ABSTRACT
Thromboses of the deep veins (DVT) and potential complications are disorders with which physicians need to be well familiarized so they can be recognized and managed. Hypercoagulable states play a significant role in the development of DVT and these disorders must be suspect when thrombosis occurs, especially in the upper extremities. Antiphospholipid antibody syndrome (APS) is one such hypercoagulable state in which autoantibodies are formed against anionic phospholipid complexes. In vivo, these antibodies cause a hypercoagulable state through a number of proposed mechanisms, whereas in vitro they interfere with the assembly of phospholipid complexes, thereby inhibiting coagulation and prolonging various clotting times. Though appearing to be anticoagulated on ancillary testing, patients with APS are actually in a pro-thrombotic state requiring treatment with the anticoagulants heparin and warfarin. This case discussion focuses on the recognition and treatment of thrombotic events in the setting of APS.
Subject(s)
Antiphospholipid Syndrome/diagnosis , Adult , Anticoagulants/therapeutic use , Antiphospholipid Syndrome/blood , Arm/blood supply , Diagnosis, Differential , Female , Humans , Lupus Coagulation Inhibitor/blood , Venous Thrombosis/diagnosis , Venous Thrombosis/drug therapyABSTRACT
This prospective, blinded, observational, efficacy study is one of the first to evaluate ultrasound in detecting esophageal intubation, a significant source of morbidity and mortality. We utilized a convenience sample of patients undergoing elective surgery during July 2004 in an urban teaching hospital. Trained Emergency Physician sonographers performed transtracheal ultrasounds of intubations to identify esophageal intubation. In 35 of the 40 patients enrolled, there was intubation of the trachea, whereas esophageal intubation occurred in five patients. Sonographers correctly identified all five esophageal intubations, for a sensitivity of 100% (95% confidence interval [CI] 48-100). Ultrasound correctly identified 34 of 35 tracheal intubations and misidentified one resulting in a specificity of 97% (95% CI 90-100). It seems that transtracheal ultrasound may be an efficacious adjunct for detecting esophageal intubation.
