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In this month's EM Quick Hits podcast, Anand Swaminathan on postpartum hemorrhage, Justin Morgenstern on phenobarbital in pediatric status epilepticus, Michelle Klaiman on managed alcohol programs, Andrew Petrosoniak on traumatic cardiacarrest, Brit Long on cholangitis pearls and pitfalls and Bourke Tillman on ED approach to ARDS.
As expected, GLP-1s reduced MI risk by 9%, cardiacarrest by 22%, incident HF by 11%, ischemic stroke by 7%, and hemorrhagic stroke by 14%. Starting with the good news, GLP-1s lowered risks for 42 health outcomes while increasing risks for 19 outcomes. The less good news? Theres still no free lunch in healthcare.
BackgroundAcute pulmonary embolism (APE) is a common and potentially fatal cardiovascular disease that can lead to sudden cardiacarrest in severe cases. During the treatment, the patient received two sessions of external cardiopulmonary resuscitation (ECPR) as supportive care and experienced cerebral hemorrhage.
We periodically review this intriguing ECG finding that is best known for its association with hypothermia — but which may also be seen in association with a number of other entities, including acute infarction and cardiacarrest. My Comment addresses a few additional aspects of this phenomenon.
IntroductionSubarachnoid Hemorrhage (SAH) resulting from the spontaneous rupture of an aneurysm is a rare and highly debilitating condition. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023.
Massive pulmonary embolism (MPE) carries significant 30-day mortality and is characterized by acute right ventricular failure, hypotension, and hypoxia, leading to cardiovascular collapse and cardiacarrest. Considerable heterogeneity in studies is a significant weakness of the available literature.
Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiacarrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm.
This phenomenon has been associated with cardiacarrest; after cardiac surgery; post-cardioversion following a sustained tachyarrhythmia; with certain types of acute cerebrovascular events ( such as subarachnoid hemorrhage ) — and , in association with large acute MI , which could potentially be the clinical scenario in today's case!
Additionally, 38(45%) were ischemic and 34(40%) were hemorrhagic strokes.Of MCA was affected in 22(26%), PCA 8(9%), ACA 8(9%), MCA+ACA 5(6%), and MCA+PCA 2(2%).
Thirty-six patients (36%) presented with cardiacarrest, and 78% (28/36) underwent emergent angiography. Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiacarrest; shock/profound hypotension; GI bleeding; anemia; "sick patient"; etc. ).
A man in his 40s with multitrauma from motor vehicle collision Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated. These include ( among others ) — acute febrile illness — variations in autonomic tone — hypothermia — ischemia-infarction — malignant arrhythmias — cardiacarrest — and especially Hyperkalemia.
NOTE #3: In the context of a long QTc or ischemia — the finding of ST segment and/or T wave alternans may predict the occurrence of malignant ventricular arrhythmias.
The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. Less common etiologies include uremia, bacterial or tubercular pericarditis, chronic idiopathic pericarditis, hemorrhage, and other causes such as autoimmune diseases, radiation, myxedema, etc.
Because the patient had asystole, was resuscitated without difficulty, and had no neurologic function, suspected a cerebral hemorrhage was suspected as the etiology of the arrest, specifically subarachnoid hemorrhage. She went for a head CT and had a severe subarachnoid hemorrhage (SAH) due to ruptured aneurysm.
Introduction:Brain injury is the main cause of death and disability post-cardiacarrest, and hypoxic-ischemic brain injury (HIBI) severity is associated with poor outcomes. Patients with MRI in the first 7 days after cardiacarrest were included. The patients with acute ischemic stroke were older (p<0.01).
This false electrical capture may have made cardiacarrest recognition difficult, and the re-arrest may have gone unrecognized for an unknown amount of time. The patient did have massive pulmonary emboli, but he also had profound intraventricular and subarachnoid hemorrhages. Current 85mA. On ED arrival ROSC is achieved.
Total 494 patients had cardiacarrest and 191 patients out of this 494 had died. Hemorrhagic stroke with an odd ratio of 1.73, ischemic stroke with an odd ratio of 1.72, depression with an odd ratio of 1.5, Hemorrhagic stroke with an odd ratio of 1.73, ischemic stroke with an odd ratio of 1.72, depression with an odd ratio of 1.5,
The primary clinical outcome was a composite of in-hospital mortality, renal failure requiring dialysis, cardiacarrest, or mechanical circulatory support, and the primary safety outcome was major bleeding defined as an intracranial hemorrhage or bleeding that required transfusion was compared in an inverse probability weighted model.
Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiacarrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.
Eligible patients were adults (>=18) admitted with ischemic stroke, intracerebral hemorrhage, or coma after cardiacarrest as the primary reason for hospitalization and who met at least one severity criteria (e.g. NIHSS 10 on day 2).
BackgroundTraumatic cardiacarrest (TCA) poses significant challenges in resuscitation, with extremely high mortality rates, making it a critical issue in emergency and critical care medicine. The patient experienced cardiacarrest upon admission to a local hospital.
The patient was unconscious BEFORE the cardiacarrest, at the same time that she had strong pulses. Therefore, cardiacarrest is NOT the etiology of the coma. Moreover, when someone has immediate resuscitation of an arrest witnessed by paramedics, they rarely have a GCS of 3 (deep coma).
J waves can also be induced by Occlusion MI (5), STEMI mimics including takotsubo and myocarditis complicated by ventricular arrhythmias (6, 7), and subarachnoid hemorrhage with VF (8). The final letter in the SLOWED mnemonic is " D " for "Dead" ( resulting from VT/VF or asystolic cardiacarrest ).
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