Lucio’s phenomenon: A life-threatening medical emergency

Background : Major bleeding is a life-threatening condition and a medical emergency with high mortality risk. It is often the complication of anticoagulant’s intake. Anticoagulants are commonly used for the prevention and the treatment of thrombotic events. The standard therapy with vitamin K antagonist (warfarin) has been frequently replaced by direct oral anticoagulants (DOACs). The latter agents (rivaroxaban, apixaban, edoxaban, dabigatran, betrixaban) showed a better efficacy and safety compared to standard warfarin treatment and they are recommended for the reduction of ischemic stroke. Literature data reported a high risk of gastrointestinal bleeding with DOACs, in particular with dabigatran and rivaroxaban. In case of life-threatening gastrointestinal bleeding, these patients could benefit from the use of reversal agents. Methods: We performed an electronic search on PUBMED of the literature concerning reversal agents for DOACs and gastrointestinal bleeding in the Emergency Department from 2004 to 2020. AIM: This review summarizes the current evidences about three reversal agents idarucizumab, andexanet alfa and ciraparantag, and the use of the first two in the emergency setting in patients with an active major bleeding or who need urgent surgery to offer physicians indications for a better management approach in order to increase patient’s safety. Conclusion: Although these agents have been marketed for five years (idarucizumab) and two years (andexanet alfa) respectively, and despite guidelines considering antidotes as first-line agents in treating life-threatening hemorrhage when available, these antidotes seem to gain access very slowly in the clinical practice. Cost, logistical aspects and need for plasma level determination of DOAC for an accurate therapeutic use probably have an impact on this phenomenon.. An expert multidisciplinary bleeding team should be established so as to implement international guidelines based on local resources and organization.

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Acute pericardial tamponade: The initial manifestation of systemic lupus erythematosus with Graves’ hyperthyroidism

Lupus ◽

10.1177/09612033211004729 ◽

2021 ◽

pp. 096120332110047

Author(s):

Muming Yu ◽

Yulei Gao ◽

Heng Jin ◽

Songtao Shou

Keyword(s):

Myocardial Infarction ◽

Systemic Lupus Erythematosus ◽

Female Patient ◽

Lupus Erythematosus ◽

Pericardial Tamponade ◽

Medical Emergency ◽

Systemic Lupus ◽

Initial Manifestation ◽

Life Threatening ◽

Obstructive Shock

Acute pericardial tamponade, which can cause obstructive shock, is a serious life-threatening medical emergency that can be readily reversed by timely identification and appropriate intervention. Acute pericardial tamponade can occur for a number of reasons, including idiopathic, malignancy, uremia, iatrogenic, post-myocardial infarction, infection, collagen vascular, hypothyroidism, and others. Systemic lupus erythematosus (SLE) and hyperthyroidism associated with pericardial tamponade are rarely reported. Here, we report the case of a 20-year-old female patient was final diagnosed of SLE with Graves’ hyperthyroidism.

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Myelodysplastic Syndrome Clinically Presenting with the “Classic TTP Pentad”

Case Reports in Hematology ◽

10.1155/2017/4619406 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Santiago Fabián Moscoso Martínez ◽

Evelyn Carolina Polanco Jácome ◽

Elizabeth Guevara ◽

Vijay Mattoo

Keyword(s):

Myelodysplastic Syndrome ◽

Clinical Presentation ◽

Renal Involvement ◽

Medical Emergency ◽

Complete Blood Cell Count ◽

Blood Cell Count ◽

Thrombocytopenic Purpura ◽

Life Saving ◽

Threatening Condition ◽

Life Threatening

The clinical presentation of myelodysplastic syndrome (MDS) is not specific. Many patients can be asymptomatic and can be detected only due to an abnormal complete blood cell count (CBC) on routine exam or for other reasons while others can be symptomatic as a consequence of underlying cytopenias. Thrombotic thrombocytopenic purpura (TTP) usually is suspected under the evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia and because it is a life-threatening condition (medical emergency) immediate initiation of plasmapheresis could be life-saving. The following case illustrates an unusual presentation of MDS in a patient who came in to the emergency room with the classic TTP “pentad” of fever, renal involvement, MAHA, mental status changes, and thrombocytopenia. We will focus our discussion in the clinical presentation of this case.

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A forgotten life-threatening medical emergency: myxedema coma

Emergency Care Journal ◽

10.4081/ecj.2016.5790 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Elisa Pizzolato ◽

Alberto Peano ◽

Letizia Barutta ◽

Emanuele Bernardi ◽

Elena Maggio ◽

...

Keyword(s):

Life Support ◽

Neurological Status ◽

Medical Emergency ◽

Myxedema Coma ◽

Emergency Department Stay ◽

Life Threatening ◽

Appropriate Therapy ◽

Alithiasic Cholecystitis ◽

The Right ◽

Tomography Scan

Nowadays myxedema coma is a rare medical emergency but, sometimes, it still remains a fatal condition even if appropriate therapy is soon administered. Although physical presentation is very non-specific and diversified, physicians should pay attention when patients present with low body temperature and alteration of neurological status; the presence of precipitating events in past medical history can help in making a diagnosis. Here we discuss one such case: an 83-year-old female presented with abdominal pain since few days. Laboratory tests and abdomen computed tomography scan demonstrated alithiasic cholecystitis; she was properly treated but, during the Emergency Department stay she experienced a cardiac arrest. Physicians immediately started advance cardiovascular life support algorithm and she survived. Later on, she was admitted to the Intensive Care Unit where doctors discovered she was affected by severe hypothyroidism. Straightway they started the right therapy but, unfortunately, the patient died in a few hours.

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Perioperative management of a patient with primary hypoparathyroidism and severe hypocalcaemia for lumbar spine surgery

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.173253 ◽

2016 ◽

Vol 03 (01) ◽

pp. 049-051

Author(s):

Deepak Madankar ◽

Sheetal Samel ◽

Abhay Ganar ◽

Neelesh Mathankar

Keyword(s):

Perioperative Management ◽

Muscle Power ◽

Lumbar Discectomy ◽

Medical Emergency ◽

Lumbar Spine Surgery ◽

Rare Entity ◽

Ionised Calcium ◽

Life Threatening ◽

Severe Hypocalcaemia ◽

Intravenous Calcium

AbstractPrimary hypoparathyroidism and consequent hypocalcaemia in the absence of iatrogenic cause are a rare entity. Serum ionised calcium concentrations < 0.50 mmol l−1 are more frequently associated with life-threatening complications and constitute a medical emergency that necessitates intravenous calcium therapy. The anaesthesiologist should carefully look for the effects of hypocalcaemia on the heart, circulation, muscle power and blood coagulation. We report perioperative management of a case of hypoparathyroidism and associated hypocalcaemia posted for lumbar discectomy in prone position and its anaesthetic implications.

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Intensive Care Management of Multiorgan Dysfunction and Hypoxic Brain Injury Secondary to Refractory Status Epilepticus

Life and Science ◽

10.37185/lns.1.1.122 ◽

2021 ◽

Vol 2 (4) ◽

pp. 3

Author(s):

Sanum Kashif

Keyword(s):

Status Epilepticus ◽

Refractory Status Epilepticus ◽

Medical Emergency ◽

High Grade Fever ◽

Refractory Status ◽

Hypoxic Brain Injury ◽

Hypoxic Brain ◽

Threatening Condition ◽

Life Threatening ◽

Permanent Brain Damage

Refractory Status Epilepticus (RSE) is a medical emergency that may lead to permanent brain damage or death.Mortality rate is 16-39%. It is the life threatening condition in which continuous fits occur, despite treatmentwith benzodiazepines and one antiepileptic drug.A 25-year-old female, brought in emergency department with high-grade fever and frequent fits. GlasgowComa Scale (GCS) was 3/15 with unstable hemodynamics. Resuscitation started immediately and managed asstatus epilepticus. Patient was in multi organ failure on arrival. On the basis of history and examination, hypoxicbrain injury was diagnosed initially. Later on, refractory status epilepticus (RSE) with multi organ dysfunctionsyndrome (MODS) was diagnosed, after necessary investigations and treatment. Patient was managed as ateam with multidisciplinary approach and after continuous effort of 2 weeks, patient was successfullydischarged to home.

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Sudden death due to ruptured oesophageal varices – autopsy-based case report

Medico-Legal Journal ◽

10.1177/0025817220926929 ◽

2020 ◽

Vol 88 (4) ◽

pp. 189-191

Author(s):

Nagendra Singh Sonwani ◽

Navneet Ateriya ◽

Arvind Kumar ◽

Anil Kohli ◽

Kalyan Kumar Banerjee

Keyword(s):

Chronic Alcoholism ◽

Medical Emergency ◽

Oesophageal Varices ◽

High Morbidity ◽

Forensic Pathologist ◽

Threatening Condition ◽

Life Threatening ◽

Cirrhotic Patients ◽

Acute Haemorrhage

Acute haemorrhage from ruptured oesophageal varices is a serious consequence of portal hypertension in cirrhotic patients. It represents a medical emergency with a high morbidity and mortality rate. Studies over the years have shown a direct link with chronic alcoholism in the development of such complications. Although the gastrointestinal system accounts for a few numbers of sudden deaths, bleeding through ruptured varices represent a life-threatening condition. The role of forensic pathologist is vital in dealing with sudden deaths. Here, we report a case of a 46-year-old man who died suddenly following the rupture of oesophageal varices.

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Aortic Dissection Presenting as Acute Pancreatitis: Suspecting the Unexpected

Case Reports in Cardiology ◽

10.1155/2018/4791610 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Adam Hafeez ◽

Dillon Karmo ◽

Adrian Mercado-Alamo ◽

Alexandra Halalau

Keyword(s):

Blood Pressure ◽

Acute Pancreatitis ◽

Aortic Dissection ◽

Epigastric Pain ◽

Pressure Control ◽

Sudden Onset ◽

Medical Emergency ◽

Threatening Condition ◽

Life Threatening ◽

Normal Triglyceride

Aortic dissection is a life-threatening condition in which the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). It is considered a medical emergency. We report a case of a healthy 56-year-old male who presented to the emergency room with sudden onset of epigastric pain radiating to his back. His blood pressure was 167/91 mmHg, equal in both arms. His lipase was elevated at 1258 U/L, and he was clinically diagnosed with acute pancreatitis (AP). He denied any alcohol consumption, had no evidence for gallstones, and had normal triglyceride level. Two days later, he endorsed new suprapubic tenderness radiating to his scrotum, along with worsening epigastric pain. A MRCP demonstrated evidence of an aortic dissection (AD). CT angiography demonstrated a Stanford type B AD extending into the proximal common iliac arteries. His aortic dissection was managed medically with rapid blood pressure control. The patient had excellent recovery and was discharged home without any surgical intervention.

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Haemoptysis

10.1093/med/9780199568741.003.0018 ◽

2018 ◽

Author(s):

Rakesh Panchal

Keyword(s):

Pulmonary Arteries ◽

Medical Emergency ◽

Haemodynamic Instability ◽

Respiratory Compromise ◽

Bronchial Arteries ◽

Specific Symptom ◽

Massive Haemoptysis ◽

Life Threatening ◽

Lung Condition ◽

Inpatient Management

Haemoptysis is the expectoration of blood or blood-stained sputum resulting from haemorrhage into the respiratory tract. Massive haemoptysis (5% of cases) is usually defined as >600 ml in 24 hours. Haemoptysis is a common and non-specific symptom. It can vary from blood-streaked sputum to massive, life-threatening haemorrhage. Haemoptysis may originate from the bronchial arteries (90%), pulmonary arteries (5%), or non-bronchial collaterals. Haemoptysis causing haemodynamic instability and/or respiratory compromise is a medical emergency. Unexplained haemoptysis may herald a serious underlying lung condition and therefore requires a thorough diagnostic workup. The majority of patients can be safely investigated and managed as outpatients. Urgent workup or inpatient management will be determined by the rate and severity of bleeding, and knowledge of either the source of bleeding and/or the underlying condition. This chapter covers the approach to diagnosis, diagnostic tests, therapies, prognosis, and dealing with uncertainty.

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Automated segmentation and diagnosis of pneumothorax on chest X-rays with fully convolutional multi-scale ScSE-DenseNet: a retrospective study

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01325-5 ◽

2020 ◽

Vol 20 (S14) ◽

Author(s):

Qingfeng Wang ◽

Qiyu Liu ◽

Guoting Luo ◽

Zhiqin Liu ◽

Jun Huang ◽

...

Keyword(s):

Retrospective Study ◽

Automatic Segmentation ◽

Medical Emergency ◽

Dice Similarity Coefficient ◽

X Rays ◽

X Ray ◽

Learning Framework ◽

Multi Scale ◽

Life Threatening ◽

Chest X Ray

Abstract Background Pneumothorax (PTX) may cause a life-threatening medical emergency with cardio-respiratory collapse that requires immediate intervention and rapid treatment. The screening and diagnosis of pneumothorax usually rely on chest radiographs. However, the pneumothoraces in chest X-rays may be very subtle with highly variable in shape and overlapped with the ribs or clavicles, which are often difficult to identify. Our objective was to create a large chest X-ray dataset for pneumothorax with pixel-level annotation and to train an automatic segmentation and diagnosis framework to assist radiologists to identify pneumothorax accurately and timely. Methods In this study, an end-to-end deep learning framework is proposed for the segmentation and diagnosis of pneumothorax on chest X-rays, which incorporates a fully convolutional DenseNet (FC-DenseNet) with multi-scale module and spatial and channel squeezes and excitation (scSE) modules. To further improve the precision of boundary segmentation, we propose a spatial weighted cross-entropy loss function to penalize the target, background and contour pixels with different weights. Results This retrospective study are conducted on a total of eligible 11,051 front-view chest X-ray images (5566 cases of PTX and 5485 cases of Non-PTX). The experimental results show that the proposed algorithm outperforms the five state-of-the-art segmentation algorithms in terms of mean pixel-wise accuracy (MPA) with $$0.93\pm 0.13$$ 0.93 ± 0.13 and dice similarity coefficient (DSC) with $$0.92\pm 0.14$$ 0.92 ± 0.14 , and achieves competitive performance on diagnostic accuracy with 93.45% and $$F_1$$ F 1 -score with 92.97%. Conclusion This framework provides substantial improvements for the automatic segmentation and diagnosis of pneumothorax and is expected to become a clinical application tool to help radiologists to identify pneumothorax on chest X-rays.

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