ABSTRACT
Blunt thoracic trauma may cause cardiac contusion and cardiogenic shock resistant to inotropic support. The use of intra-aortic balloon counterpulsation (IABCP) as a mechanical means of augmenting cardiac function following cardiac contusion is rare with case reports largely limited to its use in young trauma patients. We describe the case of a frail, 80-year-old woman who suffered cardiac contusion in a motor vehicle crash. She developed cardiogenic shock with electrocardiograph changes, elevated troponin T and severe global dysfunction on echocardiography. She was successfully managed with invasive monitoring, inotropic support and IABCP. This case provides support for aggressive resuscitation even in the very elderly as recovery from severe cardiac contusion may be possible.
Subject(s)
Heart Injuries/diagnostic imaging , Intra-Aortic Balloon Pumping , Shock, Cardiogenic/therapy , Ventricular Dysfunction/diagnostic imaging , Wounds, Nonpenetrating/complications , Accidents, Traffic , Aged , Aged, 80 and over , Contusions/blood , Contusions/etiology , Echocardiography , Female , Heart Injuries/etiology , Humans , Shock, Cardiogenic/etiology , Treatment Outcome , Troponin/blood , Ventricular Dysfunction/etiologyABSTRACT
Hanging as a method of attempting suicide is increasing in incidence. A retrospective review of victims of hanging injuries presenting to our institution over a 5-year period was performed. Forty-two cases were reviewed. Drug and/or alcohol ingestion was identified in 70% of cases. There were no cervical spine injuries identified, although two unexpected thoracic spine fractures were found. There was an 88% survival rate, with a low incidence (5%) of poor neurological outcome. The Glasgow Coma Score at scene or on arrival at hospital was found to be a prognostic indicator. Victims without spontaneous cardiac output at scene did not survive, even if cardiopulmonary resuscitation was successful initially.
Subject(s)
Asphyxia/therapy , Cardiopulmonary Resuscitation , Suicide, Attempted , Adolescent , Adult , Aged , Female , Glasgow Coma Scale , Heart Arrest/therapy , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Survival RateABSTRACT
We describe a man vaccinated with the 17D204 strain of yellow fever virus, who subsequently died of yellow fever. Sequencing of the NS5-39 untranslated region showed that the virus isolated from the patient was identical to the vaccine strain of the same batch, and different from wild-type virus. Both viruses contained a mutation, although the association of this mutation with virulence is unknown. Severe, rapidly progressive, and ultimately fatal disease can follow use of the 17D204 vaccine strain. There is need for renewed discussion as to the safety of the vaccine and the indications for its use.
Subject(s)
Hepatitis/etiology , Yellow Fever Vaccine/adverse effects , Adverse Drug Reaction Reporting Systems , Autopsy , Base Sequence , DNA, Viral/analysis , DNA, Viral/genetics , Fatal Outcome , Hepatitis/blood , Hepatitis/diagnosis , Hepatitis/mortality , Humans , Male , Middle Aged , Mutation/genetics , Polymerase Chain Reaction , Vaccines, Attenuated/adverse effects , Yellow fever virus/geneticsABSTRACT
Chiari (or Arnold-Chiari) malformations are a continuum of abnormalities of the hindbrain with the possibility of disordered cerebrospinal fluid flow and craniospinal pressure gradients. We describe the management of a 30-year-old primigravida who presented following a grand mal seizure during the first trimester. A Chiari type I malformation was diagnosed radiologically. She was delivered at term by elective caesarean section using a general anaesthetic technique. The difficulties in anaesthetising the patient with Chiari malformation are considered, and a literature review is presented to illustrate the risk-benefit analysis undertaken.
