep ; 70: 205-208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32417739

RESUMO

INTRODUCTION: Liver injury is the most vulnerable to blunt abdominal trauma. Diagnostic evaluation and treatment of blunt liver trauma in children have changed essentially over the last decades. PRESENTATION OF CASE: A 3-year-old girl, weighing 10 kg was run over by a car and admitted to our hospital. Due to the liver injury and increased intra-abdominal hemorrhage confirmed by computed tomography, emergent transcatheter arterial embolization (TAE) was performed. Hemostasis was successfully obtained without complications. The patient had a good postoperative course and was discharged on the 9th day after admission. DISCUSSION: To the best of our knowledge, this case is the youngest and lowest weight emergency TAE success cases of childhood liver injury. TAE is an alternative to laparotomy and a useful procedure to accomplish nonsurgical management in adult who are hemodynamically stable and have no other associated injury requiring laparotomy. On the other hand, TAE is considered to have some complications in child cases because of the small diameter of the artery and the tendency to spasm. Our case showed that TAE can be a safe option for emergency hemostasis in pediatric trauma cases weighing 10 kg. CONCLUSION: Emergency physicians must be aware that radiological intervention is an important adjunct to management of childhood liver injury.

6.
Case Rep Emerg Med ; 2019: 4383086, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31316840

RESUMO

Orbital emphysema occurs when air enters the soft tissue surrounding the orbit. Although orbital blowout fractures are often caused by face trauma, nontraumatic orbital fractures can also occur but have been rarely described. Here, a case of orbital and palpebral emphysema caused by forceful nose-blowing is presented. Examination uncovered gross swelling of the right eye and discernable subcutaneous emphysema. The patient had normal eye movement and visual acuity. Orbital computed tomography (CT) revealed orbital emphysema secondary to an orbit floor fracture into the maxillary sinus, resulting from high intranasal pressure upon blowing her nose. The patient received conservative management with antibiotics and was given instructions not to sneeze or blow her nose. She fully recovered and all her symptoms completely resolved.

8.
Acta Med Okayama ; 73(2): 101-107, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31015744

RESUMO

Sedatives are administered during extracorporeal membrane oxygenation (ECMO) therapy to ensure patient safety, reduce the metabolic rate and correct the oxygen supply-demand balance. However, the concentrations of sedatives can be decreased due to absorption into the circuit. This study examined factors affecting the absorption of a commonly used sedative, midazolam (MDZ). Using multiple ex vivo simulation models, three factors that may influence MDZ levels in the ECMO circuit were examined: polyvinyl chloride (PVC) tubing in the circuit, use of a membrane oxygenator in the circuit, and heparin coating of the circuit. We also assessed changes in drug concentration when MDZ was re-injected in a circuit. The MDZ level decreased to approximately 60% of the initial concentration in simulated circuits within the first 30 minutes. The strongest factor in this phenomenon was contact with the PVC tubing. Membrane oxygenator use tended to increase MDZ loss, whereas heparin circuit coating had no influence on MDZ absorption. Similar results were obtained when a second dose of MDZ was injected to the second-use circuits.


Assuntos
Oxigenação por Membrana Extracorpórea/instrumentação , Hipnóticos e Sedativos/farmacocinética , Midazolam/farmacocinética , Humanos , Cloreto de Polivinila
9.
Acta Med Okayama ; 72(3): 297-300, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29926008

RESUMO

A healthy 10-year-old boy vomited during sleep and later complained of abdominal pain; he became drowsy and uncommunicative. At the nearby hospital E.R., he deteriorated rapidly, and his respiratory movements were absent with cardiac arrest. He was immediately resuscitated. Brain MRI showed no abnormalities. EEG revealed an abnormal pattern with recurrent multifocal epileptiform activity over the bilateral occipital and frontal regions during sleep. Based on the clinical/radiological findings we diagnosed Panayiotopoulos syndrome (PS), a benign form of early-onset pediatric epilepsy characterized by autonomic symptoms. Lifethreating cardiopulmonary arrest is rare in PS, but long seizure duration of PS may associate with apnea and bradycardia.


Assuntos
Parada Cardíaca/etiologia , Epilepsia Mioclônica Juvenil/complicações , Estado Epiléptico/complicações , Criança , Eletroencefalografia , Humanos , Masculino , Vômito/etiologia
10.
Acta Med Okayama ; 72(2): 181-183, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29674767

RESUMO

The primary toxicity of hydrogen peroxide results from its interaction with catalase, which liberates water and oxygen. We report the case of a 14-year-old Japanese girl with portal venous gas that was caused by oxygen liberated from intentionally ingested hydrogen peroxide. Although she had a past history of atrial septal defect, recovery without cardiac or neurological sequelae was achieved using hyperbaric oxygen therapy. Emergency physicians must be aware of the danger of liberated oxygen due to hydrogen peroxide ingestion.


Assuntos
Gasometria , Peróxido de Hidrogênio/envenenamento , Oxigenação Hiperbárica , Veia Porta , Adolescente , Feminino , Humanos , Envenenamento/terapia
11.
Undersea Hyperb Med ; 45(6): 701-703, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31158940

RESUMO

Emphysematous cystitis is an uncommon acute infection of the underlying bladder musculature and mucosa, caused by gas-producing organisms. Here we describe an 87-year-old woman with diabetes mellitus and emphysematous cystitis who was successfully treated with hyperbaric oxygen (HBO2) therapy. Her predisposition of diabetes and infection with gas-producing bacteria was considered to precede the development of emphysematous cystitis. Computed tomography revealed gas accumulation in the bladder wall and lumen. Antibiotics and HBO2 therapy were administered. HBO2 therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease. HBO2 is a useful adjunct therapy for the management of severe emphysematous cystitis.


Assuntos
Cistite/terapia , Enfisema/terapia , Oxigenação Hiperbárica/métodos , Idoso de 80 Anos ou mais , Cistite/diagnóstico por imagem , Diabetes Mellitus Tipo 2/complicações , Enfisema/diagnóstico por imagem , Feminino , Humanos , Tomografia Computadorizada por Raios X , Bexiga Urinária/diagnóstico por imagem
12.
Acta Med Okayama ; 71(6): 467-473, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29276219

RESUMO

Early mobilization is advocated to prevent intensive care unit-acquired physical weakness, but the patient's workload and its changes in response to body position changes have not been established. We used indirect calorimetry to determine the energy expenditure (EE) in response to body position changes, and we assessed EE's correlation with respiratory parameters in healthy volunteers: 8 males and 8 females, mean age 23.4±1.3 years. The subjects started in the resting supine position followed by a 30° head-up position, a 60° head-up position, an upright sitting position, a standing position, and the resting supine position. EE was determined in real time by indirect calorimetry monitoring the subject's respiratory rate, tidal volume (VT), and minute volume (MV). The highest values were observed immediately after the subjects transitioned from standing to supine, and this was significantly higher compared to the original supine position (1,450±285 vs. 2,004±519 kcal/day, p<0.01). Moderate correlations were observed between VT and EE (r=0.609, p<0.001) and between MV and EE (r=0.576, p<0.001). Increasing VT or MV indicates an increasing patient workload during mobilization. Monitoring these parameters may contribute to safe rehabilitation. Further studies should assess EE in critically ill patients.


Assuntos
Calorimetria Indireta/métodos , Metabolismo Energético , Postura , Adulto , Feminino , Humanos , Masculino , Respiração
13.
Acute Med Surg ; 4(1): 38-45, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-29123834

RESUMO

Aim: Gastrointestinal dysmotility frequently occurs during sepsis and multiple organ failure, remaining a major cause of morbidity and mortality in critically ill patients. Previous studies have shown that hydrogen, a new therapeutic gas, can improve various organ damage associated with sepsis. In this study, we investigated the protective efficacies of inhaled hydrogen against lipopolysaccharide (LPS)-induced ileus. Methods: Sepsis was induced in rats and mice by a single i.p. injection of LPS at 15 mg/kg for mice and 5 mg/kg for rats. Four groups of rats and mice including sham/air, sham/hydrogen, LPS/air, and LPS/hydrogen were analyzed. Hydrogen (1.3%) was inhaled for 25 h beginning at 1 h prior to LPS treatment. Gastrointestinal transit was quantified and cytokine levels, as well as neutrophil extravasation, in the intestinal muscularis propria were determined. Results: Lipopolysaccharide challenge remarkably delayed gastrointestinal transit of non-absorbable dextran, associated with increased leukocyte recruitment and upregulation of pro-inflammatory cytokine mRNA expressions in the muscularis propria. Hydrogen significantly prevented LPS-induced bowel dysmotility and reduced leukocyte extravasation, as well as inhibition of inflammatory cytokine expression. In vitro analysis of cytokine levels after LPS treatment of cultured macrophages showed an increase of interleukin-10 by hydrogen regardless of the presence of nitric oxide. Conclusions: This study showed the protective effects of hydrogen inhalation on LPS-induced septic ileus through inhibition of inflammation in the muscularis propria. These inhibitory effects on the pro-inflammatory response may be partially derived from anti-inflammatory cytokine interleukin-10 induction.

14.
Acute Med Surg ; 4(4): 394-400, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-29123899

RESUMO

Aim: Venous thromboembolism (VTE) can be a life-threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D-dimer for screening for VTE in major trauma cases among the Japanese population. Methods: We examined a single-center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D-dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D-dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE. Results: The study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D-dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704-0.866; P < 0.001). The cut-off that maximized the Youden index was 12.45 µg/mL. Conclusions: At least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D-dimer levels on day 10 can be a useful predictor of VTE.

15.
Acta Med Okayama ; 71(5): 363-368, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29042693

RESUMO

Worldwide, hemorrhagic shock in major trauma remains a major potentially preventable cause of death. Controlling bleeding and subsequent coagulopathy is a big challenge. Immediate assessment of unidentified bleeding sources is essential in blunt trauma patients with hemorrhagic shock. Chest/pelvic X-ray in conjunction with ultrasonography have been established classically as initial diagnostic imaging modalities to identify the major sources of internal bleeding including intra-thoracic, intra-abdominal, or retroperitoneal hemorrhage related to pelvic fracture. Massive soft tissue injury, regardless of whether isolated or associated with multiple injuries, occasionally causes extensive hemorrhage and acute traumatic coagulopathy. Specific types of injuries, including soft tissue injury or retroperitoneal hemorrhage unrelated to pelvic fracture, can potentially be overlooked or be considered "occult" causes of bleeding because classical diagnostic imaging often cannot exclude such injuries. The purpose of this narrative review article is to describe "occult" or unusual sources of bleeding associated with blunt trauma.


Assuntos
Hemorragia/etiologia , Ferimentos não Penetrantes/complicações , Fraturas Ósseas/complicações , Humanos , Lesões dos Tecidos Moles/complicações
16.
J Clin Diagn Res ; 11(4): OD01-OD02, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28571191

RESUMO

Thallium was once commonly used as a household rodent or ant killer, but many countries have banned such use due to unintentional or criminal poisonings of humans. A common initial clinical manifestation of thallium poisoning is gastrointestinal symptoms followed by delayed onset of neurological symptoms and alopecia. These clinical characteristics can provide important diagnostic clues regarding thallium poisoning. Here, we report a 23-year-old woman who was poisoned by a business colleague when she unknowingly drank tea containing the toxic substance several times. The patient was treated with multi-dose activated charcoal with airway protection and Prussian blue.

17.
Int J Surg Case Rep ; 36: 42-45, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28531868

RESUMO

INTRODUCTION: Traumatic cardiopulmonary arrest has a very high mortality, and survival of patients with this condition without neurological disability is rare. PRESENTATION OF CASE: We herein report a case of traumatic cardiopulmonary arrest secondary to accidental amputation of the left lower leg that was successfully treated without any higher brain dysfunction. Although the long duration of cardiopulmonary arrest in this patient suggested hypoxic ischemic encephalopathy, amplitude-integrated electroencephalogram showed normal findings. DISCUSSION: This system may help intensivists evaluate the neurological conditions of patients with suspected hypoxic ischemic encephalopathy in the early stage of the clinical course and may assist in guiding therapeutic interventions. CONCLUSION: Our case supports the usefulness of neurological monitoring using amplitude-integrated electroencephalogram.

18.
Ann Clin Microbiol Antimicrob ; 16(1): 22, 2017 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-28376885

RESUMO

BACKGROUND: Polyethylene glycol (PEG) is widely used for bowel cleaning in preparation for colonoscopy because of its safety. Septic shock after PEG preparation is an extremely rare complication. Herein, we describe a case of septic shock that occurred immediately after colonoscopy preparation with PEG. CASE PRESENTATION: A 75-year-old Japanese male who had previously developed diabetes after total pancreatectomy received PEG in preparation for colonoscopy. He had been admitted to the emergency intensive care unit 4 days earlier due to hematochezia presenting with shock. He ingested PEG to prepare for a colonoscopy examination, which was performed to identify the source of his bleeding over a 5-h period, but suddenly exhibited septic shock and markedly elevated procalcitonin levels. A blood culture subsequently revealed Citrobacter braakii. Immediate resuscitation and intensive care with appropriate antibiotics improved his condition. CONCLUSIONS: Clinicians should be aware of the possibility of deteriorating conditions after bowel preparation with PEG among severely ill patients with recent episodes of hemorrhagic shock.


Assuntos
Citrobacter/isolamento & purificação , Infecções por Enterobacteriaceae/induzido quimicamente , Infecções por Enterobacteriaceae/complicações , Polietilenoglicóis/efeitos adversos , Choque Séptico/etiologia , Choque Séptico/patologia , Idoso , Sangue/microbiologia , Estado Terminal , Humanos , Masculino , Polietilenoglicóis/administração & dosagem
19.
Int J Surg Case Rep ; 33: 115-118, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28292664

RESUMO

BACKGROUND: Celiac artery aneurysm is a rare vascular lesion. It is frequently discovered after rupture, which leads to death in most cases. We present a case of an asymptomatic celiac artery aneurysm discovered in a 72-year-old female during an evaluation for high grade fever and general fatigue. CASE PRESENTATION: The patient visited our department with complaints of fever and general fatigue. The patient's medical history included type 2 diabetes mellitus with poor control and hypertension. Blood culture and urine culture that were submitted at arrival presented E. Coli. Then, she was diagnosed with bacteremia by urinary tract infection. Transesophageal echocardiography revealed no vegetation at her valves. Computed tomography was performed for investigating her urological abnormalities, revealing a 28×30 mm aneurysm at the trunk of the celiac artery. Blood and urine cultures submitted at arrival were positive for E. coli. Surgical repair performed after the improvement of her urinary tract infection revealed a non-infective aneurysm; thus, aneurysm closure and prosthetic grafting were conducted. CONCLUSION: Clinician awareness regarding this rare entity and discovery efforts to discover the splanchnic aneurysm before rupturing are imperative.

20.
J Med Case Rep ; 11(1): 55, 2017 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-28241852

RESUMO

BACKGROUND: Pneumatosis cystoides intestinalis, marked by numerous gas-filled cysts in the intestinal wall and submucosa or intestinal submucosa, is a very uncommon condition. CASE PRESENTATION: A 79-year-old Asian man presented to our emergency department after 2 days of lower abdominal pain with nausea and constipation. His past medical history included chronic obstructive pulmonary disease and he had been treated with home oxygen therapy. The patient was hemodynamically stable and had mild generalized abdominal pain and a soft, distended abdomen without signs of peritonism. A computed tomography scan showed diffuse intraluminal gas and intraperitoneal free gas. Based on the images, a clinical diagnosis of pneumatosis cystoides intestinalis with pneumoperitoneum was made. Considering the patient's physical examination, the peritoneal free air was drained by aspiration and he was observed for 12 h, but remained well. Abdominal symptoms and pneumoperitineum resolved after drainage of the peritoneal air by aspiration. The suspected etiopathogenic mechanism of pneumatosis cystoides intestinalis in the presented patient may have been alveolar air leakage secondary to high airway pressure due to chronic obstructive pulmonary disease; air leakage from an alveolar rupture may have traveled to the retroperitoneum through the mediastinal vessels and entered the mesentery of the bowel. CONCLUSION: Emergency physicians should be aware of the potential development of pneumatosis cystoides intestinalis in chronic obstructive pulmonary disease patients.


Assuntos
Pneumatose Cistoide Intestinal/complicações , Pneumoperitônio/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Colo Ascendente/diagnóstico por imagem , Colo Transverso/diagnóstico por imagem , Tratamento Conservador , Diagnóstico Diferencial , Humanos , Íleo/diagnóstico por imagem , Masculino , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Radiografia , Tomografia Computadorizada por Raios X
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