A pulmonary embolism (PE) is an acute life-threatening respiratory event that results in upwards of 200,000 deaths per year in the United States. While anticoagulation is currently the standard of treatment for PEs, there is increasing evidence to suggest that in certain cases anticoagulation in combination with thrombolytic therapy may improve patient outcomes and reduce mortality. This article aims to compare the effects of combined intervention with thrombolytic therapy and anticoagulation to the effects of anticoagulation alone in patients with submassive PEs in terms of various outcome measures, including but not limited to: mortality, hemodynamic status, length of hospital stay, and safety. The methodology consisted of the critical appraisal of the primary literature articles pertaining to intervention with thrombolytic agents in cases of a submassive or intermediate risk PE, including a discussion of each study’s strengths and limitations. Ultimately, this review found that the use of thrombolytic agents in conjunction with anticoagulants has been associated with decreased hemodynamic decompensation and decreased length of hospital stay, with no change in mortality outcomes, at a cost of increased rate of bleeding and stroke. The use of thrombolytic agents with anticoagulants may be warranted in a specific subset of patients, but clinicians should consider the potential benefits and harms of this intervention.
Schwannomas are tumors of neoplastic Schwann cells generally found in peripheral nerves in the head, neck, and extremities. They do not demonstrate hormonal abnormalities, and initial symptoms are typically secondary to adjacent organ compression. These tumors are rarely found in the retroperitoneum. We present a rare finding of an adrenal schwannoma in a 75-year-old female who presented to the emergency department with right flank pain. Imaging incidentally demonstrated a 4.8 cm left adrenal mass. Ultimately, she underwent a left robotic adrenalectomy, and immunohistochemical testing confirmed the presence of an adrenal schwannoma. It is imperative to undergo adrenalectomy and immunohistochemical testing to confirm the diagnosis and rule out malignancy.
A thyroid storm is a rare but life-threatening manifestation of thyrotoxicosis. It still remains a diagnostic challenge as there are no specific laboratory investigations or universally accepted criteria for diagnosing thyroid storms. Diagnosis is mainly based on clinical findings, evidence of hyperthyroidism, and lifethreatening symptoms. A thyroid storm has a high risk of mortality mostly due to multi-organ failure and heart failure. Cardiovascular manifestations are the most common presentation of hyperthyroidism; cardiac involvement also has the potential to be the most serious complication. Management of cardiovascular manifestations should be managed aggressively to prevent long-term myocardial damage. A high index of suspicion should be maintained in young adults presenting with heart failure and arrhythmia. We present a case of potentially life-threatening cardiovascular effects of thyroid storm and management in the ICU.
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