The American journal of emergency medicine
-
Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. ⋯ In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy.
-
Case Reports
Spontaneous rupture of the urinary bladder (SRUB): A rare case of recovery from cardiopulmonary arrest.
Spontaneous rupture of the urinary bladder (SRUB) is rare and results in a lethal condition, i.e., pan peritonitis. However, early and accurate diagnosis of SRUB is very difficult. A 54-year-old woman was transported to our hospital with suspicion of pan peritonitis after spontaneous return of circulation with pulseless electrical activity. ⋯ Exploratory laparotomy showed unexpected rupture of urinary bladder. Her recovery after surgery was relatively smooth. SRUB should be considered in the differential diagnosis of pan peritonitis, because urgent appropriate surgical intervention can rescue patients from this rare lethal disease.
-
Observational Study
Long-term survival of out-of-hospital cardiac arrest patients with malignancy.
The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy. ⋯ Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy.
-
Treatment with low-potency anti-psychotic agents is an important risk factor in the development of pulmonary embolism (PE). We report a case of 74years old female patient receiving olanzapine for psychotic depression admitted to the emergency service with the complaints of chest pain and shortness of breath. She had tachypnea, hypotension and tachycardia. ⋯ As the only possible risk factor for PE was olanzapine, olanzapine treatment was terminated with pyschiatry consultation. During the 12-month follow-up of the patient; malignancy was not observed. Diagnosis and prevention of PE are the important goals to reduce morbidity and mortality in subjects receiving olanzapine.
-
Sedative-hypnotic medications (e.g., Benzodiazepines [BZDs] and non-benzodiazepine receptor agonists [nBZRAs]) are associated with adverse events, especially in the elderly, that may require emergency department (ED) treatment. This study assessed outcomes from ED visits attributed to BZDs and/or nBZRAs, and variations in these associations by age group. ⋯ Findings highlight the need for clinical and regulatory initiatives to reduce BZD use, especially in combination with nBZRAs, and to promote treatment with safer alternatives to these medications.