急诊医学(英文)最新文献

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Palliative Care in Emergency Medicine. What Are We Missing? 急诊医学中的姑息治疗。我们缺少什么？

急诊医学(英文) Pub Date : 2019-03-29 DOI: 10.4236/OJEM.2019.71002

Lauren Nigolian, R. Gantioque, J. Dexheimer

引用次数: 1

Unexpectedly Good Neurological Outcome after Prolonged Cardiac Arrest 长时间心脏骤停后出人意料的良好神经预后

急诊医学(英文) Pub Date : 2019-03-21 DOI: 10.4236/OJEM.2019.71001

Kohei Ichinohashi, Tomoaki Natsukawa, T. Ueda, Hirotaka Sawano, Y. Hayashi, H. Shigeoka, Y. Kitazawa, A. Hiraide

{"title":"Unexpectedly Good Neurological Outcome after Prolonged Cardiac Arrest","authors":"Kohei Ichinohashi, Tomoaki Natsukawa, T. Ueda, Hirotaka Sawano, Y. Hayashi, H. Shigeoka, Y. Kitazawa, A. Hiraide","doi":"10.4236/OJEM.2019.71001","DOIUrl":"https://doi.org/10.4236/OJEM.2019.71001","url":null,"abstract":"Backgoround: Generally, neurological outcome of patients who have achieved return of spontaneous circulations (ROSC) with abnormal blood tests date and some severe organ complications is extremely poor. Because we experienced a case of good neurological outcome using two different types of extracorporeal membrane oxygenation (ECMO) in spite of prolonged cardiac arrest, we reported this case and reviewed the literature. Case presentation: A 36-year-old male suddenly collapsed at bar after drinking. Initial ECG showed ventricular fibrillation (VF) and subsequently underwent advanced cardiovascular life support. On admission, the ECG still showed VF, but pupillary light reflex was faintly present. Then, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was established 54 minutes after collapse. Blood tests showed lactate was 15.8 mmol/l and NH3 of 251 μg/dl. To improve respiratory function after cardiogenic shock, we changed to veno-venous ECMO (VV-ECMO) and removed superabundant fluid using continuous hemodiafiltration. Patient was discharged on day-26 after a full functional recovery. Conclusion: In severe respiratory disorder, it would be more effective to change to VV-ECMO after recovering from cardiogenic shock while removing superabundant fluid using continuous hemodiafiltration. In predicting the neurological outcome of a post cardiac arrest patient, the presence of a pupillary light reflex may be more significant than NH3 and lactate.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46558190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Case Report on Gallstone Ileus Treated with the Endoscopy 内镜治疗胆石性肠梗阻1例

急诊医学(英文) Pub Date : 1900-01-01 DOI: 10.4236/ojem.2021.94019

Masnobu Kishimoto, Y. Okamoto, T. Muroya, K. Kajino, H. Ikegawa, Y. Kuwagata

{"title":"A Case Report on Gallstone Ileus Treated with the Endoscopy","authors":"Masnobu Kishimoto, Y. Okamoto, T. Muroya, K. Kajino, H. Ikegawa, Y. Kuwagata","doi":"10.4236/ojem.2021.94019","DOIUrl":"https://doi.org/10.4236/ojem.2021.94019","url":null,"abstract":"An 85-year-old female patient visited our emergency department with a history of lower abdominal pain and vomiting. Abdominal plain CT showed small bowel obstruction caused by a gallstone measuring 3 cm in size in the terminal ileum, gas in the gallbladder and adhesion in the gallbladder and duodenum. Thus, gallstone ileus with a cholecystoduodenal fistula was diagnosed. The gallstone was removed by the lower gastrointestinal endoscopy. Because of the high-risk status of the patient surgery, such as cholecystectomy or resection of the cholecystoduodenal fistula was not performed. Upper gastrointestinal endoscopy and radiography revealed the cholecystoduodenal fistula in the anterior wall of the duodenal bulb. Upper gastrointestinal radiography showed that the cholecystoduodenal fistula had been closed spontaneously without any complications on the 13th hospital day. Endoscopic removal of gallstone causing ileus is safe and effective as a less invasive alternative compared with surgery, although it requires condition that endoscope could reach the gallstone. The treatment method for the cholecystoduodenal fistula should be selected keeping in mind that conservative treatment, without surgery, may be effective.","PeriodicalId":57857,"journal":{"name":"急诊医学(英文)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70627472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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