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Haemorrhagic shock management

N M Al-Namnam, P Nambiar, P Shanmuhasuntharam, M Harris
Dengue is a mosquito transmitted flaviviral infection which can give rise to severe haemorrhage (dengue haemorrhagic fever/DHF) and with capillary leakage induces hypovolemic shock (dengue shock syndrome/DSS). Although dengue symptoms and complications have been known for many decades there has only been one documented case of osteonecrosis of the maxilla which was treated by excision of the necrotic bone. In this case of dengue infection, extensive maxillary osteonecrosis and minimal root resorption appeared to follow factitious injury with a toothpick but resolved with nonsurgical management...
October 15, 2016: Australian Dental Journal
Isabelle Clavagnier
Sophie assesses a patient whose condition is deteriorating. She manages the critical situation in conjunction with the doctor on duty.
October 2016: Revue de L'infirmière
Piriyankan Ananthavarathan, Kamlesh Patel, Catherine Doran, Nigel Suggett
INTRODUCTION: Atraumatic splenic rupture is a rare surgical emergency that is often attributed to neoplastic or infectious causes. Rarely, it has been identified to also occur in the setting of an acute severe sepsis and in cases of pelvic or splenic abscess formation post-appendicectomy. However, to our knowledge, the co-presentation of acute appendiceal abscess and splenic rupture has not been previously described. PRESENTATION OF CASE: We present the case of a 67-year old male with decompensating haemorrhagic shock secondary to atraumatic splenic rupture on a background of an inadequately treated complicated appendicitis originally managed as diverticulitis with antibiotics in the community...
April 13, 2016: International Journal of Surgery Case Reports
Ovidiu Horea Bedreag, Marius Papurica, Alexandru Florin Rogobete, Mirela Sarandan, Carmen Alina Cradigati, Corina Vernic, Corina Maria Dumbuleu, Radu Nartita, Dorel Sandesc
Nowadays, fluid resuscitation of multiple trauma patients is still a challenging therapy. Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient. Patients presenting with multiple trauma often develop hemorrhagic shock, which triggers a series of metabolic, physiological and cellular dysfunction. These disorders combined, lead to complications that significantly decrease survival rate in this subset of patients. Volume and electrolyte resuscitation is challenging due to many factors that overlap...
2016: Burns and trauma
Yann Daniel, S Habas, L Malan, J Escarment, J-S David, S Peyrefitte
BACKGROUND: Despite the early uses of tourniquets and haemostatic dressings, blood loss still accounts for the vast majority of preventable deaths on the battlefield. Over the last few years, progress has been made in the management of such injuries, especially with the use of damage control resuscitation concepts. The early application of these procedures, on the field, may constitute the best opportunity to improve survival from combat injury during remote operations. DATA SOURCES: Currently available literature relating to trauma-induced coagulopathy treatment and far-forward transfusion was identified by searches of electronic databases...
August 16, 2016: Journal of the Royal Army Medical Corps
T Viergutz, J Grüttner, T Walter, C Weiss, B Haaff, G Pollach, C Madler, T Luiz
BACKGROUND: In the current guidelines for the treatment of patients with ST-segment elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) recommends preclinical fibrinolysis as a reperfusion therapy if, due to long transportation times, no cardiac catheterisation is available within 90-120 min. However, there is little remaining in-depth expertise in this method because fibrinolysis is presently only rarely indicated. METHODS: In a rural area in southwestern Germany, where an emergency primary percutaneous coronary intervention was not routinely available within 90-120 min, 156 STEMI patients underwent fibrinolysis with the plasminogen activator reteplase, performed by trained emergency physicians...
September 2016: Der Anaesthesist
A G P Bullingham
The Great War of 1914-1918 ushered in a new era of technology on the battlefield resulting in casualties on an unprecedented scale. There had been progress in many related areas of medicine before the outbreak of hostilities but these had not been applied or fully developed in clinical practice. This is particularly true for the management of haemorrhagic shock and resuscitation. This article discusses the history and development of medical treatment of shock and trauma patients during the conflict.
July 2016: Anaesthesia and Intensive Care
G Justus Hofmeyr, Zahida Qureshi
Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol...
June 23, 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
Anna Sandstrom, Pankhaj Jha
INTRODUCTION: Visceral artery aneurysms (VAA) are an uncommon vascular pathology with an incidence estimated at 0.01% to 2%. The likely aetiology of visceral artery aneurysms is uncertain includes atherosclerosis, trauma and inflammation. VAAs are often asymptomatic until rupture which causes life threatening haemorrhage and is associated with a high mortality. Gastric artery aneurysms (GAA) form a very small proportion of VAAs (<4%). CASE DESCRIPTION: This is a case series of three patients who presented to Nambour Hospital with a ruptured left gastric aneurysm...
July 14, 2016: Annals of Vascular Surgery
Ronald Kintu-Luwaga
INTRODUCTION: Male circumcision is traditionally carried out by ascribed practitioners, so self-circumcision is very rare. It is intriguing why the victims should not seek available modern health care. This article highlights another case of self-circumcision, the related causes, complications and their management. The gradual increase in numbers is contributing to the surgical disease burden. CASE PRESENTATION: A 21year old male circumcised himself using a razor-blade 13days prior to presentation at the hospital...
2016: International Journal of Surgery Case Reports
Carlotta Sorini Dini, Chiara Lazzeri, Marco Chiostri, Gian Franco Gensini, Serafina Valente
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) represents a therapeutic option in patients with refractory cardiogenic shock (RCS). This strategy is limited to a restricted number of centres with capabilities for implanting VA ECMO and management patients on this support. We report on the initial experience of our ECMO referral centre for patients with RCS. METHODS: We retrospectively analysed our ECMO data registry for RCS of 14 patients treated with VA ECMO, consecutively admitted to our intensive cardiac care unit (ICCU), which is an ECMO referral centre...
June 9, 2016: Acute Cardiac Care
Daniel H Moreno, Daniel G Cacione, Jose C C Baptista-Silva
BACKGROUND: An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair...
2016: Cochrane Database of Systematic Reviews
Obed Dolo, Alice Clack, Hannah Gibson, Naomi Lewis, David P Southall
PROBLEM: The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care. APPROACH: In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts. LOCAL SETTING: The training took place in CB Dunbar Maternity Hospital...
May 1, 2016: Bulletin of the World Health Organization
Mark Wagener
A 36-year-old man who had been bitten on his left index finger by a snake identified as a boomslang (Dispholidus typus) presented with haematemesis and hypovolaemic shock. Coagolopathy was presumed, and the platelet count was 2 × 10⁹/L. Findings on upper endoscopy included oesophageal petechial haemorrhages, severe haemorrhagic gastritis and an antral ulcer. The patient was successfully managed using freeze-dried plasma, packed red blood cells, isotonic crystalloids and polyvalent antivenom.
May 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
A Koscielny, M Kühnel, F Verrel, J C Kalff
Introduction: Although the perioperative management has been optimised over the past few decades, there has not been a remarkable improvement in the mortality rates of patients with a ruptured abdominal aortic aneurysm (rAAA). The aim of this retrospective trial was to define pre-, intra- and postoperative parameters which influence the perioperative and long-term outcome of patients and which can be modified by the operating team. Methods: A retrospective database analysis was performed in 49 patients who had undergone an operation of rAAA in our certified centre of vascular surgery between the beginning of 2006 and the end of 2012...
October 2016: Zentralblatt Für Chirurgie
Swati Sharma, Sandhya Jain, Shalini Rajaram
Dengue is a vector transmitted viral infection; tropical and subtropical countries see outbreaks of dengue each year. There is a paucity of literature on effects of dengue infection on pregnancy outcome and this prompted us to undertake a study for better understanding of pregnancy implications with dengue infection. Pregnant women admitted during the seasonal outbreak of dengue between September 2015 and October 2015 were studied and maternal and fetal outcomes in sixteen NS1Ag positive women were analysed...
2016: Infectious Diseases in Obstetrics and Gynecology
F Wallet, D Maucort Boulch, S Malfroy, S Ledochowski, C Bernet, V Kepenekian, G Passot, O Vassal, V Piriou, O Glehen, A Friggeri
BACKGROUND: Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) are promising new approaches of peritoneal metastases. However these surgical procedures are associated with a high morbidity rate thus intensive care (IC) management following serious complications may be warranted for these patients. The impact of the prolonged IC stay or re-admission on long-term survival remains unknown. METHODS: We retrospectively analysed 122 consecutive HIPEC procedures over a one year period (2010-2011) in a single academic hospital...
June 2016: European Journal of Surgical Oncology
Simon Rauch, Kai Schenk, Bernhard Rainer, Giacomo Strapazzon, Peter Paal, Hermann Brugger
Rescue operations in mountain and remote areas pose special challenges for the rescue team and often differ substantially from rescue missions in the urban environment. Given the growing sports and leisure activities in mountains, incidence of alpine emergencies is expected to rise further. The following article describes the treatment of haemorrhagic shock, analgesic therapy and airway management in mountain rescue.
January 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Panagiotis Nikolaos Chronopoulos, Georgios Nikolaos Kaisidis, Christos Konstantinos Vaiopoulos, Dragana Milosav Perits, Michail Nikolaos Varvarousis, Apostolos Vasilios Malioris, Elissabeth Pazarli, Ioannis Konstantinos Skandalos
INTRODUCTION: Herein we present a rare case of pontaneous rupture of a giant renal angiomyolipoma (AML), with symptoms of hypovolemic shock (Wunderlich's syndrome), which was managed by urgent total nephrectomy. PRESENTATION OF CASE: A 53 year old female was transferred to the emergency room with progressive acute painful swelling of the left lateral abdominal area, duration of 5h. An emergent ultrasonic examination, revealed a heterogeneous-solid mass with maximum diameter of 23cm, with probable origin from the left kidney...
2016: International Journal of Surgery Case Reports
Guenter Froeschl, Pitchou Kasongo Kayembe
Cases of monkeypox in humans are frequently reported from the Democratic Republic of Congo. The few reports from the Central African Republic have been limited to cases in the far South closely bordering the Congos. Team members of an international medical organisation have suspected clinically two human cases of MPX, associated with clinical signs of coagulopathy and haemorrhage in the North of the country. Key findings were history of a squirrel, fever and vesicular dermal eruptions. Subsequently patients developed profuse epistaxis and hematemesis, associated with clinical signs of shock...
2015: Pan African Medical Journal
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