Thrombus intraventriculaire gauche chez un jeune patient atteint de COVID-19 / Left intraventricular thrombus in a young patient with COVID-19

La COVID-19 est associée à un état d'hypercoagulabilité. L'incidence du thrombus intraventriculaire gauche est relativement faible en absence d'une cardiopathie hypokinétique sévère avec altération de la fraction d'éjection. Nous rapportant le cas d'un homme de 37 ans infecté par le SARS-CoV-2 présentant un thrombus intraventriculaire gauche en absence de cardiopathie connue. Le décès était survenu suiteà un arrêt cardiaque.

Arrêt cardio-respiratoire de l'enfant. Aspects épidémiologiques, thérapeutiques et pronostiques au Sénégal

Introduction : L'Arrêt Cardio-Respiratoire (ACR) est un évènement fréquent dans les services d'urgences et de réanimation pédiatrique. Bien que de nombreuses données soient rapportées dans plusieurs régions du monde, peu sont disponibles en Afrique subsaharienne. L'objectif de cette étude était d'évaluer les aspects épidémiologiques, thérapeutiques et le pronostic des enfants victimes d'ACR au CNHEAR.Patients et méthodes : Il s'agissait d'une étude prospective sur 1 an, concernant les enfants âgés de 0 à 15 ans, ayant présenté un ACR et bénéficié de manœuvres de réanimation au CNHEAR. Les données ont été saisies et analysées avec le logiciel Epi info 3.5.4 et SPSS 24.0. Résultats : Cent-soixante-dix-neuf (179) cas d'ACR ont été enregistrés. Les motifs de consultation les plus fréquents étaient la fièvre et la détresse respiratoire (38,5% chacun). Le délai de consultation moyen était de 3,5 jours. Quarante-neuf virgule sept pour cent (49,7%) avaient consulté dans une structure périphérique avant d'atteindre le niveau central et 13,9% étaient transportés par un transport médicalisé. Les principales circonstances ayant conduit à l'ACR étaient la détresse respiratoire (45,2%), la défaillance hémodynamique (48,7%), et les troubles métaboliques (19,6%). Les pathologies sous- jacentes étaient dominées par le sepsis 20,1%. Au plan thérapeutique, 71,5% avaient eu un massage cardiaque externe. Au décours de la réanimation initiale, le retour à une activité cardio-circulatoire spontanée était de 60,9%. L'évolution secondaire était marquée par la récidive de l'ACR chez 71,6% et finalement le décès de 85,3%. Au final, sur les 179 enfants ayant fait un ACR et bénéficié d'une réanimation, 16 (8,9%) ont survécu et ont été suivis en ambulatoire.Conclusion : La survie après ACR pédiatrique au Sénégal est faible. Des efforts importants restent à faire, notamment une amélioration des ressources matérielles ainsi que des compétences et la formation continue des praticiens en vue d'une meilleure prise en charge des enfants gravement malades

Characterization of in-hospital cardiac arrest in adult patients at a tertiary hospital in Kenya

Background: In-hospital cardiac arrest (IHCA) is defined as a cardiac arrest that occurs in a hospital and for which resuscitation is attempted. Despite the increased morbidity and mortality, IHCA incidence and outcomes remain largely unknown especially in sub-Saharan Africa. This study describes the baseline characteristics, prearrest physiological parameters and the rate of survival to hospital discharge of adult patients with an IHCA at a tertiary hospital in Kenya. Methods: This was a retrospective chart review. Data on patient characteristics, pre-arrest physiological parameters and discharge condition were collected on all patients 18 years of age or older with an IHCA at the Aga Khan University Hospital, Nairobi, from January 2013 to December 2013. Results: The main study population comprised 108 patients. The mean age was 59.3 ± 18.4 years and 63 (58.3%) patients were men. The initial rhythm post cardiac arrest was pulseless electrical activity (41.7%) or asystole (35.2%) in the majority of cases. Hypertension (43.5%), septicaemia (40.7%), renal insufficiency (30.6%), diabetes mellitus (25.9%) and pneumonia (15.7%) were the leading pre-existing conditions in the patients. A Modified Early Warning Score (MEWS) of 5 or more was reached in 56 (67.5%, n= 83) patients before the cardiac arrest. The rate of survival to hospital discharge was 11.1%. All the patients who survived to hospital discharge had a good neurological outcome. Conclusions: Early identification of warning signs that precede many in-hospital arrests may enable institution of treatment to prevent patient deterioration. Local hospitals should be encouraged to provide patients with resuscitation services and equipment in line with evidence-based programmes

Audits of Emergency Trolleys' Contents in Selected Hospitals in Botswana

Cardiac arrest is a life-threatening emergency situation. The outcome depends on timely and effective cardio-pulmonary resuscitation (CPR). Successful CPR attempts in hospitals require well-equipped emergency trolleys and properly functioning equipment; as well as staff members skilled in performing CPR. The study aimed to determine whether the emergency trolleys in Botswana's hospitals' wards or units met the expected standards. The contents of the emergency trolleys in 20 wards or units of two referral government hospitals in Botswana were audited by using a standardised checklist. No hospital ward or unit had all the expected equipment or drugs on its emergency trolley; some units failed to check their emergency trolleys' contents daily. All 20 hospital wards or units that participated in this study; needed to improve the contents and maintenance of their emergency trolleys; otherwise in-hospital CPR efforts in Botswana might be doomed to failure; losing lives that could have been saved if emergency trolleys' equipment and supplies had been up to standard

Knowledge of Cardiopulmonary Resuscitation of Clinicians at a South African Tertiary Hospital

Objectives: The objectives of this study were to assess clinicians' knowledge about evaluating possible cardiac arrest patients and recognising cardiac arrest; to assess clinicians' knowledge about appropriate decisions and actions during cardiopulmonary resuscitation (CPR); and to determine which advanced life support courses had been undertaken and whether they were still valid.Design: This was a descriptive; cross-sectional survey. Setting and subjects: The subjects were doctors who worked in clinical disciplines at a South African tertiary hospital. Using convenience sampling; doctors from each clinical discipline were invited to participate. Those who consented were included; until a sample of 100 was obtained.Outcome measures: A self-administered; closed-ended questionnaire that was based on the course content of the American Heart Association (AHA) Basic Life Support (BLS) course was used. The minimum score of 84; benchmarked against the AHA BLS course; was used to define adequate knowledge.Results: One hundred doctors participated. None of the participants showed adequate knowledge. The mean total score was 35.1 (95 CI: 31.7; 38.6). The mean adult CPR score was 40.6 (95 CI: 37.4; 45.6). The mean paediatric CPR score was 36.6 (95 CI: 37.0; 41.6).Conclusion: The participants' knowledge of resuscitation was poor. This raises considerable concern about the effectiveness of the CPR that is performed. This study highlights the need for adequate training of clinicians in the skill of resuscitation and the importance of developing appropriate CPR training programmes that are accessible; innovative and inexpensive

Pattern of Perioperative Cardiac Arrests at University of Maiduguri Teaching Hospital

Perioperative cardiac arrests and death on the table represent the most serious complications of surgery and anaesthesia. This paper was designed to study their pattern; causes and outcomes following cardiopulmonary resuscitation (CPR) and intensive care unit (ICU) management in our institution. Three year retrospective review of perioperative cardiac arrests and death on operating table following surgical procedure under anaesthesia. For each cardiac arrest or death on the table the sequence of events leading to the arrest was evaluated using case notes; anaesthetic chart and ICU records. Study variables which include demographic data; ASA score; anaesthetic technique; causes and outcome were analysed and discussed. Fourteen perioperative cardiac arrests were encountered following 4051 anaesthetics administered over the three year study period. Twelve out of the fourteen cardiac arrests occurred following general anaesthesia; while the remaining two occurred following spinal anaesthesia. There was no cardiac arrest following local anaesthesia. Children suffered more cardiac arrest than adults.ASAclass III and IV risk status suffered more arrests than ASA I and II. Hypoxia from airway problems was the commonest cause of cardiac arrest followed by septic shock. Monitoring with pulse oximeter was done in only 4 out of the 14 cardiac arrests. Only 2(14) out of 14 cardiac arrests recovered to home discharge; one of them with significant neurological deficit. Majority of arrests were due to hypoxia from airway problems that were not detected early. There is need to improve on patient monitoring; knowledge of CPR and intensive care so as to improve the outcome of perioperative cardiac arrest

Reversible Cortical Blindness Following Successful Surgical Repair of Two Wounds in the Heart

This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest (shock and low cardiac output status); following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle; and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly; but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy; Electroencephalograms (EEGs) and Computed Tomography Scans revealed no abnormalities; apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later; the patient regained his vision gradually and was discharged on the 7th postoperative day without any remarks

A guide to the management of common acute cardiopulmonary problems

This manuscript is merely meant to be a broad guideline to the overall management of acute and or chronic cardiac and respiratory emergencies. It was first concerned with the drawn up as a short guideline 12 years ago to assist junior staff in the management of patients in critical care situations. Its scope has been progressively widened to encompass many of the problems that commonly confront the clinician and are still controversial today. It is by no means a substitute for textbook material but summarises the experience of the compiler which it is hoped will be a value to his colleagues - medical; nursing and paramedical. Not all agents discussed are currently available in this country but a total profile of the therapeutic agents in each section is overviewed. Other physicians may have their own ideas about managment of therapeutic regimes and the presented data is; therefore published as a guideline and reflects basically my own experience. [abstract terminated]