The American journal of emergency medicine
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Hyperbaric oxygen (HBO) is widely accepted as a treatment for air or gas embolism, carbon monoxide (CO) poisoning, clostridial myonecrosis, crush injuries, and thermal burns. To the best of our knowledge, after HBO therapy, atrial fibrillation (AF) has not been reported in the literature yet. We herein describe a case of AF that occurred in a woman who had taken HBO therapy for CO poisoning. ⋯ After the HBO therapy, ECG showed AF. Her rhythm returned to the normal sinus rhythm after amiodarone treatment. Physicians should keep in mind that HBO treatment could contribute to AF, and all patients' ECG should be monitored before and after HBO therapy.
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Severe malaria complicated by circulatory shock is known as algid malaria. Cases of severe imported malaria are seen increasingly frequently in emergency departments in the United States, Europe, and other locales. The optimal volume resuscitation strategy for patients with severe malaria is not well-defined. ⋯ Although not identical, the late inflammatory response in severe malaria leading to capillary permeability shares many similarities with the immunologic response in bacterial sepsis. Our case report discusses a patient with severe imported malaria complicated by shock, successfully managed with large-volume fluid resuscitation, hemodynamic optimization, early antimalarial agents, and broad-spectrum antibiotics. This report questions the strategy of cautious fluid resuscitation in algid malaria and suggests that case series comparing goal-directed resuscitation to historic controls along with prospective multicenter controlled trials should be conducted to determine the best fluid resuscitation strategy.
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The purpose of this study was to define whether the semiquantitative analysis of hemoperitoneum increases the accuracy of early prediction of massive transfusion (MT). ⋯ The assessment of the size of hemoperitoneum on admission substantially improves the prediction of MT in trauma patients and should be used to trigger and guide initial haemostatic resuscitation.