The American journal of emergency medicine
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Case Reports
Stress-related cardiomyopathy, ventricular dysfunction, artery thrombosis: a hidden pheochromocytoma.
Clinical presentation of pheochromocytoma can vary, and it can sometimes mimic other diseases. Some patients with pheochromocytoma may have atypical presentations, such as clinical features consistent with an acute coronary syndrome, that only later suggest a classical picture of stress-related cardiomyopathy. To our best knowledge, pheochromocytoma has been incidentally revealed in a few cases of catecholamine-induced cardiomyopathy and in only 1 case of peripheral arterial thrombosis. This is the first case of pheochromocytoma revealed after left ventricular dysfunction caused by stress-related cardiomyopathy associated with inferior limb artery thrombosis in a patient with a complex cardiovascular history.
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Regional nerve blocks provide superior analgesia over opioid-based pain management regimens for traumatic injuries such as femur fractures. An ultrasound-guided regional nerve block is placed either as a single-shot injection or via a perineural catheter that is left in place. Although perineural catheters are commonplace in the perioperative setting, their use by emergency physicians (EPs) for emergency pain management in adults has not been previously described. ⋯ Recent studies also suggest excellent analgesic outcomes with intermittent perineural bolusing of local anesthetic, thereby dispensing with the need for complex and expensive infusion pumps. Herein, we describe our successful placement of perineural femoral catheters at a busy inner-city public hospital ED. Our experience suggests that this is a promising new technique for emergency pain management of acute extremity injuries.
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Case Reports
Early diagnosis of pneumoperitoneum in bowel perforation by capnography: a report of 2 cases.
Capnography is commonly used for monitoring purposes. Here, we describe a new application of capnography as a bedside diagnostic modality. ⋯ It can also detect gas in supine position. This technique is useful even in doubtful cases of pneumoperitoneum differentiating from pseudopneumoperitoneum.
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Massive posttraumatic bleeding is the leading cause of potentially preventable death among patients with severe trauma. Immediate diagnosis and treatment of traumatic coagulopathy and its differentiation from surgical bleeding after major trauma are critical in the management of such patients. ⋯ Therapy based on massive transfusion protocol and on laboratory coagulation tests would be insufficient to stop bleeding. We conclude that rotational thromboelastometry/thromboelastography analysis plays a critical role in the management of traumatic bleeding and helps us provide more aggressive and targeted therapy for coagulopathy both in the acute and later phases of treatment of severe bleeding.
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Toxin-mediated vasodilation in the sepsis syndrome can lead to end-organ dysfunction and shock. Assessing for fluid responsiveness and preload optimization with intravenous fluids is a central tenet in the management of sepsis. Aggressive fluid administration can lead to pulmonary edema and heart failure, whereas premature inotropic or vasopressor support can worsen organ perfusion. Inferior vena cava ultrasonography is commonly used to assess for fluid responsiveness but has multiple limitations.