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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: bleeding

An overview of thrombolytic therapy for pulmonary embolism: a single centre experience

Abstract

Pulmonary embolism (PE) is considered to be a major cause of mortality, morbidity and hospitalization in Europe. Haemodynamic benefits of thrombolysis in patients with shock and hypotension are undeniable, but the role of thrombolytic therapy on the outcome of haemodynamically stable patients still remains controversial.

This is a retrospective analysis of patients with acute PE treated with thrombolytic therapy in medical intensive care unit (ICU), University Hospital Sveti Duh, between March 2014 and April 2015 .

Twenty two of 75 (29%) patients with PE received thrombolytic therapy. The mean age of patients was 63 years, 45% were male and 55% female. The major symptoms were: dyspnea (73%), chest pain (18%) and syncope (9%). 27% of patients receiving thrombolytic therapy were haemodynamically unstable and 73% were stable. All patients had an extensive clot burden on computed tomographic pulmonary angiography (CTPA). All haemodynamically stable patients had echocardiographic signs of right ventricular (RV) dysfunction. Troponin I was positive in all haemodynamically unstable patients and in 50% of haemodynamically stable patients. Only one (5%) haemodynamically unstable patient died but not because of PE or therapy complication. All other patients survived and recovered completely. Two patients (9%) had major non-intracranial bleeding complications, which were successfully treated with supportive therapy.

Key words: pulmonary embolism, thrombolytic therapy, right ventricular dysfunction, bleeding

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Administration of protein C concentrates in patients without congenital deficit: a systematic review of the literature

Abstract

Endogenous protein C levels are frequently decreased in septic patients, probably due to increased conversion to activated protein C. Protein C levels inversely correlate with morbidity and mortality of septic patients regardless of age, infecting microorganisms, presence of shock, disseminated intravascular coagulation, degree of hypercoagulation, or severity of illness. Taken together, these considerations suggest a strong correlation between protein C pathways and survival from severe sepsis/septic shock, and reinforce the rationale for the attempts to normalize plasma activity of protein C to improve survival, hamper coagulopathy, and modulate inflammation. We therefore conducted a systematic review of all manuscripts describing protein C concentrates administration in adult and pediatric populations. We identified 28 studies, for a total of 340 patients, 70 of whom died (20.6%). Septic patients were the most represented in this review of case reports and case series. In the majority of these patients sepsis was associated with meningitis, purpura fulminans or disseminated intravascular coagulation. No bleeding complications related to the study drug were reported and most studies underlined normalization of inflammatory markers and of coagulation abnormalities. We conclude that protein C concentrate is an attractive option in septic patients (especially those with meningitis, purpura fulminans, or disseminated intravascular coagulation) and that its cost-benefit ratio must be studied with a large multicenter randomized control trial, possibly including also high risk patients with septic shock and multiple organ failure.

Key words: protein C zymogen, bleeding, amputations, intensive care, critical care.

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Human protein C concentrate in a patient with meningitis and bleeding as a complication of treatment with recombinant activated protein C

Abstract

Some case reports suggest that protein C zymogen supplementation may improve the outcome of patients with congenital or acquired protein C deficiency, such as sepsis-induced purpura fulminans. We describe the case report of a patient suffering from meningitis who developed a bleeding complication after recombinant human activated protein C administration and was successfully treated without any further bleeding complication with protein C concentrate.
Protein C concentrate can be considered in adult patients with meningitis, even if at risk or in the presence of bleeding.

Key words: sepsis, purpura fulminans, protein C, bleeding

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Difficult airway management in the emergency room using an airway scope

Abstract

In the emergency room, some cases need adequate airway management. We present a patient whom we intubated using a new device. This device might be an option in airway management but some considerations should also be taken into account.

Key words: airway management, sco-pe, secretions, bleeding

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