34 research outputs found
Penetrating injury to cauda equina from a missile fragment, completely recovered after delayed surgical removal of ballistic fragment
The use of recombinant activated factor VII in three patients with central nervous system hemorrhages associated with factor VII deficiency
Successful Transplantation of Organs from a Donor with Bacterial Meningitis Caused by Streptococcus pneumonia
Probable right atrial thrombus immediately after recombinant activated factor VII administration
We report the finding of a probable right atrial thrombus in a 33-yr-old male patient with severe head, chest, and abdominal trauma. Refractory coagulopathy and gross haemodynamic instability ensued, which was only partially controlled with massive blood product transfusion and high-dose inotropic support during laparotomy. Continuous transoesophageal echocardiography revealed a probable atrial thrombus partially occluding the right ventricular inflow tract, which appeared immediately after the patient received 100 µg kg–1 of recombinant activated factor VII (rFVIIa) via a left internal jugular central line. This is the first report documenting an immediate temporal relationship between rFVIIa administration and a space-occupying lesion compatible with localized thrombosis, despite ongoing severe systemic coagulopathy. We review the clinical use of rFVIIa and discuss possible factors contributing to this event. © The Board of Management and Trustees of the British Journal of Anaesthesia 200