scholarly journals Your Automated Implantable Cardioverter Defibrillator Is Not a Bulletproof Vest but It Might Save Your Life

2019 ◽  
Vol 3 (3) ◽  
pp. 191-193
Author(s):  
Tzlil Perahia ◽  
David Kleinman ◽  
Wassim Habre
Keyword(s):  
Emergency Department ◽  
Implantable Cardioverter Defibrillator ◽  
Upper Extremity ◽  
Gunshot Wounds ◽  
Direct Impact ◽  
Left Chest ◽  
Cardioverter Defibrillator ◽  
Arm Pain ◽  
Trauma Activation ◽  
Bulletproof Vest

A 43-year-old male was brought to the emergency department as the highest level trauma activation with complaints of chest and arm pain after sustaining gunshot wounds (GSW). Initial workup was notable for superficial GSWs to the left chest and upper extremity with direct impact to the patient’s automated implantable cardioverter defibrillator. The patient underwent replacement of the device without rewiring and was discharged home without complications.

Gunshot Injuries to the Extremity: Is Immediate General Surgery Presence Needed?

2018 ◽  
Vol 84 (9) ◽  
pp. 1450-1454
Author(s):  
Brian G. Harbrecht ◽  
Keith R. Miller ◽  
Amirrezat Motameni ◽  
Matthew V. Benns ◽  
Matthew C. Bozeman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Injury Severity ◽  
Demographic Data ◽  
Gunshot Wounds ◽  
Operative Intervention ◽  
General Surgeon ◽  
Vascular Repair ◽  
Body Regions ◽  
Trauma Activation

Gunshot wounds (GSW) are becoming increasingly prevalent in urban settings. GSW to the trunk mandate full trauma activation and immediate surgeon response because of the high likelihood of operative intervention. Extremity GSW proximal to the knee/elbow also require full trauma activation based on American College of Surgeons Committee on trauma standards. However, whether isolated extremity GSW require frequent operative intervention is unclear. We evaluated GSW at our Level I trauma center from January 2012 to December 2016. Demographic data and injury patterns were abstracted from the trauma registry and charts. The number of GSW increased yearly but the age, gender, Injury Severity Score and injury pattern did not change (P = ns, not shown). There were 504 GSW that included an extremity and 194 (38%) involved multiple body regions. There were 310 GSW (62%) isolated to an extremity and 176 were proximal to the elbow/knee. If proximal GSW had an Emergency Department systolic blood pressure <90 mm Hg, 53 per cent underwent vascular repair, 12 per cent had soft tissue repair, and 29 per cent required no operation. If proximal GSW had an Emergency Department blood pressure >90 mm Hg, 57 per cent underwent orthopedic repair, 22 per cent required no surgery, and only 13 per cent required vascular repair (P < 0.01). In the absence of other criteria for full trauma activation such as shock, the need for the immediate presence of a general surgeon to perform emergency surgery for a GSW isolated to the extremity is low.

scholarly journals Extracardiac Inappropriate Shocks in Subcutaneous Implantable Cardioverter Defibrillator: Management in Emergency Department

2020 ◽  
Vol 16 (4) ◽  
Author(s):  
Maurizio Santomauro
Keyword(s):  
Emergency Department ◽  
Sudden Cardiac Death ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Cardioverter Defibrillator ◽  
Inappropriate Shocks ◽  
Established Treatment

The subcutaneous implantable cardioverter defibrillator (S-ICD) is an established treatment for the prevention of sudden cardiac death. In the S-ICD studies, inappropriate shocks (IAS) rate were reported to renge between 5% to 25% and to be mainly due to cardiac and noncardiac oversensing.

scholarly journals Twiddler’s Syndrome

2019 ◽  
Vol 3 (3) ◽  
pp. 299-300
Author(s):  
Jason Lesnick ◽  
Benjamin Cooper ◽  
Pratik Doshi
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Implantable Cardioverter Defibrillator ◽  
Chest Radiograph ◽  
Rare Condition ◽  
Operative Intervention ◽  
Cardioverter Defibrillator ◽  
Twiddler’S Syndrome ◽  
Automatic Implantable Cardioverter Defibrillator

Twiddler’s syndrome refers to a rare condition in which a pacemaker or automatic implantable cardioverter-defibrillator (AICD) malfunctions due to coiling of the device in the skin pocket and resultant lead displacement. This image is the chest radiograph (CXR) of a 54-year-old male who presented to the emergency department with chest pain five months after his AICD was placed. The CXR shows AICD leads coiled around the device and the absence of leads in the ventricle consistent with Twiddler’s syndrome. Patients with twiddler’s syndrome should be admitted for operative intervention.

A Case of Convulsion: Brugada Syndrome

2002 ◽  
Vol 9 (2) ◽  
pp. 105-109 ◽  
Author(s):  
CK Shum ◽  
ML Tse ◽  
FL Lau ◽  
WK Chan
Keyword(s):  
Emergency Department ◽  
Ventricular Fibrillation ◽  
Implantable Cardioverter Defibrillator ◽  
Brugada Syndrome ◽  
Heart Diseases ◽  
Icd Implantation ◽  
Cardioverter Defibrillator

A healthy 28-year-old man presented with multiple brief episodes of convulsion. He was found to have ventricular fibrillation which required defibrillation in the emergency department. After exclusion of organic heart diseases, Brugada syndrome was diagnosed and required implantable cardioverter defibrillator (ICD) implantation. The case emphasized the recognition of malignant cardiac dysrrhythmias as a cause for seizures. The management in the emergency department was discussed.

scholarly journals Erector Spinae Plane Block in the Emergency Department for Upper Extremity: A Case Report

2021 ◽  
Vol 5 (3) ◽  
pp. 353-356
Author(s):  
Daniel Lee ◽  
Marc Martel ◽  
Robert Reardon
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Case Report ◽  
Upper Extremity ◽  
Erector Spinae ◽  
Thoracic Pain ◽  
Arm Pain ◽  
Erector Spinae Plane Block ◽  
Brachial Plexus Blockade ◽  
One Year

Introduction: The erector spinae plane block (ESPB) has been described as an effective analgesic modality in the emergency department (ED) for thoracic pain. It has not previously been described to treat ED patients with pain in the upper extremity. Case Report: We present a case of a 52-year-old female who presented to the ED with an acute exacerbation of her chronic radicular left arm pain originating after a fall she sustained one year prior. After a variety of analgesic modalities failed to control her pain, an ESPB was used to successfully treat her pain and facilitate discharge from the ED. Conclusion: A significant portion of patients who present to the ED have underlying chronic pain; however, opioids are a potentially dangerous and ineffective modality to treat chronic pain. In addition to avoiding opiates, the ESPB has the advantage of preserving motor function, thus avoiding the complications associated with brachial plexus blockade.

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