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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Misdiagnosed acute aortic dissection type A

Abstract

In the absence of diagnostic imaging, chest pain can represent a diagnostic dilemma, especially, if the patient’s condition requires immediate action. We present a case of a patient with signs of obstructive shock that turned out to result from an acute aortic dissection (AAD) and consequent cardiac tamponade. Before the correct diagnosis was made, myocardial infarction and/or pulmonary embolism were suspected and the patient was treated with antithrombotic and anticoagulant drugs, which are contraindicated in AAD. We discuss the correct procedures and treatment in suspected AAD.

Key words: acute aortic dissection, Stanford type A, misdiagnosis

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Emergency Open Cardiac Massage via Subxyphoid Approach in Ruptured Type A Aortic Dissection

Abstract

Patient sustained cardiac tamponade caused by rupture of type A aortic dissection may result in sudden death. Pericardiocentesis is a lifesaving procedure; nevertheless, blood may occlude the catheter and fail to relieve the pressure. However, open-chest cardiac massage in resuscitation has been studied in animal models by some medical centers and laboratories with inspiring results. We report a 58-year-old woman who was transferred from a local hospital with the diagnosis of cardiac tamponade caused by ruptured type A aortic dissection. Pulseless electrical activity followed by cardiac arrest occurred thereafter. Successful resuscitation in the emergency department was achieved using open cardiac massage through the sub-xyphoid region by opening a pericardial window. Therefore, in unstable patients with cardiac tamponade due to aortic dissection, this resuscitative procedure is feasible, safe and efficient.

Keywords: direct cardiac compression, resuscitation, sub-xyphoid approach, cardiac tamponade, aortic dissection

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Anaesthesiological problems in children with congenital laryngeal stenosis

Abstract

Congenital laryngeal stenosis is a rare condition, which can be diagnosed in the early neonatal period. Manifest stenosis can be life threatening. Severe (“critical”) types of stenosis require securing an adequate airway just after the birth, as well as early tracheotomy as a life-saving procedure.
This paper presents a case report of a preterm newborn with severe laryngeal stenosis diagnosed at birth. It was not possible to secure the airway even with endotracheal tubes of the smallest diameter, thus a laryngeal mask (LMA) was placed to provide adequate ventilation and oxygenation. Anaesthesia was administered in the same way during the tracheotomy procedure, which was performed in the earliest hours of the baby’s life.

Key words: laryngeal stenosis, laryngeal mask, newborn, airway

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Acute mesenteric ischemia caused by isolated dissection of the superior mesenteric artery and thrombotic occlusion of its major branches: treatment by systemic thrombolysis with recombinant tissue plasminogen activator (rtPA)

Abstract

Introduction. Isolated superior mesenteric artery (SMA) dissection, without associated aortic dissection, is relatively uncommon. Therefore, there are insufficient data to support a particular therapeutic option in the specific setting of isolated SMA dissection associated with thrombotic complications.
Case report. In this article we describe the diagnosis and treatment of a patient who presented to the Emergency Department with the clinical picture of an acute abdomen and signs suggestive of acute occlusion of the SMA. Diagnostic studies showed an isolated SMA dissection with acute thrombotic occlusion of its main branches. The patient was successfully treated with systemic recombinant tissue plasminogen activator (rtPA) thrombolysis. To the best of our knowledge, this is the first description of a case of isolated SMA dissection associated with thrombotic occlusion of its main branches.
Conclusion. In patients presenting with persistent abdominal pain and unspecific clinical findings, rare causes should be considered because of their life threatening complications. Systemic thrombolysis is a feasible technique for the treatment of isolated SMA dissection associated with thrombotic complications in the absence of bowel necrosis.

Keywords: acute intestinal ischemia, superior mesenteric artery, dissection, thrombosis, systemic lysis, recombinant tissue plasminogen activator (rtPA)

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