ObjectivesOur primary goal is to investigate the hypothesis that in patients with a detectable ventricular wall motion (VWM) in cardiac ultrasonography (US) during cardiopulmonary resuscitation (CPR), survival rate is significantly more than in patients without VWM in US.Material and methodsIn our prospective, single center study, 129 adult cardiac arrest (CA) patients were enrolled. Cardiac US according to Focus Assessed Transthoracic Echo (FATE) protocol was performed before CPR. Presence of VWM was recorded on forms along with demographic data, initial rhythm, CA location, presence of return of spontaneous circulation (ROSC) and time until ROSC was obtained.Results129 patients were included. ROSC was obtained in 56/77 (72.7%) patients with VWM and 3/52 (5.8%) patients without VWM which is statistically significant (p > 0.001). Presence of VWM is 95% (95% CI: 0.95–0.99) sensitive and 70% (95% CI: 0.58–0.80) specific for ROSC. 43/77 (55.8%) patients with VWM and 1 (1.9%) of 52 patients without VWM survived to hospital admission which was statistically significant (p < 0.001). Presence of VWM was 100% (95% CI: 0.87–1.00) sensitive and 54% (95% CI: 0.43–0.64) specific for survival to hospital admission.ConclusionNo patient without VWM in US survived to hospital discharge. Only 3 had ROSC in emergency department and only 1 survived to hospital admission. This data suggests no patient without VWM before the onset of CPR survived to hospital discharge and this may be an indication to end resuscitative efforts early in these patients.
Pneumatosis intestinalis (PI) is the presence of gas within the wall of the intestine. It was first defined in 1783 by Du Vernoi (1). It is a critical condition and is a clinical sign rather than a disease. PI is difficult to diagnose because most patients are asymptomatic. This can be because of acute mesenteric ischemia (AMI) and subsequent bowel infarctions (2). The mortality rate of AMI is very high (3). PI is a rarely associated with the immunosuppressive status of a patient. Multidetector computed tomography (CT) is an important tool for assessing patients in the emergency room (ER). CT can provide important information regarding the cause of abdominal pain and site of ischemia if present. Conservative treatment with fasting and antibiotics can be considered in mild cases (4). However, the situation sometimes requires surgery and can be life threatening. 5) demonstrated that the most common causes of PI are vascular ischemia of mesentery, intestinal obstruction, and chemotherapy. The chemotherapeutics that have been reported with PI are methotrexate, daunorubicin, cytarabine, fluorouracil, paclitaxel, docetaxel, and intravenous etoposide (6). PI due to etoposide chemotherapy are mostly benign (6,7). However, in our case, we aim to show a patient who had etoposide chemotherapy because of testis neoplasm and was admitted to the hospital with abdominal pain but died because of AMI.
Lee et al (
High pressure injection injuries most commonly occur in industrial accidents. In accident due to high pressure gun injuries, the nature of injected materials, the degree of toxicity, and the amount injected will affect the clinical outcome. Early vigorous treatment is essential to reduce morbidity. We reported a case of hand injuries due to inadvertent use of a high pressure injector device for haemostasis. 46-year-old male technician tried to stop bleeding from his injured hand by directing air jet from a high pressure injector to the wound resulting in significant subcutaneous emphysema. Adequate training and knowledge on occupational safety should be reinforced to avoid similar accidents.
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