scholarly journals Research Protocol and Case Report of Emergency Department Endovascular Aortic Occlusion (REBOA) in Non-traumatic Cardiac Arrest

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
James Ian Daley ◽  
Kathryn Cannon ◽  
Ryan Buckley ◽  
Ani Aydin ◽  
Igor Latich ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
The United States ◽  
Spontaneous Circulation ◽  
Substantial Improvement ◽  
Aortic Occlusion ◽  
Coronary Perfusion ◽  
Research Protocol ◽  
Arterial Access ◽  
End Tidal

Background There are over 395,000 out-of-hospital cardiac arrests (OHCA) annually in the United States with an estimated 70-90% mortality rate and fewer than 10% surviving with a favorable neurologic outcome. Research in animal models and early human studies suggests that REBOA may play a role in augmenting coronary perfusion during OHCA by reducing blood flow to the lower body and re-directing it towards the heart and brain. We describe our initial case and research protocol to investigate the feasibility of REBOA in the emergency department (ED) for OHCA as an adjunct to ACLS. Methods We plan to enroll twenty patients in a single-arm interventional device study utilizing an exception from informed consent over a two-year period. The primary outcome is feasibility, with secondary outcomes assessing for hemodynamic changes pre- and post-aortic occlusion. Results Enrollment began in January 2020 and is ongoing. For the initial patient, an EP obtained ultrasound guided common femoral arterial access under chest compressions, followed by advancement of the REBOA catheter by an interventional radiologist. Immediately after aortic occlusion, investigators noted a substantial improvement in mean arterial pressure (MAP) (37 mmHg to 50 mmHg) and end tidal carbon dioxide (ETCO2) (33 mmHg to 50 mmHg), with transient but non-sustained return of spontaneous circulation (ROSC). Conclusion This is the first research protocol and case report of ED-REBOA initiation involving emergency physicians (EP) for non-traumatic OHCA. We describe our research protocol and initial case of a patient in OHCA who and underwent successful REBOA placement in the ED as an adjunct to ACLS.

The Use of Intravenous Lidocaine for the Management of Acute Pain Secondary to Traumatic Ankle Injury: A Case Report

2017 ◽  
Vol 31 (1) ◽  
pp. 126-129 ◽  
Author(s):  
Billy Sin ◽  
Diana Gritsenko ◽  
Grace Tam ◽  
Kimberly Koop ◽  
Eva Mok
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Acute Pain ◽  
Single Case ◽  
Case Series ◽  
The United States ◽  
Prescribing Patterns ◽  
Intravenous Lidocaine ◽  
Inpatient Hospitalization ◽  
Acute Distress

Sports-related injuries are a frequent cause of visits to the emergency department (ED) across the United States. A majority of these injuries affect the lower extremities with the ankle as the most frequently reported site. Most sports-related injuries are not severe enough to require inpatient hospitalization; however, they often lead to acute distress and pain which require prompt treatment with analgesics. Approximately 22% of patients who presented to the ED required pharmacotherapy for acute pain management. Opioids have been traditionally used for the management of severe acute pain in the ED; however, there are growing concerns for opioid overuse and misuse. As a result, there is growing controversy regarding the appropriate selection of analgesic agents, optimal dosing, and need for outpatient therapy which has contributed to changes in prescribing patterns of opioids in the ED. Lidocaine, a class 1b antiarrhythmic, has been utilized as an analgesic agent. Its use has been documented for the management of intractable chronic pain caused by cancer, stroke, neuropathies, or nephrolithiasis. However, literature describing the use of intravenous lidocaine for the management of acute pain secondary to trauma is limited to a single case series. This case report describes the use of intravenous lidocaine in a 17-year-old male who presented to the ED in acute distress secondary to ankle dislocation and fracture. This report serves to describe additional clinical experience with intravenous lidocaine for the management of acute pain secondary to ankle fracture in the emergency department.

Miniaturization of a Chest Compressor for Cardiopulmonary Resuscitation

2008 ◽  
Vol 3 (1) ◽  
Author(s):  
Carlos Castillo ◽  
Joe Bisera ◽  
Giuseppe Ristagno ◽  
Wanchun Tang ◽  
Max Harry Weil
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Industry Standard ◽  
Manual Chest Compression ◽  
Operator Fatigue ◽  
Pneumatic Power ◽  
Mechanical Devices ◽  
End Tidal

A miniaturized chest compressor (MCC®) for cardiopulmonary resuscitation (CPR) was designed to serve as a compact portable device to overcome limitations of manual chest compression and of currently marketed mechanical devices. We sought to especially address constraints of size and weight of current devices, together with the need for ease of application and consistent compressions with appropriate force and depth. We further intended that the device allows for ease of evacuation and transport through small spaces. These objectives are responsive to the increasingly recognized requirements for uninterrupted chest compression including that which results from operator fatigue during manual compressions. Utilizing a garment applied to the torso, the device incorporated a telescopic piston for chest compression. The compressor was pneumatically powered so as to avoid the added weight and potential electrical adversity of power delivered by batteries. Pneumatic power was supplied by the same compressed air or oxygen tank, which is routinely carried by professional emergency medical rescuers. The MCC® was tested on a porcine model during cardiac arrest and resuscitation with comparisons to the current industry standard, the Michigan Thumper®. Arterial, carotid, and coronary perfusion pressures, together with end-tidal carbon dioxide as a surrogate for cardiac output, were measured. The MCC® threshold levels of pressure, flow, and end-tidal PCO2 are achieved, which were predictive of successful defibrillation with restoration of spontaneous circulation. We conclude that the MCC® is as effective as that of the established industry standard, the Michigan Thumper®, with the potential advantage of portability and facile application, especially for out-of-hospital resuscitation.

scholarly journals Older female relatives of Covid-19 patients have an unsatisfactory perception of emergency room performance by clinical staf

2021 ◽  
Vol 3 (2) ◽  
pp. 37-38
Author(s):  
Tiziana Ciarambino ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Case Report ◽  
Cardiopulmonary Resuscitation ◽  
Adverse Reactions ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Cardiac Arrhythmia Suppression Trial ◽  
Supraventricular Tachyarrhythmias

Flecainide is a class I antiarrhythmic used for supraventricular tachyarrhythmias with mild adverse reactions. We present a case report in a 78-year-old male that came to the emergency department with atrial fibrillation and was subsequently treated with flecainide. During the infusion, the patient went into cardiac arrest. Cardiopulmonary resuscitation was performed until the return of spontaneous circulation was achieved after 1min and 40 seconds. Conclusion. Some trials, like The Cardiac Arrhythmia Suppression Trial (CAST), consider flecainide to be safe, but our case report, together with several other published reports brings attention to the use of flecainide in pharmacologic cardioversion of atrial fibrillation as a cause of cardiac arrest. Keywords: Older man, atrial fibrillation, emergency department, cardiac arrest, flecainide

scholarly journals Cardiac arrest in an older male patient treated with flecainide for atrial fibrillation

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Tiziana Ciarambino ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Case Report ◽  
Cardiopulmonary Resuscitation ◽  
Male Patient ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Cardiac Arrhythmia Suppression Trial ◽  
Supraventricular Tachyarrhythmias

Flecainide is a class I antiarrhythmic used for supraventricular tachyarrhythmias with mild adverse reactions.We present a case report in a 78-year-old male that came to the emergency department with atrial fibrillation and was subsequently treated with flecainide. During the infusion, the patient went into cardiac arrest. Cardiopulmonary resuscitation was performed until the return of spontaneous circulation was achieved after 1 min and 40 seconds. Conclusion. Some trials, like The Cardiac Arrhythmia Suppression Trial (CAST), consider flecainide to be safe, but our case report, together with several other published reports brings attention to the use of flecainide in pharmacologic cardioversion of atrial fibrillation as a cause of cardiac arrest. Keywords: Older man, atrial fibrillation, emergency department, cardiac arrest, flecainide

scholarly journals Unique ECG Findings in Acute Pulmonary Embolism: STE with Reciprocal Changes and Pathologic Q Wave

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Amanda Grant-Orser ◽  
Brennan Ballantyne ◽  
Wael Haddara
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Case Report ◽  
Acute Pulmonary Embolism ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Presumptive Diagnosis ◽  
Coronary Syndrome ◽  
First Case ◽  
Pulmonary Angiogram

A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1–V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction. His ongoing metabolic acidosis and dependence on an intra-aortic balloon pump, despite adequate cardiac output, prompted a CT pulmonary angiogram which showed multiple segmental filling defects. He was treated for a pulmonary embolism and was discharged 5 days later. Acute pulmonary embolism (APE) has variable clinical presentations. To our knowledge, this is the first case report of an APE presenting with these ECG findings suggestive of myocardial ischemia. In this case report, we discuss the underlying physiological mechanisms responsible and offer management suggestions for emergency department and critical care physicians to better expedite the treatment of APE mimicking acute coronary syndrome on ECG.

scholarly journals Optimizing Non-invasive Oxygenation for COVID-19 Patients Presenting to the Emergency Department with Acute Respiratory Distress: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 327-331
Author(s):  
David Zodda ◽  
Allyson Hanson ◽  
Alyssa Berns
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Respiratory Distress ◽  
The United States ◽  
Nasal Cannula ◽  
Blood Oxygenation ◽  
Severe Hypoxia ◽  
Emergency Physicians ◽  
Non Invasive ◽  
Number Of Patients

Introduction: The novel coronavirus (COVID-19) pandemic has led to an increase in the number of patients presenting to the emergency department (ED) with severe hypoxia and acute respiratory distress. With limited resources and ventilators available, emergency physicians working at a hospital within the epicenter of the United States outbreak developed a stepwise, non-invasive oxygenation strategy for treating COVID-19 patients presenting with severe hypoxia and acute respiratory distress. Case Report: A 72-year-old male suspected of having the COVID-19 virus presented to the ED with shortness of breath. He was found to be severely tachypneic, febrile, with rales in all lung fields. His initial oxygen saturation registered at SpO2 (blood oxygenation saturation) 55% on room air. Emergency physicians employed a novel non-invasive oxygenation strategy using a nasal cannula, non-rebreather, and self-proning. This approach led to a reversal of the patient’s respiratroy distress and hypoxia (SpO2 88-95%) for the following 24 hours.This non-invasive intervention allowed providers time to obtain and initiate high-flow nasal cannula and discuss end-of-life wishes with the patient and his family. Conclusion: Our case highlights a stepwise, organized approach to providing non-invasive oxygenation for COVID-19 patients presenting with severe hypoxia and acute respiratory distress. This approach primarily employs resources and equipment that are readily available to healthcare providers around the world. The intent of this strategy is to provide conventional alternatives to aid in the initial airway management of confirmed or suspected COVID-19 patients.

scholarly journals Severe acute respiratory syndrome coronavirus 2-induced acute aortic occlusion: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Artem Minalyan ◽  
Franklin L. Thelmo ◽  
Vincent Chan ◽  
Stephanie Tzarnas ◽  
Faizan Ahmed
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Severe Acute Respiratory Syndrome ◽  
Vascular Tissue ◽  
Viral Infections ◽  
Fatal Outcome ◽  
Aortic Occlusion ◽  
Bilevel Positive Airway Pressure ◽  
Thrombotic Complications ◽  
Acute Aortic Occlusion

Abstract Background Severe acute respiratory syndrome coronavirus 2 infection can lead to a constellation of viral and immune symptoms called coronavirus disease 2019. Emerging literature increasingly supports the premise that severe acute respiratory syndrome coronavirus 2 promotes a prothrombotic milieu. However, to date there have been no reports of acute aortic occlusion, itself a rare phenomenon. We report a case of fatal acute aortic occlusion in a patient with coronavirus disease 2019. Case report A 59-year-old Caucasian male with past medical history of peripheral vascular disease presented to the emergency department for evaluation of shortness of breath, fevers, and dry cough. His symptoms started 5–7 days prior to the emergency department visit, and he received antibiotics in the outpatient setting without any effect. He was found to be febrile, tachypneic, and hypoxemic. He was placed on supplemental oxygen via a non-rebreather mask. Chest X-ray showed multifocal opacifications. Intravenous antibiotics for possible pneumonia were initiated. Hydroxychloroquine was initiated to cover possible coronavirus disease 2019 pneumonia. During the hospitalization, the patient became progressively hypoxemic, for which he was placed on bilevel positive airway pressure. D-dimer, ferritin, lactate dehydrogenase, and C-reactive protein were all elevated. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was positive. On day 3, the patient was upgraded to the intensive care unit. Soon after he was intubated, he developed a mottled appearance of skin, which extended from his bilateral feet up to the level of the subumbilical plane. Bedside ultrasound revealed an absence of flow from the mid-aorta to both common iliac arteries. The patient was evaluated emergently by vascular surgery. After a discussion with the family, it was decided to proceed with comfort-directed care, and the patient died later that day. Discussion Viral infections have been identified as a source of prothrombotic states due to direct injury of vascular tissue and inflammatory cascades. Severe acute respiratory syndrome coronavirus 2 appears to follow a similar pattern, with numerous institutions identifying elevated levels of thrombotic complications. We believe that healthcare providers should be aware of both venous and arterial thrombotic complications associated with coronavirus disease 2019, including possible fatal outcome.

scholarly journals A Case Report of a Novel Harm Reduction Intervention Used to Detect Opioid Overdose in the Emergency Department

2020 ◽  
Vol 4 (4) ◽  
pp. 548-550
Author(s):  
Kraftin Schreyer ◽  
Saloni Malik ◽  
Andrea Blome ◽  
Joseph D’Orazio
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Harm Reduction ◽  
The United States ◽  
Opioid Overdose ◽  
Waiting Room ◽  
Harm Reduction Intervention ◽  
High Incidence ◽  
Reduction Strategies ◽  
Risk Areas

Introduction: As over 130 people die daily from opioid overdose in the United States, harm reduction strategies have become increasingly important. Because public restrooms are a common site for opioid overdose, emergency department waiting room restrooms (EDWRR) should be considered especially high-risk areas.  Case Report: We present the case of a patient found after a presumed opioid overdose in our EDWRR. Staff were alerted to his condition by a reverse motion detector (RMD), and rapidly treated him with naloxone.  Conclusion: The RMD is a novel intervention that can save lives and should be considered in EDs with a high incidence of opioid overdose.

Resuscitative Endovascular Balloon Occlusion of the Aorta for Refractory Out-of-Hospital Non-Traumatic Cardiac Arrest – A Case Report

2019 ◽  
Vol 34 (05) ◽  
pp. 566-568 ◽  
Author(s):  
Carlo Coniglio ◽  
Lorenzo Gamberini ◽  
Cristian Lupi ◽  
Piergiorgio Cavallo ◽  
Marco Tartaglione ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Animal Studies ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Spontaneous Circulation ◽  
Balloon Occlusion ◽  
Coronary Perfusion ◽  
Traumatic Cardiac Arrest ◽  
Endovascular Balloon Occlusion

AbstractResuscitative endovascular balloon occlusion of the aorta (REBOA) is a percutaneous transfemoral balloon technique used in select centers for resuscitation and temporary hemostasis of bleeding patients. Several animal studies demonstrated that its application in non-traumatic cardiac arrest could enhance cerebral and coronary perfusion during cardiopulmonary resuscitation (CPR); despite this, there are few reports of its application in humans. This is a case report of REBOA application during a refractory out-of-hospital cardiac arrest in a 50-year-old man where Advanced Cardiac Life Support (ACLS) alone was unable to maintain a stable return of spontaneous circulation (ROSC) and Extracorporeal Cardiac Life Support (ECLS) was not available.

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