European journal of case reports in internal medicine
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Eur J Case Rep Intern Med · Jan 2019
Detecting Pneumoperitoneum via Point-of-Care Abdominal Ultrasound: To See Beyond Touch.
Point-of-care ultrasound is increasingly important in the management of acute medical emergencies. An elderly man was brought to the emergency department after 2 days of fever and urinary retention. He was drowsy and had peri-arrest arrhythmia. ⋯ Chest and abdominal physical examinations were unremarkable. The source of sepsis was unclear. A point-of-care abdominal ultrasound was performed by the reviewing internist which detected a pneumoperitoneum, leading to a change in diagnosis to a perforated viscus which was confirmed later by a CT of the abdomen and pelvis.
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Eur J Case Rep Intern Med · Jan 2019
Abrupt Severe Chest Pain and Vomiting: Remember to Think of a Ruptured Oesophagus (Boerhaave Syndrome).
Boerhaave syndrome or spontaneous rupture of the oesophagus is a severe condition commonly misdiagnosed or unrecognized. Prognosis is poor even if the diagnosis is made promptly. ⋯ Unfortunately, the patient died 48 hours after admission to the Intensive Care Unit. This entity requires a multidisciplinary management approach which may include conservative, surgical or endoscopic procedures.
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Cerebral venous air embolism (CVAE) is an extremely rare phenomenon. Most reports of cerebral air embolism focus on the arterial territory, and consequently CVAE has remained poorly understood, especially regarding its pathophysiology and treatment. The authors describe an elderly male patient who was admitted through the Emergency Department with subacute confusion. ⋯ No potential causes were found apart from previous peripheral vein cannulation and intravenous medication administration. The patient received supportive treatment, with complete radiological resolution of the gas emboli, while maintaining his previous confusional state. The aim of this report is to highlight a rare and understudied entity, and discuss its causes, proposed pathophysiology and appropriate management.
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Platypnoea-orthodeoxia syndrome (POS) is an uncommon clinical entity characterized by dyspnoea and hypoxaemia induced by upright posture and relieved by recumbence. It is often associated with right-to-left shunting through a patent foramen ovale (PFO) or an atrial septal defect. ⋯ A thoracic CT angiogram and ventilation/perfusion lung scan excluded a pulmonary embolism, but a transoesophageal echocardiogram with a bubble test showed a PFO with a right-to-left shunt, without pulmonary hypertension. The patient underwent percutaneous closure of the PFO which led to prompt symptom relief and full functional recovery.
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Eur J Case Rep Intern Med · Jan 2019
Case ReportsTwo Dabigatran Fast Reversals in a 4-month Period - a Case Report.
Idarucizumab is available for immediate reversal of dabigatran-induced anticoagulation in life-threatening bleeding or urgent surgery in patients with non-valvular atrial fibrillation (nvAF). ⋯ Clinical situations requiring urgent reversal of the anticoagulant effects of non-vitamin K antagonist oral anticoagulants are expected to be relatively rare but the existence of antidotes enables the clinical management of these situations.Even in independent urgent circumstances occurring over a short period of time, the repeated use of idarucizumab promptly and safely reverses the dabigatran anticoagulant effect without compromising the patient's clinical outcome.The development and implementation of specific anticoagulation reversal protocols and better guidance on using baseline coagulation tests are needed to ensure timely and appropriate use of this new therapeutic option.