1/8. Massive prehospital transfusion in multiple blunt trauma.A 15-year-old male passenger in a motor vehicle accident was transfused 15 units of blood products and 8.5 litres of polygeline while still trapped in the wreckage. This and other advanced interventions at the scene contributed to the patient's survival. This first case report of massive prehospital transfusion highlights some of the advantages of senior physician staffed emergency medical services in the prehospital phase of trauma management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Whole blood transfusion for exsanguinating coagulopathy in a US field surgical hospital in postwar kosovo.An urgent blood drive in which active duty military field surgical hospital personnel volunteered to donate whole blood was conducted, and administration of warm, whole blood prevented the exsanguination of a normothermic coagulopathic patient who had received a massive transfusion. In austere care settings in which full blood banking capability may not be available, physicians should consider that exsanguinating hemorrhage can potentially be controlled surgically, but nonsurgical bleeding requires specific replacement therapy, and whole blood may be the best selection for repleting deficiencies of components that are otherwise unavailable.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result.Ectopic pregnancy has been increasing in frequency over the past 2 decades. The sudden rupture of a fallopian tube caused by ectopic pregnancy can lead to hemorrhagic shock and death if not diagnosed and treated in a timely fashion. The emergency physician is often the health professional that is called on to make the diagnosis and coordinate timely and effective intervention. The first step in the diagnosis of ectopic pregnancy is demonstration of pregnancy by means of a rapidly performed and sensitive qualitative urine test for the beta-subunit of human chorionic gonadotropin (beta-hCG). A negative urine pregnancy test result will generally be used to exclude ectopic pregnancy from further consideration. The following is a report of a patient presenting to an emergency department with hypovolemic shock in conjunction with 2 negative urine beta-hCG analysis results and a quantitative serum beta-hCG level of 7 mIU/mL, a value less than the lower limit of detection for the highly sensitive qualitative urine and serum tests. This case report demonstrates the importance of further consideration of the diagnosis of ectopic pregnancy in the setting of a negative urine pregnancy test result.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Spontaneous haemopneumothorax: a rare clinical entity.A 39 yr old man presented with a spontaneous pneumothorax. On initial pleural drainage 120 ml of haemorrhagic fluid were collected. Twenty four hours, after re-expansion of the lung, shock developed and 1,200 ml of haemorrhagic fluid were spontaneously collected. The diagnosis haemopneumothorax was considered and at operation a bleeding vessel, which originated from the parietal pleura, was located and coagulated. The occurrence of an air fluid line at radiological examination, the development of a haemorrhagic pleural effusion and shock should alert the physician of this entity. This case stresses the importance of early recognition and surgical intervention because of the possible lethal evolution.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Ruptured ectopic pregnancy after medical management: current conservative management strategies.A case of hypotension caused by hemorrhage in a patient receiving systemic methotrexate to treat a known ectopic pregnancy is presented. A primary goal of gynecologic practice in the 1990s is to conserve tubal patency and fertility. Consequently, ectopic pregnancy is more frequently being managed by conservative strategies. The emergency physician must be familiar with conservative methods for the management of ectopic pregnancy and the complications that may cause emergency presentations in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Enteric fistulization of a common iliac artery aneurysm: an unusual cause of gastrointestinal hemorrhage and shock.A 78-year-old man with a history of recent unexplained lower gastrointestinal bleeding presented to the emergency department with the acute onset of abdominal pain, tenesmus, and shock. Computed tomography of the abdomen showed a fistula between a common iliac artery aneurysm and the small intestine. laparotomy demonstrated a saccular aneurysm of the common and proximal internal iliac arteries with fistulous communication to the distal ileum. Aneurysmectomy, arteriorrhaphy, and segmental ileal resection with primary anastomosis were successfully performed. This case illustrates a rare complication of an uncommon aneurysm, emphasizing the need for emergency physicians to consider complicated vascular disease in the evaluation of a patient with abdominal pain and shock.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Perforated duodenal ulcer presenting with shock in a child.Presentation of peptic ulcer disease in children covers a broad spectrum ranging from subtle, and thus overlooked and underdiagnosed, to catastrophic, as in this case. It is important for the emergency physician to realize the potential morbidity and mortality of this disease and be aware of the spectrum of presentation for primary and secondary pediatric ulcer disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. psoas abscess with sepsis mimicking traumatic hemorrhagic shock after a fall.Abscess of the psoas muscle is infrequently encountered. An infectious emergency of this type usually presents in a nonspecific manner and thus poses a significant diagnostic challenge to the emergency physician. diagnosis and specific treatment are often delayed, which can lead to increased mortality. This case report presents a patient with altered mental status and hypotension after a fall, who was initially managed as a trauma victim. Emergency department evaluation initially focused on a traumatic etiology of the above abnormalities. Subsequent assessment determined that the patient's condition was due to an underlying psoas abscess with sepsis. Appropriate anatomy, clinical presentation, and management are discussed in hopes of increasing physician awareness of this uncommon infectious condition.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |