Hepatic artery pseudoaneurysm rupture: a case report and review of the literature.

BACKGROUND: Ruptured hepatic artery pseudoaneurysm, a type of visceral artery aneurysm, is a rare condition that is life threatening if not diagnosed and treated rapidly in the emergency department (ED). Patients presenting with this condition require aggressive resuscitation. Endovascular embolization is the first-line treatment option. OBJECTIVES: We present a case of spontaneously ruptured hepatic artery pseudoaneurysm and provide a review of the current literature on this topic, focusing on appropriate ED management. CASE REPORT: A 41-year-old woman with a history of systemic lupus erythematosus and multiple hepatic bilomas presented to the ED in critical condition with sudden onset of severe abdominal pain and hemodynamic instability. She was found to have a ruptured hepatic artery pseudoaneurysm with marked hemoperitoneum on computed tomography angiography. She was aggressively resuscitated and successfully managed via endovascular embolization. CONCLUSION: Ruptured hepatic artery pseudoaneurysm is a life-threatening condition that must be rapidly diagnosed and managed in the ED. Visceral artery aneurysm rupture is a diagnosis that should be considered in any patient presenting to the ED with hemodynamic instability and abdominal pain. Definitive management is with endovascular embolization.

The quality of cardiopulmonary resuscitation using supraglottic airways and intraosseous devices: a simulation trial.

STUDY OBJECTIVE: To assess whether using interventions such as laryngeal mask airways (LMA) and IO lines lead to improved resuscitation in a simulated cardiac arrest when compared to standard methods of endotracheal intubation (ETI) and central line placement. METHODS: Emergency Medicine residents at a single academic center were grouped into teams of four. Each team participated in two simulated ventricular fibrillation cardiac arrests using a high fidelity simulator. Peripheral IV access was unobtainable. Only ETI supplies and a central line kit were available in one case (control) and in the other case those supplies were replaced by an LMA and an EZ-IO drill kit (experimental). Groups were randomized to which set up they were given first. Data examined included time to airway placement, duration and success rate of airway placement, time to vascular access, time to defibrillation, and percent hands off time. RESULTS: 44 residents in 11 teams participated. Mean time to airway was shorter in the experimental group (122.8 seconds (s) vs. 265.6 s, p=0.001). Mean duration of airway attempt was also shorter (7.6 s vs. 22.7 s, p=0.002). Time to access was shorter in the experimental group (49.0 s vs. 194.6 s, p=<0.001). Time to defibrillation and percent hands off time did not significantly differ between the two groups. CONCLUSION: Use of an LMA and an IO device led to significantly faster establishment of an airway and vascular access in a simulated cardiac arrest. The variation in devices did not affect time to defibrillation or percent hands off time.