Recurrent hemoperitoneum due to aneurysm of the left hepatic artery. Even "Ockham's razor" can fail

The infection of Klebsiella variicola constituted a high morbility and mortality disease in the most of its guest. It is tended to be associated with a septic shock which required an intensive treatment most of the times. The pathological mechanisms are not well-defined. A correlation has been made between this clinical case and one likely pathogenicity factor, which could explain these rates. We present the case of a male patient who presented to the emergency department with a septic shock. The patient eventually developed an hemoperitoneum by the aneurysm of the left hepatic artery which is very unusual.

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Faculty Opinions recommendation of Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1092208.545603 ◽

2007 ◽

Author(s):

Patrick Ray

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

External Validation ◽

Clinical Effectiveness ◽

Goal Directed Therapy ◽

Early Goal Directed Therapy ◽

Sepsis And Septic Shock ◽

Therapy Protocol

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Faculty Opinions recommendation of Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3119960.2804058 ◽

2010 ◽

Author(s):

Walter Hasibeder

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Goal Directed Therapy ◽

Early Goal Directed Therapy ◽

Time To Antibiotics

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Management of sepsis and septic shock in the emergency department

Internal and Emergency Medicine ◽

10.1007/s11739-021-02735-7 ◽

2021 ◽

Author(s):

Francesco Gavelli ◽

Luigi Mario Castello ◽

Gian Carlo Avanzi

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Patient Management ◽

Emergency Physicians ◽

Surviving Sepsis Campaign ◽

Sepsis Management ◽

Early Management ◽

New Information ◽

Sepsis And Septic Shock ◽

Early Phases

AbstractEarly management of sepsis and septic shock is crucial for patients’ prognosis. As the Emergency Department (ED) is the place where the first medical contact for septic patients is likely to occur, emergency physicians play an essential role in the early phases of patient management, which consists of accurate initial diagnosis, resuscitation, and early antibiotic treatment. Since the issuing of the Surviving Sepsis Campaign guidelines in 2016, several studies have been published on different aspects of sepsis management, adding a substantial amount of new information on the pathophysiology and treatment of sepsis and septic shock. In light of this emerging evidence, the present narrative review provides a comprehensive account of the recent advances in septic patient management in the ED.

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Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

Clinical Nursing Research ◽

10.1177/1054773821999688 ◽

2021 ◽

pp. 105477382199968

Author(s):

Anas Alsharawneh

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Length Of Stay ◽

Febrile Neutropenia ◽

Cancer Patients ◽

Emergency Setting ◽

Extended Length ◽

Life Threatening ◽

Sepsis And Septic Shock ◽

Timely Treatment

Sepsis and neutropenia are considered the primary life-threatening complications of cancer treatment and are the leading cause of hospitalization and death. The objective was to study whether patients with neutropenia, sepsis, and septic shock were identified appropriately at triage and receive timely treatment within the emergency setting. Also, we investigated the effect of undertriage on key treatment outcomes. We conducted a retrospective analysis of all accessible records of admitted adult cancer patients with febrile neutropenia, sepsis, and septic shock. Our results identified that the majority of patients were inappropriately triaged to less urgent triage categories. Patients’ undertriage significantly prolonged multiple emergency timeliness indicators and extended length of stay within the emergency department and hospital. These effects suggest that triage implementation must be objective, consistent, and accurate because of the several influences of the assigned triage scoring on treatment and health outcomes.

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Severe sepsis and septic shock in patients transported by prehospital services versus walk in patients to the emergency department

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.08.021 ◽

2020 ◽

Author(s):

Angelica Loza-Gomez ◽

Erik Hofmann ◽

Chun NokLam ◽

Michael Menchine

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Sepsis And Septic Shock

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Multidisciplinary treatment of left hepatic artery pseudoaneurysm after hepatobiliary resection for gallbladder cancer: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0757-8 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Ryusei Yamamoto ◽

Teiichi Sugiura ◽

Yukiyasu Okamura ◽

Takaaki Ito ◽

Yusuke Yamamoto ◽

...

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Liver Failure ◽

Hepatic Artery ◽

Remnant Liver ◽

Left Hepatic Artery ◽

Artery Pseudoaneurysm ◽

Hepatobiliary Resection ◽

Portal Vein Arterialization ◽

Arterial Inflow

Abstract Background When a postoperative hepatic artery pseudoaneurysm develops after massive hepatectomy, both an intervention for the pseudoaneurysm and patency of hepatic artery should be considered because occlusion of the residual hepatic artery results in critical liver failure. However, the treatment strategy for a pseudoaneurysm of the hepatic artery after hepatobiliary resection is not well established. Case presentation A 65-year-old woman underwent right hepatectomy, extrahepatic duct resection, and portal vein resection, for gallbladder cancer. Although the patient had an uneventful postoperative course, computed tomography on postoperative day 6 showed a 6-mm pseudoaneurysm of the hepatic artery. Angiography revealed the pseudoaneurysm located on the bifurcation of the left hepatic artery to the segment 2 artery plus the segment 3 artery and 4 artery. Stent placement in the left hepatic artery was not feasible because the artery was too narrow, and coiling of the pseudoaneurysm was associated with a risk of occluding the left hepatic artery and inducing critical liver failure. Therefore, portal vein arterialization constructed by anastomosing the ileocecal artery and vein was performed prior to embolization of the pseudoaneurysm to maintain the oxygen level of the remnant liver, even if the left hepatic artery was accidentally occluded. The pseudoaneurysm was selectively embolized without occlusion of the left hepatic artery, and the postoperative laboratory data were within normal limits. Although uncontrollable ascites due to portal hypertension occurred, embolization of the ileocolic shunt rapidly resolved it. The patient was discharged on postoperative day 45. Conclusion Portal vein arterialization prior to embolization of the aneurysm may be a feasible therapeutic strategy for a pseudoaneurysm that develops after hepatectomy for hepatobiliary malignancy to guarantee arterial inflow to the remnant liver. Early embolization of arterioportal shunting after confirmation of arterial inflow to the liver should be performed to prevent morbidity induced by portal hypertension.

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Treatment of suspected sepsis and septic shock in children with chronic disease seen in the pediatric emergency department

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.01.026 ◽

2021 ◽

Vol 44 ◽

pp. 56-61

Author(s):

Emily Hegamyer ◽

Nadine Smith ◽

Amy D. Thompson ◽

Andrew D. Depiero

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Chronic Disease ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Suspected Sepsis ◽

Sepsis And Septic Shock

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Atrioesophageal Fistula as a Complication of Radiofrequency Ablation for Atrial Fibrillation

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000522 ◽

2021 ◽

pp. 1-3

Author(s):

Mustafa Emin Canakci ◽

Cengiz Ovali ◽

İrem Aydogdu ◽

Betul Tiryaki Bastug ◽

Obaidullah Ahmadzai ◽

...

Keyword(s):

Atrial Fibrillation ◽

Emergency Department ◽

Radiofrequency Ablation ◽

Gastrointestinal Bleeding ◽

Male Patient ◽

Delayed Diagnosis ◽

Infectious Complications ◽

Morbidity And Mortality ◽

Important Complication ◽

Atrioesophageal Fistula

Abstract Atrioesophageal fistula (AEF) is an important complication of radiofrequency ablation (RFA). Delayed diagnosis is associated with increased morbidity and mortality. Despite the name “atrioesophageal fistula,” fistulas functionally act esophageal to atrial, which accounts for the neurologic and infectious complications. This report presents the management of a 60-year-old male patient who was admitted to the emergency department (ED) with AEF-caused gastrointestinal bleeding. The patient was operated urgently, but he had serious comorbidities and died after the operation. The aim of this case was to evaluate patients who underwent RFA, within 10 days to two months, carefully in the ED and to know the possible complications.

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