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Source: The American Journal of Emergency Medicine

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Total 261 results found since Jan 2013.

Endotoxin adsorption by polymyxin B column or intraaortic balloon pumping use for severe septic cardiomyopathy
Septic patients often have low cardiac output. Some of them present severe cardiac dysfunction such as septic cardiomyopathy. However, no well-known and effective treatment for septic cardiomyopathy exists. The effect of endotoxin adsorption by polymyxin B–immobilized fiber column–direct hemoperfusion (PMX-DHP) and intraaortic balloon pumping (IABP) for septic shock remains uncertain. We experienced 2 very contrastive case reports of severe septic cardiomyopathy. We experienced 2 cases of severe septic cardiomyopathy with refractory shock. Case 1 with colon perforation presented refractory shock 6 hours after PMX-DHP, ...
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Kensuke Nakamura, Kent Doi, Ryota Inokuchi, Tatsuma Fukuda, Takahiro Hiruma, Takeshi Ishii, Susumu Nakajima, Eisei Noiri, Naoki Yahagi Tags: Case Reports Source Type: research

Transient ischemic attack in hereditary hemorrhagic telangiectasia
We describe the case of a 53-year-old woman with a previous history of recurrent epistaxis, admitted to our unit for a transient episode of diplopia and unbalance. Cerebrovascular screening showed the presence of a right to left shunt at saline contrast transcranial Doppler, related to 3 PAVMs detected by subsequent chest computed tomographic scan. Genetic screening evidenced deletion in endoglin gene (ENG), suggesting diagnosis of HHT type 1. Secondary cerebrovascular prevention with antithrombotic therapy was early stopped for the worsening of epistaxis. Neurologic symptoms are common in HHT, and saline contrast transcra...
Source: The American Journal of Emergency Medicine - February 4, 2013 Category: Emergency Medicine Authors: Gino Gialdini, Alberto Chiti, Michelangelo Mancuso, Eva Terni, Nicola Giannini, Giovanni Orlandi Tags: Case Reports Source Type: research

Optimal initial anticoagulant therapy in pulmonary thromboembolism: randomized trial suggested
Numerous lines of evidence suggest a need for an improvement in pulmonary thromboembolism (PTE) therapy: According to relevant US data (Heart Disease and Stroke Statistics–2012 Update), 30-day mortality of PTE is no less than 40.9%, which is clearly not acceptable .
Source: The American Journal of Emergency Medicine - November 19, 2012 Category: Emergency Medicine Authors: Goran P. Koracevic Tags: Correspondence Source Type: research

Fatal dabigatran toxicity secondary to acute renal failure
We describe the case of a 74-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation who presented to the emergency department after 20 mL of hematemesis at home. Laboratory evaluation revealed a partial thromboplastin time of 99 seconds, international normalized ratio of 11.7, and creatine of 3.1 mg/dL (baseline creatine, 0.9 mg/dL). Upper endoscopy revealed diffuse gastritis and bleeding. Despite treatment with packed red blood cells and fresh frozen plasma, the patient's hematemesis persisted resulting in significant aspiration requiring endotracheal intubation. Per poison control center recommendation...
Source: The American Journal of Emergency Medicine - November 19, 2012 Category: Emergency Medicine Authors: Joseph K. Maddry, Mana Kouros Amir, Daniel Sessions, Kennon Heard Tags: Case Reports Source Type: research

Subconjunctival hemorrhage in a patient on dabigatran (Pradaxa)
Dabigatran is a direct thrombin inhibitor that has gained increasing popularity for prevention of thromboembolic events such as stroke, pulmonary embolism, and myocardial ischemia. Because of the increasing use of this drug, emergency department (ED) physicians are going to be evaluating patients taking this medication. It is important to understand the potential for ocular bleeding complications associated with this class of anticoagulant. Traditionally, patients have been placed on vitamin K antagonists to decrease the risk of thromboembolism. In the RE-LY and RE-COVER studies, dabigatran showed non-inferiority to coumad...
Source: The American Journal of Emergency Medicine - September 24, 2012 Category: Emergency Medicine Authors: Tam M. Nguyen, Michael P. Phelan, Xiang Q. Werdich, Paul J. Rychwalski, Christopher M. Huff Tags: Case Reports Source Type: research

Systemic thrombolysis for stroke in pregnancy
Pregnancy is an exclusion criterion for all clinical trials that validate alteplase in acute stroke, so our knowledge about its use in this condition is relative only to case reports and case series. Herein, we report the successful use of intravenous recombinant tissue-type plasminogen activator (rt-PA) in pregnant women with acute stroke. The patient was a 28-year-old who was 16 weeks pregnant. She presented to our hospital 1 hour after a sudden onset of mothor aphasia, hemiparesis, and hypoesthesia on the right side due to incipient ischemia in the left cerebral hemisphere resulting from ipsilateral middle cerebral arte...
Source: The American Journal of Emergency Medicine - August 6, 2012 Category: Emergency Medicine Authors: Rossana Tassi, Maurizio Acampa, Giovanna Marotta, Samuele Cioni, Francesca Guideri, Simone Rossi, Alfonso Cerase, Giuseppe Martini Tags: Case Reports Source Type: research