scholarly journals Consequences of Misdiagnosed and Mismanaged Hereditary Angioedema Laryngeal Attacks: An Overview of Cases from the Romanian Registry

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Dumitru Moldovan ◽  
Noémi Bara ◽  
Valentin Nădășan ◽  
Gabriella Gábos ◽  
Enikő Mihály
Keyword(s):  
Emergency Department ◽  
Effective Treatment ◽  
Hereditary Angioedema ◽  
Case Reports ◽  
Laryngeal Edema ◽  
Emergency Physicians ◽  
Treatment Protocols ◽  
Life Threatening

Emergency department (ED) physicians frequently encounter patients presenting with angioedema. Most of these involve histamine-mediated angioedema; however, less common forms of angioedema (bradykinin-mediated) also occur. It is vital physicians correctly recognize and treat this; particularly since bradykinin-mediated angioedema does not respond to antihistamines, corticosteroids or epinephrine and hereditary angioedema (HAE) laryngeal attacks can be fatal. Here we present four case reports illustrating how failures in recognizing, managing, and treating laryngeal edema due to HAE led to asphyxiation and death of the patient. Recognition of the specific type of angioedema is critical for rapid and effective treatment of HAE attacks. Bradykinin-mediated angioedema should be efficiently differentiated from the most common histamine-mediated form. Improved awareness of HAE and the associated risk of life-threatening laryngeal edema among emergency physicians, patients, and relatives and clear ED treatment protocols are warranted. Moreover, appropriate treatments should be readily available to reduce fatalities associated with laryngeal edema.

scholarly journals Using Fresh Frozen Plasma for Acute Airway Angioedema to Prevent Intubation in the Emergency Department: A Retrospective Cohort Study

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Aya Saeb ◽  
Karen H. Hagglund ◽  
Christine T. Cigolle
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Reports ◽  
Fresh Frozen Plasma ◽  
Laryngeal Edema ◽  
Icu Stay ◽  
Fresh Frozen ◽  
Frozen Plasma

Background. Angioedema (AE) is a common condition which can be complicated by laryngeal edema, having up to 40% mortality. Although sporadic case reports attest to the benefits of fresh frozen plasma (FFP) in treating severe acute bouts of AE, little evidence-based support for this practice is available at present.Study Objectives. To compare the frequency, duration of intubation, and length of intensive care unit (ICU) stay in patients with acute airway AE, with and without the use of FFP.Methods. A retrospective cohort study was conducted, investigating adults admitted to large community hospital ICU with a diagnosis of AE during the years of 2007–2012. Altogether, 128 charts were reviewed for demographics, comorbidities, hospital courses, and outcomes. A total of 20 patients received FFP (108 did not).Results. Demographics and comorbidities did not differ by treatment group. However, nontreated controls did worse in terms of intubation frequency (60% versus 35%;p=0.05) and ICU stay (3.5 days versus 1.5 days;p<0.001). Group outcomes were otherwise similar.Conclusion. In an emergency department setting, the use of FFP should be considered in managing acute airway nonhereditary AE (refractory to steroid, antihistamine, and epinephrine). Larger prospective, better controlled studies are needed to devise appropriate treatment guidelines.

scholarly journals Life-threatening Development of Cardiac Tamponade in the Span of 24 Hours

2019 ◽  
Vol 3 (3) ◽  
pp. 267-270 ◽  
Author(s):  
Patrick Kishi ◽  
Thaer Ahmad ◽  
Kenneth Dodd
Keyword(s):  
Cardiac Output ◽  
Cardiac Tamponade ◽  
Effective Treatment ◽  
Medical Emergency ◽  
Emergency Physicians ◽  
Pericardial Space ◽  
Severe Hypotension ◽  
Life Threatening

Cardiac tamponade is a medical emergency that requires immediate treatment. Caused by the development of fluid in the pericardial space, it can result in a severe decrease in cardiac output. When encountering patients with severe hypotension and tachycardia, emergency physicians must always consider the diagnosis of tamponade to facilitate prompt and effective treatment and stabilization. We report our experience with a patient who developed life-threatening cardiac tamponade within a span of less than 24 hours.

scholarly journals Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243222
Author(s):  
Kristof Segher ◽  
Liesbeth Huys ◽  
Tania Desmet ◽  
Evi Steen ◽  
Stefanie Chys ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Case Reports ◽  
Alcohol Use Disorders ◽  
Interrater Agreement ◽  
History Taking ◽  
Key Words Ethanol ◽  
Life Threatening ◽  
Ethanol Reactions ◽  
Ethanol Interaction

Objectives Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department. Methods Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words “ethanol use” and “disulfiram”. Their diagnoses were then scored by a panel regarding the probability of an interaction. Results Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either ‘highly likely’, ‘likely’ or ‘possible’ in 54.4% and as ‘doubtful’ or ‘certainly not present’ in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64–0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a ‘possible’ to ‘highly likely’ disulfiram interaction. One patient with a disulfiram overdose died and was considered as a ‘possible’ interaction. Discussion and conclusions A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.

Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin

2012 ◽  
Vol 50 (2) ◽  
Author(s):  
Giuseppe Lippi ◽  
Mario Plebani ◽  
Salvatore Di Somma ◽  
Valter Monzani ◽  
Marco Tubaro ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Clinical Decision Making ◽  
Current Evidence ◽  
Emergency Physicians ◽  
Prognostic Information ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Rule Out

AbstractThe evaluation of patients admitted at the emergency department (ED) for chest pain is challenging and involves many different clinical specialists including emergency physicians, laboratory professionals and cardiologists. The preferable approach to deal with this issue is to develop joint protocols that will assist the clinical decision-making to quickly and accurately rule-out patients with non life-threatening conditions that can be considered for early and safe discharge or further outpatient follow-up, rule-in patients with acute coronary syndrome and raise the degree of alert of the emergency physicians on non-cardiac life-threatening emergencies. The introduction of novel biomarkers alongside the well-established troponins might support this process and also provide prognostic information about acute short-term or chronic long-term risk and severity. Among the various biomarkers, copeptin measurement holds appealing perspectives. The utility of combining troponin with copeptin might be cost-effective due to the high negative predictive value of the latter biomarker in the rule-out of an acute coronary syndrome. Moreover, in the presence of a remarkably increased concentration (e.g., more than 10 times the upper limit of the reference range), to reveal the presence of acute life-threatening conditions that may not necessarily be identified with the use of troponin alone. The aim of this article is to review current evidence about the clinical significance of copeptin testing in the ED as well as its appropriate placing within diagnostic protocols.

Effective Treatment of Hereditary Angioedema with Fresh Frozen Plasma in an Emergency Department

2007 ◽  
Vol 33 (2) ◽  
pp. 137-139 ◽  
Author(s):  
Murat Pekdemir ◽  
Murat Ersel ◽  
Ersin Aksay ◽  
Sedat Yanturali ◽  
Aysun Akturk ◽  
...  
Keyword(s):  
Emergency Department ◽  
Effective Treatment ◽  
Hereditary Angioedema ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals Spontaneous Isolated Celiac Artery Dissection: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 414-416
Author(s):  
Clifford Freeman ◽  
Aaron Lacy ◽  
Aubrey Miner ◽  
Devin Rogers ◽  
Austin Smith ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Celiac Artery ◽  
Chief Complaint ◽  
Diagnostic Tools ◽  
Artery Dissection ◽  
Emergency Physicians ◽  
Threatening Condition ◽  
Life Threatening

Introduction: Abdominal pain is a common chief complaint that can represent a wide breadth of diagnoses, ranging from benign to life-threatening. As our diagnostic tools become more sophisticated, we are able to better identify more causes of potentially life-threatening diseases. One such disease that is relatively unfamiliar to clinicians is spontaneous isolated celiac artery dissection (SICAD). Case Report: We describe a case of a 46-year-old man who presented to our emergency department with a chief complaint of abdominal pain and was found to have a SICAD and was successfully treated with anticoagulation, antihypertensives, and observation. Conclusion: It is important for emergency physicians to keep this potentially life-threatening condition in mind and to know the appropriate first steps once identified.

scholarly journals Timely Diagnosis of Pneumoperitoneum by Point-of-care Ultrasound in the Emergency Department: A Case Series

2021 ◽  
Vol 5 (4) ◽  
pp. 377-380
Author(s):  
Jung Yum ◽  
Taryn Hoffman ◽  
Leily Naraghi
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Elderly Patients ◽  
Point Of Care ◽  
Case Series ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Hollow Viscus ◽  
Timely Diagnosis ◽  
Life Threatening

Introduction: Pneumoperitoneum is a life-threatening diagnosis that requires timely diagnosis and action. We present a case series of patients with perforated hollow viscus who were accurately diagnosed by emergency physicians using point-of-care ultrasound (POCUS) while in the emergency department (ED). Case Series: Three elderly patients presented to the ED with the complaints of syncope, abdominal pain with constipation, and unresponsiveness. The emergency physicians used POCUS to diagnose and then expedite the necessary treatment. Conclusion: Point-of-care ultrasound can be used by emergency physicians to diagnose pneumoperitoneum in the ED.

scholarly journals Emergency department ultrasound — practical and political

CJEM ◽  
1999 ◽  
Vol 1 (02) ◽  
pp. 121-122 ◽  
Author(s):  
Ron Matthews
Keyword(s):  
Emergency Department ◽  
The Body ◽  
Bedside Ultrasound ◽  
Rapid Evaluation ◽  
Emergency Physicians ◽  
Life Threatening

Practically speaking, bedside ultrasound is well within the scope of emergency physicians (EPs) and is gaining acceptance. The literature supports the use of limited, goal-directed ultrasound in the diagnosis of many emergent conditions. EPs should use ultrasound as a tool to answer specific questions (e.g., Is there blood in the belly?); they should not surf the body for clues. ED ultrasound offers rapid evaluation of potentially life-threatening conditions

Large Sternocleidomastoid Haematoma after Minor Trauma in a Postradiation Neck

2012 ◽  
Vol 19 (6) ◽  
pp. 420-422
Author(s):  
YJ Cheon ◽  
BC Kang ◽  
HS Kim
Keyword(s):  
Emergency Department ◽  
Radiation Therapy ◽  
Head And Neck ◽  
Nasopharyngeal Cancer ◽  
Blunt Injury ◽  
Minor Trauma ◽  
Emergency Physicians ◽  
Head And Neck Tumours ◽  
Life Threatening

Sternocleidomastoid (SCM) muscle haematoma after minor blunt injury is rare. Radiation therapy as a treatment for head and neck tumours e.g. nasopharyngeal cancer can result in complications, including fibrosis, scarring, and atrophy. We report a 51-year-old man suffering from massive haematoma of SCM muscle after minor blunt injury to a postradiation neck. Signs of haematoma were absent during his first visit to the emergency department. Emergency physicians need to be aware that bleeding from a postradiation neck, even after minor trauma, may be life threatening.

Individual Replacement Therapy (IRT) with a Pasteurized C1-Inhibitor Concentrate Compared to Prophylaxis with Danazol in Patients with Hereditary Angioedema (HAE) - a Prospective Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1028-1028 ◽  
Author(s):  
Wolfhart Kreuz ◽  
Inmarculada Martinez-Saguer ◽  
Emel Aygoeren-Puersuen ◽  
Eva Rusicke ◽  
Thomas Klingebiel
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Replacement Therapy ◽  
Hereditary Angioedema ◽  
Parvovirus B19 ◽  
Laryngeal Edema ◽  
C1 Inhibitor ◽  
Life Threatening

Abstract Attenuated androgens like danazol are the current treatment of choice for long-term prophylaxis in patients with hereditary angioedema (HAE), who may experience life-threatening acute attacks. Unfortunately, this group of drugs bears the risk of severe side effects (e.g. depression, weight gain, hirsutism, transaminase elevations, liver adenoma and carcinoma, headaches, hypertension, menstrual abnormalities). Objectives: We therefore explored the option to administer a pasteurized, plasma-derived C1-Inhibitor concentrate (C1-INH, Berinert®P) for individual replacement therapy (IRT) in patients with HAE in whom danazol induced severe side effects, was not effective or was contraindicated (e.g. children, pregnant women). Methods: Prospective, observational, intra-individual cross over study, comparing efficacy, safety and quality of life of danazol (prophylaxis) vs. C1-INH (IRT) in 23 patients suffering from severe HAE. Results: Mean annual attack frequency decreased from 48.8 ± 37.1 (danazol) to 8.1 ± 22.1 (C1-INH); p&lt;0.001. All patients who received pasteurized C1-INH were free of life threatening attacks (laryngeal edema) or adverse events, which did occur under long-term prophylaxis with danazol (Fig.). In addition, all quality of life parameters improved significantly; p&lt;0.001. During the entire 20-year observation period with C1-INH in all patients there was no transmission of HIV type 1/2, hepatitis A-, B-, C-, G-viruses, or parvovirus B19. Conclusions: Compared to danazol, IRT with pasteurized C1-INH in patients with severe HAE significantly reduces the frequency of HAE attacks, especially of life-threatening attacks, and significantly improves the quality of life.

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