RESUMEN
The Joint Trauma System in Afghanistan, while designed for the care of injured patients, can provide timely, multimodal, coordinated care for nontraumatic medical emergencies as patients are evacuated from theater. To illustrate this, a case of out-of-hospital cardiac arrest is presented. The patient was able to receive all recommended components of postcardiac arrest care in a timely, coordinated manner at four different medical treatment facilities and while traveling over 8,600 miles with critical care provided en route.
Asunto(s)
Hospitales Militares , Personal Militar , Paro Cardíaco Extrahospitalario/terapia , Adulto , Apoyo Vital Cardíaco Avanzado , Campaña Afgana 2001- , Humanos , Masculino , Transporte de Pacientes , Estados UnidosAsunto(s)
Pancreatitis/complicaciones , Cardiomiopatía de Takotsubo/complicaciones , Enfermedad Aguda , Anciano , Medios de Contraste , Angiografía Coronaria , Diagnóstico Diferencial , Electrocardiografía , Femenino , Humanos , Pancreatitis/diagnóstico por imagen , Cardiomiopatía de Takotsubo/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
A 25-year-old man presented with complaints of nonpleuritic, substernal chest pain, dyspnea, and decreasing exercise tolerance. His vital signs were normal, with the exception of an oxygen saturation level of 93% while breathing room air. During his assessment, he developed transient left facial droop, left arm and leg weakness, and an ataxic gait, which lasted 15 min then resolved spontaneously. Cardiac enzyme levels were elevated, and an ECG revealed T-wave inversion in leads III, aVF, V1, and V2 with evolving ST-segment elevation in leads V3 through V5. The findings of a CT scan and MRI of the head were negative; a Doppler ultrasound of the right lower extremity revealed a thrombus extending from the common femoral vein to the popliteal vein. Cardiac catheterization revealed no evidence of epicardial coronary artery disease. CT pulmonary angiography revealed bilateral pulmonary emboli. Transesophageal echocardiography (TEE) showed a 4-cm, dumbbell-shaped mass lodged in a patent foramen ovale, confirming the diagnosis of an impending paradoxical embolism. The patient was started on therapy with unfractionated heparin, and his thrombus resolved spontaneously by hospital day 5. An impending paradoxical embolism is rare but should be suspected in anyone presenting with evidence of both venous and arterial emboli. The therapeutic options include anticoagulation, thrombolysis, and surgical embolectomy. We would propose that initial treatment with anticoagulation therapy and following with serial TEEs may be appropriate therapy in an otherwise stable patient, with surgical embolectomy or thrombolysis reserved for the treatment of thrombi that do not resolve with anticoagulation therapy or for patients with clinical deterioration.
Asunto(s)
Embolia Paradójica/complicaciones , Ataque Isquémico Transitorio/etiología , Infarto del Miocardio/etiología , Embolia Pulmonar/etiología , Adulto , Ecocardiografía Transesofágica , Embolia Paradójica/diagnóstico , Embolia Paradójica/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Humanos , Masculino , Embolia Pulmonar/diagnóstico por imagen , Radiografía , Trombosis/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagenRESUMEN
The use of performance-enhancing and weight-loss supplements is prevalent in the United States, and over the past decade, there has been growing concern with regard to the safety and efficacy of these products. It is well documented that ephedra-based products are associated with adverse reactions, including serious cardiovascular and neurologic injuries. With new restrictions placed on such products, companies are now marketing caffeine-based ephedra-free herbal supplements. Less is known about the potential side effects of these products. We present the case of a 42-year-old, previously healthy man who developed malignant hypertension and hypertensive retinopathy while taking Hydroxycut, a caffeine-based ephedra-free supplement. To our knowledge, this is the first documented case of hypertensive retinopathy associated with the use of Hydroxycut. Given the lack of investigative studies in regard to their safety and efficacy, judicious care should be taken with the use of all herbal supplements, including those designated as ephedra-free.