Acute and Critical Care

Case Report

Neurosurgery
A point-of-care evaluation after visual loss following paraclinoid aneurysm repair: the role of sonographic and pupillometer assessment: Giacomo Bertolini, Ernesto Migliorino, Diego Mazzatenta, Carlo Bortolotti, Raffaele Aspide; Received January 9, 2022 Accepted March 17, 2022 Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00045 [Epub ahead of print]

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Abstract PDF: Visual complications represent common deficits following surgical or endovascular repair of paraclinoid aneurysms. Different etiologies should be investigated to prevent devastating consequences. Herein we present a point-of-care evaluation to investigate sudden visual loss after coiling of a paraclinoid aneurysms. A 20-year-old male were admitted for a sudden headache. Head computed tomography showed a subarachnoid hemorrhage and subsequent angiography revealed a 9-mm left supraclinoid aneurysm of the internal carotid artery treated with endovascular coil embolization. Thirty minutes after intensive care unit admission the patient reported a left amaurosis. To exclude secondary etiologies an immediate evaluation with point-of-care devices (color-doppler and B-mode ultrasound and automated pupillometry) were performed. Sonographic evaluations were negative for ischemic/thrombotic events and neurologic pupil index within physiological ranges provide evidence of third cranial nerve responsiveness. The symptomatology resolved progressively over 120 minutes with low-dose steroid therapy, 30° head-of-bed elevation and blood pressure management. Visual deficits can occur after endovascular procedure and should be investigated. Suspected visual loss is a neurological emergency that deserve a prompt evaluation. Ultrasound and automated pupillometry have proved to be an effective, rapid, reliable and non-invasive combination for a clinical decision-making strategy in the management of post-procedural acute visual deficits.

Review Article

Trauma
Damage control strategy in bleeding trauma patients: Maru Kim, Hangjoo Cho; Acute Crit Care. 2020;35(4):237-241. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00941

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Hemorrhagic shock is a main cause of death in severe trauma patients. Bleeding trauma patients have coagulopathy on admission, which may even be aggravated by incorrectly directed resuscitation. The damage control strategy is a very urgent and essential aspect of management considering the acute coagulopathy of trauma and the physiological status of bleeding trauma patients. This strategy has gained popularity over the past several years. Patients in extremis cannot withstand prolonged definitive surgical repair. Therefore, an abbreviated operation, referred to as damage control surgery (DCS), is needed. In addition to DCS, the likelihood of survival should be maximized for patients in extremis by providing appropriate critical care, including permissive hypotension, hemostatic resuscitation, minimization of crystalloid use, early use of tranexamic acid, and avoidance of hypothermia and hypocalcemia. This review presents an overview of the evolving strategy of damage control in bleeding trauma patients.

Citations

Citations to this article as recorded by

Current Approaches to the Treatment of Traumatic Shock (Review)
D. A. Ostapchenko, A. I. Gutnikov, L. A. Davydova
General Reanimatology.2021; 17(4): 65. CrossRef

Original Articles

Neurosurgery
The RAP Index during Intracranial Pressure Monitoring as a Clinical Guiding for Surgically Treated Aneurysmal Subarachnoid Hemorrhage: Consecutive Series of Single Surgeon: Sung-Chul Jin, Byung Sam Choi, Jung-Soo Kim; Acute Crit Care. 2019;34(1):71-78. Published online February 28, 2019; DOI: https://doi.org/10.4266/acc.2019.00437

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Abstract PDF

Background
It is well known that assessing the RAP index along with intracranial pressure (ICP) monitoring in traumatic brain injury patients is helpful. We will discuss the usefulness of this assessment tool as a clinical guide for surgically treated poor grade aneurysmal subarachnoid hemorrhage (SAH).
Methods
This retrospective study included 35 patients with aneurysmal SAH who presented with World Federation of Neurosurgical Societies (WFNS) grade V SAH and received surgical treatment from January 2013 to December 2018. Emergency surgical clipping, hematoma removal, extraventricular drainage, and if needed, wide decompressive craniectomy were combined as the proper surgical treatments. Outcomes were assessed based on in-hospital survival and the Glasgow outcome scale score at 14-day follow-up. We compared the mortality rate of two groups of seven patients: ICP monitoring only (n=5) and ICP monitoring combined with the RAP index (n=2).
Results
The in-hospital 14-day mortality rate by brain lesion was 48.5% (n=17). Seven patients had real-time ICP monitoring. Before 2018, three of five patients with poor WFNS grade who received real-time ICP monitoring only died. There were no deaths in the group of two patients receiving real-time ICP monitoring and the RAP index.
Conclusions
Our data indicate that combining the RAP index and ICP monitoring can be used as markers for critical intracranial physiological parameters in poor grade WFNS patients.

Citations

Citations to this article as recorded by

Multimodal Neurologic Monitoring in Children With Acute Brain Injury
Jennifer C. Laws, Lori C. Jordan, Lindsay M. Pagano, John C. Wellons, Michael S. Wolf
Pediatric Neurology.2022; 129: 62. CrossRef
Intracranial pressure: current perspectives on physiology and monitoring
Gregory W. J. Hawryluk, Giuseppe Citerio, Peter Hutchinson, Angelos Kolias, Geert Meyfroidt, Chiara Robba, Nino Stocchetti, Randall Chesnut
Intensive Care Medicine.2022; 48(10): 1471. CrossRef
The application value of CT radiomics features in predicting pressure amplitude correlation index in patients with severe traumatic brain injury
Jiaqi Liu, Yingchi Shan, Guoyi Gao
Frontiers in Neurology.2022;[Epub] CrossRef

Trauma
Usefulness of Rotational Thromboelastometry as a Mortality Predictor of Hyperfibrinolysis in Patients with Severe Trauma: Ji Soo Kim, Il Jae Wang, Seok Ran Yeom, Suck Ju Cho, Jae Hun Kim, June Pill Seok, Seong Hwa Lee, Byung Gwan Bae, Mun Ki Min; Acute Crit Care. 2018;33(3):162-169. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00199

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Abstract PDF

Background
Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma.
Methods
Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed.
Results
During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P<0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality.
Conclusions
Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma.

Citations

Citations to this article as recorded by

A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage
Finn Gunn, Rheanna Stevenson, Ateeq Almuwallad, Andrea Rossetto, Paul Vulliamy, Karim Brohi, Ross Davenport
Journal of Trauma and Acute Care Surgery.2024; 96(2): 216. CrossRef
A retrospective validation of ROTEM algorithms for detecting hyperfibrinolysis demonstrates poor agreement for prediction of in-hospital mortality and transfusion requirement in a general, non-cardiac, surgical population
Leon Rosebery, Matthew Miller, Peter Loizou, Shir Jing Ho, Keith J. Adkins, Kush Deshpande
Thrombosis Research.2023; 229: 170. CrossRef
Questions about COVID-19 associated coagulopathy: possible answers from the viscoelastic tests
Vittorio Pavoni, Lara Gianesello, Maddalena Pazzi, Pietro Dattolo, Domenico Prisco
Journal of Clinical Monitoring and Computing.2022; 36(1): 55. CrossRef
Clinical value of early assessment of hyperfibrinolysis by rotational thromboelastometry during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands
Marije Tahitu, Paul I. Ramler, Ada Gillissen, Camila Caram‐Deelder, Dacia D. C. A. Henriquez, Moniek P. M. de Maat, Johannes J. Duvekot, Jeroen Eikenboom, Kitty W. M. Bloemenkamp, Thomas van den Akker, Johanna G. van der Bom
Acta Obstetricia et Gynecologica Scandinavica.2022; 101(1): 145. CrossRef
ROTEM diagnostic capacity for measuring fibrinolysis in neonatal sepsis
Maria Lampridou, Rozeta Sokou, Andreas G. Tsantes, Martha Theodoraki, Aikaterini Konstantinidi, Georgios Ioakeimidis, Stefanos Bonovas, Marianna Politou, Serena Valsami, Zoe Iliodromiti, Theodora Boutsikou, Nicoletta Iacovidou, Georgios Nikolopoulos, Argi
Thrombosis Research.2020; 192: 103. CrossRef
The Immunologic Effect of Early Intravenous Two and Four Gram Bolus Dosing of Tranexamic Acid Compared to Placebo in Patients With Severe Traumatic Bleeding (TAMPITI): A Randomized, Double-Blind, Placebo-Controlled, Single-Center Trial
Philip C. Spinella, Kimberly A. Thomas, Isaiah R. Turnbull, Anja Fuchs, Kelly Bochicchio, Douglas Schuerer, Stacey Reese, Adrian A. Coleoglou Centeno, Christopher B. Horn, Jack Baty, Susan M. Shea, M. Adam Meledeo, Anthony E. Pusateri, Jerrold H. Levy, An
Frontiers in Immunology.2020;[Epub] CrossRef

Case Report

Pulmonary
Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period: In Soo Han, Bo Mi Han, Soo Yeon Jung, Jun Rho Yoon, Eun Yong Chung; Acute Crit Care. 2018;33(3):191-195. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2016.00689

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Abstract PDF

Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.

Citations

Citations to this article as recorded by

A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature
Larri Rudman, Javier B Chambi-Torres, Farah Chohan, Mohammad Aftab, Xinyu Cao, George Michel
Cureus.2023;[Epub] CrossRef
Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report
Haruna Yamaki, Masaru Ejima, Nozomi Sato, Kei Aoyagi, Tatsushi Kozawa, Seishi Higashi, Koji Takayama, Satoko Hanada, Reiko Taki
Respiratory Endoscopy.2023; 1(2): 95. CrossRef
Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report
Hyung Joon Park, Seung Ho Park, Un Tak Woo, Sang Yun Cho, Woo Jae Jeon, Woo Jong Shin
World Journal of Clinical Cases.2021; 9(6): 1408. CrossRef
Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report
Yumin Jo, Jagyung Hwang, Jieun Lee, Hansol Kang, Boohwi Hong
Journal of Medical Case Reports.2021;[Epub] CrossRef
Incidence of negative-pressure pulmonary edema following sugammadex administration during anesthesia emergence: A pilot audit of 27,498 general anesthesia patients and literature review
Chia-Li Kao, Chuan-Yi Kuo, Yi-Kai Su, Kuo-Chuan Hung
Journal of Clinical Anesthesia.2020; 62: 109728. CrossRef

Original Articles

Hematology
Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage: Soon Chang Park, Seok Ran Yeom, Sang Kyoon Han, Young Mo Jo, Hyung Bin Kim; Korean J Crit Care Med. 2017;32(4):333-339. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00787

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Abstract PDF

Background
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
Methods
A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
Results
Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
Conclusions
This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.

Citations

Citations to this article as recorded by

Role of recombinant factor VIIa in the clinical management of severe postpartum hemorrhage: consensus among European experts
D. Surbek, J. Blatný, M. Wielgos, N. Acs, H. Edwards, O. Erez, J. L. Bartha, H. Madar, F. J. Mercier, D. Schlembach, G. C. Di Renzo
The Journal of Maternal-Fetal & Neonatal Medicine.2024;[Epub] CrossRef
Coagulation management and transfusion in massive postpartum hemorrhage
Christina Massoth, Manuel Wenk, Patrick Meybohm, Peter Kranke
Current Opinion in Anaesthesiology.2023; 36(3): 281. CrossRef
Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care
Sibylle Kietaibl, Aamer Ahmed, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa, Giedrius Barauskas, Edoardo De Robertis, David Faraoni, Daniela C. Filipescu, Dietmar Fries, Anne Godier, Thorsten Haas, Matthias Jacob, Marcus D. Lancé, Juan V. Llau, Jens Me
European Journal of Anaesthesiology.2023; 40(4): 226. CrossRef

Neurosurgery
Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage: Na Rae Yang, Kyung Sook Hong, Eui Kyo Seo; Korean J Crit Care Med. 2017;32(2):190-196. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00857

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Abstract PDF

Background
Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC.
Methods
We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC.
Results
Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024).
Conclusions
AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.

Citations

Citations to this article as recorded by

Rare or Overlooked Cases of Acute Acalculous Cholecystitis in Young Patients with Central Nervous System Lesion
Seong-Hun Kim, Min-Gyu Lim, Jun-Sang Han, Chang-Hwan Ahn, Tae-Du Jung
Healthcare.2023; 11(10): 1378. CrossRef
Acute cholecystitis as a rare and overlooked complication in stroke patients
Myung Chul Yoo, Seung Don Yoo, Jinmann Chon, Young Rok Han, Seung Ah Lee
Medicine.2019; 98(9): e14492. CrossRef
Acute Acalculous Cholecystitis in Neurological Patients; Clinical Review, Risk Factors, and Possible Mechanism
See Won Um, Hak Cheol Ko, Seung Hwan Lee, Hee Sup Shin, Jun Seok Koh
Journal of Neurointensive Care.2019; 2(2): 77. CrossRef

Case Reports

Obstetric/Emergency
Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage: Kwang Ho Lee, Seong Jin Choi, Yeong Gwan Jeon, Raing Kyu Kim, Dae Ja Um; Korean J Crit Care Med. 2016;31(4):359-363. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00325

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Abstract PDF

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.

Citations

Citations to this article as recorded by

Persephin as a diagnostic marker of acute brain injury in critically ill newborns: a clinical trial
A. A. Zadvornov, E. V. Grigoriev
Fundamental and Clinical Medicine.2021; 6(3): 15. CrossRef

Pulmonary
Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust: Sun Mi Choi, Jiwon Koh, Sang-Min Lee, Jinwoo Lee; Korean J Crit Care Med. 2016;31(2):173-177. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.173

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Abstract PDF: Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.

Neurosurgery/Hematology
Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis: Hyun Jin Baek, Doo Hyuk Lee, Kyu Hyung Han, Young Min Kim, Hyunbeom Kim, Byeongwook Cho, Inkuk Lee, Kanghyun Choi, Hojin Yong, Goohyeon Hong; Korean J Crit Care Med. 2016;31(2):134-139. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.134

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Abstract PDF

In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.

Citations

Citations to this article as recorded by

Abdominal mass in a septic infant: Case of a fatal intraluminal intestinal hematoma
Mana Taweevisit, Paul Scott Thorner
Pediatric Hematology Oncology Journal.2021; 6(3): 139. CrossRef
Perforated Mesenteric Cyst with Sepsis and Neurological Complication in a 9 Month Old Child
Mandal KC, Saha D, Halder P, Chakraborty P, Debnath B, Mukhopadhyay B
Asploro Journal of Pediatrics and Child Health.2020; 2(1): 30. CrossRef

Neurosurgery
Delayed Traumatic Subarachnoid Hemorrhage in a Polytraumatized Patient with Disseminated Intravascular Coagulation: Jiwoong Oh, Wonyeon Lee, Ji Young Jang, Pilyoung Jung, Sohyun Kim, Jongyeon Kim, Jinsu Pyen, Kum Whang, Sungmin Cho; Korean J Crit Care Med. 2015;30(4):336-342. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.336

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Abstract PDF

The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multipletrauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and antithrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.

Citations

Citations to this article as recorded by

Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments?
Bedriye Müge Sönmez, Emirhan Temel, Murat Doğan İşcanlı, Fevzi Yılmaz, Uğur Gülöksüz, Selçuk Parlak, Özhan Merzuk Uçkun
Journal of the National Medical Association.2019; 111(2): 210. CrossRef

Trauma/Vascular Surgery
Resuscitative Endovascular Balloon Occlusion of the Aorta in a Trauma Patient with Hypovolemic Shock: Hong Kyung Shin, Ho-Seong Han, Taeseung Lee, Do-Joong Park, Kyuwhan Jung, Kyuseok Kim; Korean J Crit Care Med. 2015;30(2):115-118. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.115

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Abstract PDF

Hemorrhagic shock is one of the most common causes of death in patients with multiple trauma and therefore rapid control of bleeding is the main strategy to save these patients. Resuscitative balloon occlusion of the aorta (REBOA) has been applied in several trauma cases and because of the effectiveness of this procedure it has been adopted in the trauma field. Herein, we report the first successful case of REBOA in Korea performed on a 46-year-old man with hemorrhagic shock after a fall from a height of 14-stories. The patient visited our hospital emergency room with hypovolemic shock, we performed Resuscitative Endovascular Balloon Occlusion of the Aorta under bed side blind technique. His vital sign was stabilized after procedure, then we could performed endovascular bleeding control. The patient was discharged on his 33rd in-hospital day without invasive procedure and major scar.

Citations

Citations to this article as recorded by

Implementation of resuscitative endovascular balloon occlusion of the aorta at the Korean Regional Trauma Center
Youngeun Park, Byungchul Yu, Giljae Lee, Jungnam Lee, Kangkook Choi, Ahram Han
Hong Kong Journal of Emergency Medicine.2021; 28(3): 129. CrossRef
Case Series of Zone III Resuscitative Endovascular Balloon Occlusion of the Aorta in Traumatic Shock Patients
Byungchul Yu, Gil Jae Lee, Kang Kook Choi, Min A Lee, Jihun Gwak, Youngeun Park, Jung Nam Lee
Journal of Trauma and Injury.2020; 33(3): 162. CrossRef

Pulmonary
Diffuse Alveolar Hemorrhage Confirmed by Bronchoalveolar Lavage in a Patient with Hemoptysis after Sildenafil Use for Erectile Dysfunction: Kyoung Min Moon, Sun Young Jung, Min Soo Han, Yongseon Cho, Young Min Rah, Jong Woo Kim; Korean J Crit Care Med. 2015;30(1):31-33. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.31

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Abstract PDF: A 81-year-old man was referred for respiratory failure by emergency medical technicians. He admitted at intensive care unit for ventilator treatment. Several hours before admission, he took sildenafil 100 mg for erectile dysfunction without prescription. The episodes of hemoptysis occurred several hours later. Computed tomography revealed multifocal diffuse ground-glass attenuation in both lungs. And the more we performed bronchoalveolar lavage, the more the color of it was turned into red. We treated him with empirical antibiotics and tranexamic acid, and hemoptysis was stopped in one day after admission. But in the 5th admission day, he died from sepsis combined with pneumonia caused by Acinetobacter baumannii abruptly.

Gastroenterology
Successful Bridging Hemostasis Using a Sengstaken-Blakemore Tube in Massive Rectal Variceal Bleeding: Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon; Korean J Crit Care Med. 2014;29(3):237-240. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.237

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Abstract PDF

Life-threatening rectal variceal bleeding is a rare complication of liver cirrhosis. Various therapeutic interventions including endoscopic variceal ligation and percutaneous transvenous obliteration have been proposed to control significant rectal variceal bleeding. However, these definite hemostasis modalities are not readily available and require an experienced endoscopist or interventional radiologist. Therefore, bridging therapy to control active bleeding is necessary especially in patients with massive bleeding. We report a case of massive rectal variceal bleeding in which a Sengstaken-Blakemore tube was effective at stopping the bleeding until percutaneous transvenous obliteration could be performed.

Citations

Citations to this article as recorded by

Anorectal emergencies: WSES-AAST guidelines
Antonio Tarasconi, Gennaro Perrone, Justin Davies, Raul Coimbra, Ernest Moore, Francesco Azzaroli, Hariscine Abongwa, Belinda De Simone, Gaetano Gallo, Giorgio Rossi, Fikri Abu-Zidan, Vanni Agnoletti, Gianluigi de’Angelis, Nicola de’Angelis, Luca Ansaloni
World Journal of Emergency Surgery.2021;[Epub] CrossRef

Cardiology/Neurology
Intracranial Hemorrhage Identified in the Early Stage after Applying Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation: Yong Hwan Kim, Kyoung Yul Lee, Seong Youn Hwang; Korean J Crit Care Med. 2014;29(3):197-200. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.197

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Abstract PDF: Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation, but neurologic complications may develop. Cardiac arrest is a fairly common complication following severe intracranial hemorrhage; this complication is encountered both out-of-hospital and in-hospital with variable frequency. To prevent cerebral complications, to detect the cause of cardiac arrest, and to guide further treatment, early neuroimaging study is needed. Herein, we report a case of intracranial hemorrhage identified after extracorporeal cardiopulmonary resuscitation, in which the cause of the hemorrhage was not clear.

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