Central Venous Catheter Placement in the Left Internal Jugular Vein Complicated by Perforation of the Left Brachiocephalic Vein and Massive Hemothorax: A Case Report.

An elderly male presented for emergent repair of a ruptured abdominal aortic aneurysm. For anticipated volume resuscitation, vasopressor administration, and hemodynamic monitoring, a large-bore central venous catheter was placed in the left internal jugular vein under ultrasound guidance before surgical incision. Initially, there were no readily apparent signs of venous perforation. However, a massive left hemothorax developed because of perforation of the brachiocephalic vein and violation of the pleural space. This case report discusses both prevention and management of such a complication.

Communication with survivors of motor vehicle crashes.

BACKGROUND: Communication with survivors of severe motor vehicle crashes is challenging for emergency physicians. The appropriate timing of death notification to survivors of severe motor vehicle crashes is unknown. OBJECTIVE: To determine communication preferences among survivors of motor vehicle crashes. METHODS: In this cross-sectional survey study, eligible participants included adult survivors of motor vehicle crashes in which there was a death, between 2005 and 2009. Participants were interviewed and responses to 30 questions about communication were recorded verbatim. Responses were coded and grouped for statistical analysis. RESULTS: Among 26 eligible participants, 21 consented to participate (81% participation rate). Survivors' relationship to the deceased included spouse/significant other (33%), friend (24%), child (5%) and no relationship (38%). Survivors had been notified of the death in the prehospital setting (14%), in the emergency department (43%), or later in the inpatient setting (43%). Survivors were notified of the death by family members (43%), indirect communication (14%), police (10%), prehospital provider (10%), or friend (10%). Most participants (88%) had to ask directly to obtain information about the status of others in the crash. Participants demonstrated variable opinions about the ideal time of death notification: some recommended immediately (24%), in the emergency department (24%), in the inpatient setting (29%), or it depends on the circumstances (24%). CONCLUSIONS: Survivors of motor vehicles crashes are notified of fatalities most commonly by family members, most commonly in the hospital setting. Recommendations from survivors about the appropriate timing and setting for death notification varied significantly.