1/105. Primary percutaneous transluminal coronary angioplasty performed for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura.A 72-year-old female with idiopathic thrombocytopenic purpura (ITP) complained of severe chest pain. electrocardiography showed ST-segment depression and negative T wave in I, aVL and V4-6. Following a diagnosis of acute myocardial infarction (AMI), urgent coronary angiography revealed 99% organic stenosis with delayed flow in the proximal segment and 50% in the middle segment of the left anterior descending artery (LAD). Subsequently, percutaneous transluminal coronary angioplasty (PTCA) for the stenosis in the proximal LAD was performed. In the coronary care unit, her blood pressure dropped. Hematomas around the puncture sites were observed and the platelet count was 28,000/mm3. After transfusion, electrocardiography revealed ST-segment elevation in I, aVL and V1-6. Urgent recatheterization disclosed total occlusion in the middle segment of the LAD. Subsequently, PTCA was performed successfully. Then, intravenous immunoglobulin increased the platelet count and the bleeding tendency disappeared. A case of AMI with ITP is rare. The present case suggests that primary PTCA can be a useful therapeutic strategy, but careful attention must be paid to hemostasis and to managing the platelet count.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/105. The portable Doppler: practical applications in EMS care.The practical application of a new, commercially available, portable Doppler ultrasound device to the operation of a busy city-county emergency department and ambulance service was investigated. An initial evaluation using healthy volunteers confirmed accuracy and reproducibility of the Doppler blood pressure readings comparable to that of auscultatory and palpatory measurement. In selected patients, the Doppler readings correlated well with readings from patients who had intra-arterial lines. When used in several low flow states, such as testing adequacy of cardiopulmonary resuscitation (CPR) and verification of electromechanical dissociation, the Doppler aided the clinical evaluation and treatment in many cases where traditional methods were useless. The Doppler was also helpful in the evaluation of local arterial injury but this unit was not found sensitive enough for venous disease. Finally, the Doppler enhanced the obtaining of vital signs in the noisy environment of our ambulances.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/105. Spontaneous bladder rupture: rare cause of peritonitis.Spontaneous rupture of the urinary bladder is an uncommon, but important, cause of generalized peritonitis. It is a surgical emergency which may be rapidly fatal if diagnosis and treatment are delayed. Bladder disease or obstruction, coupled with a sudden increase in intra-abdominal pressure usually accounts for the rupture. Characteristic symptoms are acute lower abdominal pain followed by generalized peritonitis. In most cases, the rupture is intra-peritoneal.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/105. Cardiovascular toxicity after ingestion of "herbal ecstacy"."Herbal Ecstacy" (sic) is an alternative drug of abuse usually containing both ephedrine and caffeine. Our literature search did not reveal any other reported cases of cardiovascular toxicity related to herbal "drugs of abuse." A case of cardiovascular toxicity following the ingestion of herbal ecstacy is presented. A 21-year-old male presented to the emergency department with an initial blood pressure of 220/110 mmHg and ventricular dysrhythmias after ingesting four capsules of herbal ecstacy. He was treated with lidocaine and sodium nitroprusside, and his symptoms resolved in 9 h. The pathophysiology and clinical course of ephedrine toxicity are discussed. Emergency physicians should consider ephedrine preparations in the differential diagnosis of patients presenting with a sympathomimetic toxidrome. Drugs of abuse containing "herbal" products can produce serious morbidity and mortality.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/105. Neurogenic pulmonary oedema after generalized epileptic seizure.The diagnosis 'tonic clonic seizure' is frequently established by emergency physicians on scene. In patients with epilepsy mortality due to accidents, asphyxia, cardiac arrhythmias or postictal neurogenic pulmonary oedema (NPO) is twice as high as in the general population. We report a case of acute pulmonary oedema after a tonic clonic seizure. Following this event, the patient developed respiratory insufficiency and evidence of pulmonary oedema not associated with the classic aetiologies of congestive heart failure, aspiration or toxic exposure. The patient survived the incident after aggressive prehospital treatment, long-term intensive care and subsequent rehabilitation. A systematic case analysis and an introduction to the pathophysiology of NPO are presented. We recommend a positive approach to the management of NPO consisting primarily of interventions to stabilize vital functions, decrease intracranial pressure and normalize vegetative dysregulation. Emergency physicians need to consider the possibility of NPO in all cases of pulmonary oedema of unknown origin.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/105. Alkaptonuric aortic stenosis: a case report.alkaptonuria is a rare disease of phenylalanine, aromatic amino acids, and tyrosine metabolism. Because of a genetic deficiency of the enzyme homogentisic acid oxidase, an accumulation of homogentisic acid causes ochronotic pigment deposition. The most common clinical manifestations are arthropathy, urinary calculi and discoloration, cutaneous and cartilaginous pigmentation, and cardiac valvular disease. Arthropathy and aortic stenosis are the most debilitating manifestations of the disease. A case of alkaptonuric aortic stenosis is described. A 75-year-old woman with a history of alkaptonuria presented in the emergency department with complaints of progressive dyspnea. Upon examination, the patient was hypertensive, tachypneic, and tachycardic with premature ventricular contractions. She had pitting edema of the lower extremities and complaints of generalized weakness. Chest x-rays revealed congestive heart failure and pulmonary edema. diuretics were administered, and a continuous nitroglycerin infusion was initiated in the emergency department. The patient was admitted for further evaluation. The patient's respiratory status continued to decline. She was intubated endotracheally 1 day after admission. Subsequent cardiac evaluation revealed an ejection fraction of 35%, severe aortic stenosis, mild coronary artery disease, ischemic cardiomyopathy, and anteroapical akinesis. A dobutamine infusion was instituted for persistent hypotension, and renal dose dopamine was initiated for oliguric renal failure. The patient underwent an emergency operation for an aortic valve replacement with a Dacron patch 10 days after admission. cardiopulmonary bypass and mild hypothermia were used during the procedure. The patient's hemodynamic status remained tenuous throughout the procedure. Although the first attempt to wean off cardiopulmonary bypass failed, the second attempt was successful with the aid of an intra-aortic balloon pump, inotropic support, and atrioventricular pacing. These measures were maintained during transport to the surgical intensive care unit. In the intensive care unit, the patient did not have an audible blood pressure or a palpable pulse without the support of the intra-aortic balloon pump and atrioventricular pacing. Coarse atrial fibrillation was the underlying electrocardiogram rhythm in the absence of atrioventricular pacing. sodium bicarbonate was given without improvement. After discussion with the family, all life support measures were discontinued. The patient died 10 minutes after her arrival in the intensive care unit. alkaptonuria's pathogenesis is manifested as both local and systemic in nature. collagen vascular diseases share a similar pattern of multisystem involvement. Despite the negative outcome for the patient described, valuable insight can be obtained by studying this case and noting the anesthetic considerations specific to collagen vascular diseases in general.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/105. Induced hypertension after head injury.The use of induced hypertension in head injury patients is controversial. We present the case of a 19-year-old man admitted with severe head trauma after a road accident and describe the beneficial effects that increasing arterial blood pressure had on the cerebral perfusion pressure, cerebral blood flow and jugular bulb oxygen saturation in this patient.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
8/105. Successful treatment of a patient with ARDS after pneumonectomy using high-frequency oscillatory ventilation.High frequency oscillatory ventilation (HFOV) was used in a patient who developed the acute respiratory distress syndrome 5 days following a right pneumonectomy for bronchogenic carcinoma. When conventional pressure-controlled ventilation failed to maintain adequate oxygenation, HFOV dramatically improved oxygenation within the first few hours of therapy. Pulmonary function and gas exchange recovered during a 10-day period of HFOV. No negative side effects were observed. Early use of HFOV may be a beneficial ventilation strategy for adults with acute pulmonary failure, even in the postoperative period after lung resection.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/105. The acute diagnosis of Takayasu's arteritis based on helical CT angiography of the chest and neck in the emergency room.Recently, a young woman presented acutely with a left hemispheric stroke and differing blood pressures in the arms as her initial manifestation of Takayasu's arteritis. Helical CT angiography, performed to rule out aortic dissection, revealed a thickened wall of the aortic arch with stenoses and occlusions of the great vessels, suggesting the diagnosis. The sequence of imaging studies and findings in this unusually catastrophic presentation of a typically insidious disease are highlighted.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/105. Severe gamma-hydroxybutyrate withdrawal: a case report and literature review.We report a case of gamma-hydroxybutyrate (GHB) withdrawal resulting in severe agitation, mental status changes, elevated blood pressure, and tachycardia hours after stopping chronic use of GHB. The patient admitted to substantial GHB abuse on a daily basis for 2.5 years. Previous attempts at cessation reportedly resulted in diaphoresis, tremors, and agitation. The patient's symptoms, negative polypharmacy history, and negative urine and blood toxicological analysis for alcohol, benzodiazepines, sedative-hypnotics, or other substances suggested the diagnosis of GHB withdrawal. Later analysis of a patient drug sample confirmed the presence of GHB. The patient required 507 mg of lorazepam and 120 mg of diazepam over 90 h to control agitation. This is one of the few reported cases of GHB withdrawal and one of the most severe. Given the increasing use of GHB, more cases of severe GHB withdrawal should be anticipated.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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