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1.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537592

RESUMO

We present the case of a 22-year-old man transferred to the regional major trauma centre following a fall of ~15 m. He remained consistently haemodynamically stable for over 10 hours of observation until he deteriorated suddenly with major haemorrhagic shock requiring immediate trauma laparotomy. At laparotomy, 2 L of blood was drained from the abdomen but no source of active bleeding identified. 30 minutes after closure of the abdomen, 500 mL of fresh blood was noted in the drain so he was returned to the theatre where the bleeding source was found to be-after manual compression of a mildly bruised hepatoduodenal ligament-the proper hepatic artery (PHA). This case describes an unusual finding at relaparotomy and shows that even when there is no active bleeding from abdominal organs or classified vessels, it is possible to have isolated injury to PHA.


Assuntos
Duodeno/lesões , Artéria Hepática/lesões , Fígado/lesões , Choque Hemorrágico/etiologia , Contusões , Diagnóstico Diferencial , Duodeno/anatomia & histologia , Humanos , Laparotomia/métodos , Ligamentos/lesões , Fígado/anatomia & histologia , Fígado/diagnóstico por imagem , Fígado/patologia , Masculino , Reoperação , Choque Hemorrágico/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
3.
Acta Chir Orthop Traumatol Cech ; 86(3): 223-227, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31333189

RESUMO

The author presents a case study of the use of resuscitative endovascular balloon occlusion (REBOA) as a suitable alternative to thoracotomy and clamping of the descending aorta to control retroperitoneal bleeding in a patient with a pelvic injury. The patient who suffered multiple trauma after car accident, type C pelvic injury and retroperitoneal bleeding among other things, was following the pre-hospital ambulance care transported to the department of emergency medicine, with catecholamine infusion to support the blood flow. After the primary survey following the ATLS principles, the patient was taken for a CT scan. The CT examination revealed also multiple sources of retroperitoneal bleeding. Subsequently, the patient was brought to the operating room, where endovascular balloon occlusion of the descending aorta was performed to temporarily control retroperitoneal bleeding, which provided more time to treat the patient in line with the damage control surgery principles. In bleeding patients who suffered blunt torso traumas and serious haemorrhagic shock, or patients "in extremis", the survival after emergency thoracotomy ranges only around 1%. The to date results of REBOA technique applied in same indications are very promising globally. The survival rate increases multiple times especially in hypotensive patients, without the necessity of their immediate cardiopulmonary resuscitation. Key words:resuscitative balloon occlusion of the aorta, REBOA, haemorrhagic shock, retroperitoneal bleeding.


Assuntos
Aorta/cirurgia , Oclusão com Balão , Fraturas Ósseas/complicações , Ossos Pélvicos/lesões , Ressuscitação/métodos , Choque Hemorrágico/cirurgia , Acidentes de Trânsito , Humanos , Traumatismo Múltiplo/etiologia , Traumatismo Múltiplo/terapia
4.
Can J Surg ; 62(1): E17-E18, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30694036

RESUMO

Summary: Expediting life-saving care for hemorrhagic shock through multi-disciplinary code protocols is a potential method to improve outcomes. Trauma codes have become standard of care at most tertiary care centres; however, it is unclear if similar protocols can improve delivery of care for other forms of hemorrhagic shock. We examined the feasibility of a code protocol for ruptured abdominal aortic aneurysms (RAAAs) by reviewing the literature and comparing patient outcomes for RAAA and trauma patients at our institution, where the latter have a wellestablished trauma code protocol. We show that, despite being similarly unstable, patients with RAAA experienced delays to care milestones compared with trauma patients, even when accounting for diagnostic delays. Combining these data with present understanding of factors implicated in RAAA survival, we propose that a "CodeAAA" protocol may fill an important gap in RAAA care and that further prospective studies examining the utility of such a code are warranted.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/métodos , Choque Hemorrágico/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Implante de Prótese Vascular/métodos , Implante de Prótese Vascular/mortalidade , Canadá , Estudos de Coortes , Emergências , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Classificação Internacional de Doenças , Masculino , Prognóstico , Estudos Retrospectivos , Medição de Risco , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Análise de Sobrevida , Centros de Traumatologia , Resultado do Tratamento
5.
Curr Probl Diagn Radiol ; 48(1): 97-99, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29107397

RESUMO

A portal vein aneurysm is the dilatation of the portal vein due to a defect in the vein wall. This rare disease manifestation is difficult to predict and has the potential for severe complications. We describe the case of a 68-year-old man involved in a motor vehicle collision who presented with abdominal hemorrhage found on ultrasound, hypotension, and vague abdominal pain. The patient underwent an exploratory laparotomy to control bleeding. Surgery and a subsequent abdominal computed tomography revealed the presence of a portal vein pseudoaneurysm and shock bowel. This case highlights the importance of radiologists to consider the prospect of portal vein aneurysm in the differential diagnosis of hypotension following abdominal trauma.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Fígado/lesões , Fígado/cirurgia , Veia Porta/lesões , Choque Hemorrágico/diagnóstico por imagem , Choque Hemorrágico/cirurgia , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Idoso , Diagnóstico Diferencial , Humanos , Masculino
6.
Mil Med ; 183(suppl_2): 55-59, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30189087

RESUMO

This clinical practice guideline (CPG) reviews the range of accepted management approaches to profound shock and post-traumatic cardiac arrest and establishes indications for considering Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a hemorrhage control adjunct. The specific management approach - within the parameters of mission, resources, and tactical situation - will depend on the casualty's physical location, mechanism and pattern of injury, and the experience level of the surgeon. The optimal management strategy is best determined by the surgeon at the bedside.


Assuntos
Oclusão com Balão/normas , Ressuscitação/métodos , Choque Hemorrágico/cirurgia , Aorta/cirurgia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/normas , Guias como Assunto/normas , Humanos , Ressuscitação/normas
7.
BMJ Case Rep ; 20182018 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30131408

RESUMO

Major vascular injury during surgery is life threatening and can be a nightmare for any surgeon.We share our experience of a 42-year-old woman where right common iliac artery and both common iliac veins were accidentally injured during lumbar discectomy leading to haemorrhagic shock. Patient was resuscitated and explored. A 4 cm segment of right common iliac artery was found lacerated along with perforations of both iliac veins. Proximal segment of internal iliac artery was mobilised quickly and vascular continuity was restored by end-to-end anastomosis of this segment to the proximal segment of common iliac artery after excising the damaged segment. Iliac veins were repaired primarily. Patient made an uneventful recovery. We share this technique as it was found expeditious and effective and may benefit surgeons working in this field.


Assuntos
Discotomia/efeitos adversos , Artéria Ilíaca/lesões , Complicações Intraoperatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões do Sistema Vascular/cirurgia , Adulto , Feminino , Humanos , Artéria Ilíaca/cirurgia , Complicações Intraoperatórias/etiologia , Vértebras Lombares/cirurgia , Choque Hemorrágico/etiologia , Choque Hemorrágico/cirurgia
8.
J Trauma Acute Care Surg ; 85(1): 101-107, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29965941

RESUMO

OBJECTIVES: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technology to augment proximal blood pressure during the resuscitation of patients with noncompressible torso hemorrhage. Currently, placement choice, supraceliac (Zone 1) versus infrarenal (Zone 3) aorta, depends on injury patterns, but remains a highly debated topic. We sought to compare the proximal hemodynamic support provided by Zone 1 versus Zone 3 REBOA placement and the degree of hemodynamic instability upon reperfusion following intervention. METHODS: Eighteen anesthetized swine underwent controlled hemorrhage of 25% total blood volume, followed by 45 minutes of Zone 1 REBOA, Zone 3 REBOA, or no intervention (control). They were then resuscitated with shed blood, aortic balloons were deflated, and 5 hours of critical care ensued prior to euthanasia. Physiologic parameters were recorded continuously, and blood was drawn for analysis at specified intervals. Significance was defined as p < 0.05. RESULTS: There were no significant differences between groups at baseline or during the initial 30 minutes of hemorrhage. During the intervention period, average proximal MAP was significantly greater in Zone 1 animals when compared with Zone 3 animals (127.9 ± 1.3 vs. 53.4 ± 1.1 mm Hg) and greater in Zone 3 animals when compared with control animals (42.9 ± 0.9 mm Hg). Lactate concentrations were significantly higher in Zone 1 animals (9.6 ± 0.4 mmol/L) when compared with Zone 3 animals (5.1 ± 0.3 mmol/L) and control animals (4.2 ± 0.8 mmol/L). CONCLUSIONS: In our swine model of hemorrhagic shock, Zone 3 REBOA provided minimal proximal hemodynamic support when compared with Zone 1 REBOA, albeit with less ischemic burden and instability upon reperfusion. In cases of impending hemodynamic collapse, Zone 1 REBOA placement may be more efficacious regardless of injury pattern, whereas Zone 3 should be reserved only for relatively stable patients with ongoing distal hemorrhage.


Assuntos
Aorta/cirurgia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Ressuscitação/métodos , Choque Hemorrágico/cirurgia , Animais , Oclusão com Balão/veterinária , Cuidados Críticos/métodos , Modelos Animais de Doenças , Procedimentos Endovasculares/veterinária , Feminino , Hemodinâmica/fisiologia , Masculino , Traumatismo por Reperfusão/etiologia , Ressuscitação/veterinária , Choque Hemorrágico/fisiopatologia , Choque Hemorrágico/veterinária , Suínos
9.
J Trauma Acute Care Surg ; 84(6): 924-928, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29794689

RESUMO

BACKGROUND: The focused abdominal sonography for trauma (FAST) examination has been reported to be unreliable in pelvic fracture patients. Additionally, given the advent of new therapeutic interventions, such as resuscitative endovascular balloon occlusion of the aorta (REBOA), rapid identification of intra-abdominal hemorrhage compared with Zone III hemorrhage may guide different therapeutic strategies. We hypothesized that FAST is reliable for detecting clinically significant intra-abdominal hemorrhage in the face of complex pelvic fractures. METHODS: Our pelvic fracture database of all hemodynamically unstable patients requiring intervention from January 1, 2005, to July 1, 2015, was reviewed. The FAST examination was compared with operative and computed tomography (CT) scan findings. Confirmatory evaluation for FAST(-) patients was considered positive if therapeutic intervention was required. RESULTS: During the study period, 81 patients in refractory shock with FAST imaging in our emergency department (ED) underwent pelvic packing. Mean age was 45 ± 2 years and Injury Severity Score was 50 ± 1.5. The FAST examination was negative in 53 patients; 52 patients did not require operative intervention for abdominal bleeding while one patient required splenectomy. The FAST examination was positive in 28 patients; 26 had findings confirmed by CT or laparotomy while two patients did not have intra-abdominal hemorrhage on further evaluation. The sensitivity and specificity for FAST in this population was 96% and 96%, respectively, positive predictive value was 93%, and negative predictive value was 98%. The false-negative and -positive rates for FAST were 2% and 7%. CONCLUSION: Focused abdominal sonography for trauma examination reliably identifies clinically significant hemoperitoneum in life-threatening, pelvic fracture related hemorrhage. The incidence of a false-negative FAST in this unstable pelvic fracture population was 2%. FAST results may be used when determining the role of REBOA in these multisystem trauma patients and requires further study. REBOA placement should be considered in hemodynamically unstable pelvic fracture patients who are FAST(-), while laparotomy should be used in FAST(+) patients. LEVEL OF EVIDENCE: Therapeutic, level IV.


Assuntos
Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico por imagem , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Ossos Pélvicos/lesões , Choque Hemorrágico/diagnóstico por imagem , Choque Hemorrágico/etiologia , Ultrassonografia/métodos , Traumatismos Abdominais/cirurgia , Feminino , Fraturas Ósseas/cirurgia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Choque Hemorrágico/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Z Geburtshilfe Neonatol ; 222(5): 212-216, 2018 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-29847845

RESUMO

HELLP syndrome, characterized by the triad of hemolysis, elevated liver enzymes due to liver impairment, and low platelet count, is a hypertensive disorder in pregnancy. Although it is said to be caused by disturbed placentation in the first trimester, its clinical presentation can be seen mostly in the third trimester, but never before the completed 20th gestational week. Predictive for its diagnosis is the reported upper abdominal pain that normally is localized under the right arc of ribs. With the aid of laboratory examination, the suspected diagnosis can be confirmed or excluded. Therapeutic options are observational treatment with the prophylaxis of respiratory distress syndrome and attempting to prolong pregnancy with the help of steroids like dexamethasone, or delivering the infant by inducing labor or performing a primary caesarian section, depending on the gestational week. Delivery is the unique causal therapy of HELLP syndrome. Clinical management is mainly influenced by the course of HELLP syndrome. There are mild forms that allow prolonging the pregnancy for several days or sometimes weeks, but also foudroyant courses with acute liver damage. We report the case of a 40-year-old, gravida 1 woman in gestational week 36+1 who was brought to our hospital in hemorrhagic shock caused by a rupture of the liver due to acute HELLP-syndrome.


Assuntos
Síndrome HELLP/diagnóstico , Hepatopatias/diagnóstico , Terceiro Trimestre da Gravidez , Doença Aguda , Adulto , Cesárea , Serviços Médicos de Emergência , Feminino , Síndrome HELLP/cirurgia , Humanos , Recém-Nascido , Hepatopatias/cirurgia , Gravidez , Ruptura Espontânea , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/cirurgia
11.
Crit Care ; 22(1): 103, 2018 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-29678197

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA), which has been increasingly used for the management of hemorrhagic shock, is a less invasive strategy for the management of patients with very severe hemorrhage. However, its effectiveness remains controversial. METHODS: This retrospective case series included trauma patients who underwent REBOA for hemorrhagic shock due to trauma in four Japanese tertiary care emergency centers from January 2013 to March 2017. Patients in cardiac arrest at the time of REBOA and those who underwent REBOA for nontraumatic causes during the study period were excluded. RESULTS: A total of 24 patients underwent REBOA during the study period. The median age was 52 years (interquartile range (IQR) 36.5-62.5), 17 (70.8%) of the patients were male, and 23 (95.8%) had blunt trauma. The 24-h survival was 50% (n = 12), and the in-hospital survival rate was 41.7% (10/24). In all cases, REBOA was performed in emergency rooms by emergency physicians without fluoroscopic guidance. Complications of REBOA were mesenteric ischemia (n = 1, 4.2%), ischemia of the lower extremities (n = 1, 4.2%), and placement of REBOA in thoracic aortic injury (n = 3, 12.5%). CONCLUSIONS: REBOA can be an effective and feasible tool for controlling massive hemorrhage due to trauma. However, caution should be exercised regarding complications including placement of REBOA in aortic injury and limb ischemia in cases where REBOA is performed in an emergency department setting with minimal or no support from trauma surgeons.


Assuntos
Oclusão com Balão/métodos , Choque Hemorrágico/cirurgia , Adulto , Aorta Torácica/fisiopatologia , Aorta Torácica/cirurgia , Feminino , Humanos , Escala de Gravidade do Ferimento , Japão , Masculino , Pessoa de Meia-Idade , Ressuscitação/métodos , Ressuscitação/normas , Estudos Retrospectivos , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Taxa de Sobrevida , Ferimentos e Lesões/sangue , Ferimentos e Lesões/complicações , Ferimentos e Lesões/mortalidade
12.
Mil Med ; 183(9-10): e460-e466, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29547998

RESUMO

INTRODUCTION: Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of traumatic death worldwide and particularly on the battlefield. They are especially challenging when present simultaneously (polytrauma), and clear blood pressure end points during fluid resuscitation are not well described for this situation. The goal of this study is to evaluate for any benefit of increasing blood pressure using a vasopressor on brain blood flow during initial fluid resuscitation in a swine polytrauma model. MATERIALS AND METHODS: We used a swine polytrauma model with simultaneous TBI, femur fracture, and HS with uncontrolled noncompressible internal bleeding from an aortic tear injury. Five animals were assigned to each of three experimental groups (hydroxyethyl starch only [HES], HES + 0.4 U/kg vasopressin, and no fluid resuscitation [No Fluids]). Fluids were given as two 10 mL/kg boluses according to tactical field care guidelines. Primary outcomes were mean arterial blood pressure (MAP) and brain blood flow at 60 min. Secondary outcomes were blood flows in the heart, intestine, and kidney; arterial blood lactate level; and survival at 6 hr. Organ blood flow was measured using injection of colored microspheres. RESULTS: Five animals were tested in each of the three groups. There was a statistically significant increase in MAP with vasopressin compared with other experimental groups, but no significant increase in brain blood flow during the first 60 min of resuscitation. The vasopressin group also exhibited greater total internal hemorrhage volume and rate. There was no difference in survival at 6 hours. CONCLUSION: In this experimental swine polytrauma model, increasing blood pressure with vasopressin did not improve brain perfusion, likely due to increased internal hemorrhage. Effective hemostasis should remain the top priority for field treatment of the polytrauma casualty with TBI.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Hemodinâmica/efeitos dos fármacos , Ressuscitação/normas , Choque Hemorrágico/cirurgia , Vasopressinas/uso terapêutico , Análise de Variância , Animais , Modelos Animais de Doenças , Hidratação/métodos , Hidratação/tendências , Hemodinâmica/fisiologia , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/cirurgia , Ressuscitação/métodos , Suínos/lesões , Suínos/cirurgia , Vasoconstritores/uso terapêutico
13.
J Emerg Med ; 54(4): 410-418, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29439891

RESUMO

BACKGROUND: Bleeding from hemorrhagic shock can be immediately controlled by blocking the proximal part of the hemorrhagic point using either resuscitative thoracotomy for aortic cross-clamping or insertion of a large-caliber (10-14Fr) resuscitative endovascular balloon occlusion of the aorta (REBOA) device via the femoral artery. However, such methods are very invasive and have various complications. With recent progress in endovascular treatment, a low-profile REBOA device (7Fr) has been developed. OBJECTIVE: The objective of this study was to report our experience of this low-profile REBOA device and to evaluate the usefulness of emergency physician-operated REBOA in life-threatening hemorrhagic shock. METHODS: Ten patients with refractory hemorrhagic shock underwent REBOA using this device via the femoral artery. All REBOA procedures were performed by emergency physicians. The success rate of the insertion, vital signs, and REBOA-related complications were evaluated. RESULTS: Median age was 54 years (interquartile range 33-78 years). The causes of hemorrhagic shock were trauma (n = 4; 1 blunt and 3 penetrating), ruptured abdominal aortic aneurysm (n = 3), and obstetric hemorrhage (n = 3). Two patients had cardiopulmonary arrest upon arrival. REBOA procedure was successful in all patients, and all became hemodynamically stable to undergo definitive interventions after REBOA. There were no REBOA-related complications. The mortality rate within 24 h and 30 days was 40%. CONCLUSIONS: This REBOA device was useful for emergency physicians in life-threatening hemorrhagic shock because of its ease in handling and low invasiveness.


Assuntos
Aorta/lesões , Oclusão com Balão/normas , Hemorragia/terapia , Adulto , Idoso , Aorta/fisiopatologia , Oclusão com Balão/métodos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Ressuscitação/métodos , Estudos Retrospectivos , Choque Hemorrágico/epidemiologia , Choque Hemorrágico/prevenção & controle , Choque Hemorrágico/cirurgia
14.
J Emerg Med ; 54(4): 419-426, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29456087

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a relatively innovative procedure designed to control critical non-compressible torso hemorrhage. In the United States, this procedure is currently in active use at only a small number of trauma centers. OBJECTIVE: We describe how we developed our REBOA program at an independent academic-affiliated community trauma center. DISCUSSION: Through a close interprofessional and multidisciplinary collaboration led by emergency physicians and trauma surgeons, we were able to successfully develop our program. CONCLUSIONS: Successful implementation of a REBOA program requires close attention to multimodal training, interprofessional roles, team dynamics, financial considerations, and quality assurance processes to safely deliver this potentially life-saving procedure to our trauma patient population.


Assuntos
Oclusão com Balão/métodos , Educação/métodos , Desenvolvimento de Programas/métodos , Aorta/lesões , Delaware , Educação/estatística & dados numéricos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/estatística & dados numéricos , Hemorragia/complicações , Hemorragia/cirurgia , Humanos , Escala de Gravidade do Ferimento , Relações Interprofissionais , Desenvolvimento de Programas/estatística & dados numéricos , Ressuscitação/métodos , Ressuscitação/normas , Ressuscitação/estatística & dados numéricos , Choque Hemorrágico/cirurgia
16.
J Am Coll Surg ; 226(3): 294-308, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29248608

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to decrease hemorrhage below the level of aortic occlusion (AO); however, the amount of collateral blood flow below the level of occlusion is unknown. Our aim was to investigate blood flow patterns during complete AO in patients who underwent CT scan after REBOA. STUDY DESIGN: Between February 2013 and January 2017, patients who received REBOA and underwent CT scan with intravenous contrast during full AO were included. Patients were excluded if they had a CT scan performed with the balloon partially or fully deflated. RESULTS: Nine patients (8 men) were included; all had blunt trauma. Mean Injury Severity Score (±SD) was 48 ± 8 and mean age was 45 ± 19 years. Four had supra-celiac AO, and 5 had infra-renal AO. Arterial contrast enhancement was noted below the level of AO in all patients, and distal to REBOA sheath placement in 5. Collateralization from arteries above and below the AO was identified in all patients. Contrast extravasation distal to AO was identified in 4 patients, and hematomas in 8. Distal vascular enhancement patterns varied by level of AO and contrast administration site. CONCLUSIONS: Aortic occlusion appears to dramatically decrease, but does not completely impede, distal perfusion during REBOA due to multiple pathways of collateralization. Active extravasation and hematomas can still be detected in the setting of full AO, with purposefully timed contrast and image acquisition. Blood flow persists below the level of both the AO and in-dwelling sheath. Dynamic flow studies are needed to determine the contribution of AO and sheath placement to distal tissue ischemia.


Assuntos
Aorta Torácica/cirurgia , Oclusão com Balão/métodos , Velocidade do Fluxo Sanguíneo/fisiologia , Procedimentos Endovasculares/métodos , Tomografia Computadorizada Multidetectores/métodos , Ressuscitação/métodos , Cirurgia Assistida por Computador/métodos , Aorta Torácica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Hemorrágico/etiologia , Choque Hemorrágico/fisiopatologia , Choque Hemorrágico/cirurgia , Ferimentos e Lesões/complicações
17.
Sao Paulo Med J ; 136(5): 488-491, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28832810

RESUMO

CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. CASE REPORT: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.


Assuntos
Aneurisma Roto/complicações , Artéria Gastroepiploica , Choque Hemorrágico/etiologia , Dor Abdominal/etiologia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Feminino , Artéria Gastroepiploica/diagnóstico por imagem , Artéria Gastroepiploica/cirurgia , Humanos , Laparotomia/métodos , Pessoa de Meia-Idade , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Choque Hemorrágico/cirurgia , Tomografia Computadorizada por Raios X/métodos
18.
BMJ Case Rep ; 20172017 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-29054903

RESUMO

A 15-year-old girl at 18 weeks gestation by the last menstrual period presented to a rural Ugandan healthcare facility for termination of her pregnancy as a result of rape by her uncle. Skilled healthcare workers at the facility refused to provide the abortion due to fear of legal repercussions. The patient subsequently obtained an unsafe abortion by vaginal insertion of local herbs and sharp objects. She developed profuse vaginal bleeding and haemorrhagic shock. She was found to have uterine rupture and emergent hysterectomy was performed. Young and poor women are at high risk of unplanned pregnancy and subsequent mortality during pregnancy and childbirth. Unsafe abortion is a leading and entirely preventable cause of maternal mortality worldwide. Multiple barriers restrict access to safe abortions including social and moral stigma, gender-based power imbalances, inadequate contraceptive use and sexual education, high cost and poor availability, and restrictive abortion laws.


Assuntos
Aborto Induzido/efeitos adversos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Medicina Tradicional Africana/efeitos adversos , Serviços de Saúde Rural , Choque Hemorrágico/etiologia , Ruptura Uterina/etiologia , Ferimentos Penetrantes/complicações , Adolescente , Feminino , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Histerectomia Vaginal , Gravidez , Estupro/legislação & jurisprudência , Serviços de Saúde Rural/legislação & jurisprudência , Choque Hemorrágico/cirurgia , Estigma Social , Resultado do Tratamento , Uganda , Ruptura Uterina/cirurgia , Direitos da Mulher , Ferimentos Penetrantes/cirurgia
19.
Innovations (Phila) ; 12(4): e1-e2, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28737565

RESUMO

The usage of resuscitative endovascular balloon occlusion of the aorta, also known as aortic balloon occlusion, is an emerging method for bleeding control as a bridge to definitive treatment in trauma management. We describe a trauma case where resuscitative endovascular balloon occlusion of the aorta was used as part of the EndoVascular hybrid Trauma and bleeding Management concept to facilitate transient hemorrhage control and thereby to permit damage control surgery. The case is an illustration of the adoption of a multidisciplinary approach.


Assuntos
Aorta , Oclusão com Balão/métodos , Ressuscitação/métodos , Acidentes de Trânsito , Adolescente , Aorta/lesões , Aorta/cirurgia , Humanos , Masculino , Traumatismo Múltiplo/cirurgia , Choque Hemorrágico/cirurgia
20.
BMC Surg ; 17(1): 74, 2017 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-28651560

RESUMO

Background: Adrenal myelolipoma is an uncommon, benign, and hormonally non-functioning tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Case presentation: Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R't was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of tumor was done. Conclusion: Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Mielolipoma/diagnóstico , Choque Hemorrágico/etiologia , Dor Abdominal/etiologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Hemoperitônio/etiologia , Humanos , Laparotomia/métodos , Masculino , Choque Hemorrágico/cirurgia
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