Anaphylaxis, successful cardiopulmonary resuscitation out of hospital

INTRODUCTION: Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Coronary artery spasm may occur with subsequent myocardial infarction, dysrhythmia, or cardiac arrest. Those with underlying coronary disease are at greater risk of cardiac effects from anaphylaxis. The coronary spasm is related to the presence of histamine-releasing cells in the heart. Cardiopulmonary resuscitation (CPR) is an emergency procedure for manually preserving brain function until further measures to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations. CASE REPORT: This is a case report of a 56 years old female with anaphylactic shock after a successful cardiopulmonary resuscitation (CPR) . After the call our team was send to the patient's household. The patient was on the floor, unconscious. She was cyanotic, with very weak respiratory effort and decrease respiratory rate. As per patient's husband present at the scene , the patient has history of COPD. She took Ibuprofen(tablet400 mg). Her conditon was deteriorating . She was not breathing, and the pulse was not palplable. Cardiac monitor was showing asystoly. CPR was started iv line was placed. After 2 series of compression the patient was intubated. CPR was continued and after 15 minutes the pulse was palpable and the patient was transferred to hospital- Clinical Ceneter for futher investigation and treatment. During the transport her GCS was improving but patient was still unconsciousness. During hospitalization underwent a complete diagnostic and she was treated with H2 blockers, low molecular weight heparin, bronchodilatators and, xanthine therapy. She was discharged after 7 days of hospitalization. CONCLUSION: The sooner CPR is started the better is the outcome. In the first 3 minutes the chance of return of spontaneous circulation is 75%. After 4 minutes is 40%. After 5 minutes the chance of return of spontaneous circulation is minimal

Cardiac arrest after STEMI and importance of early cardiopulmonary resuscitation in non hospital setting-time is life/myocard

INTRODUCTION: In 23 % of cases, sudden cardiac death can be the first manifestation of coronary artery disease. In these cases pulseless VT and VF are the most common causes for cardiac arrest. Early appropriate resuscitation - involving early defibrillation and appropriate implementation of post-cardiac arrest care lead to improved survival and favorable neurologic outcomes. AIM: Case of successful CPR for out of hospital cardiac arrest (home visit), importance of timely and adequate implementation of CPR by EMS staff. MATERIALS AND METHODS: A descriptive overview of data, dispatcher's Protocol, Physician's Protocol and Patient's Discharge Note. CASE PRESENTATION: At 10:29 pm the emergency crew was dispatched to the scene for 73 y/o woman who was suffering chest and left arm pain. Crew arrived at the patient's residence 4 minutes after the call. The patient's daughter states that her mom had SOB and chest pain that radiated to left arm just 30 minutes prior emergency crew arrival. Ther patient did not have any other cardiac risk factors apart from her age and history of oh da izvini hypertension. During immediate examination the patient's vital signs are stable. (BP 140/80, saturating 95% on room air, pulse 90/min.) Physical exam revealed decreased breath sounds billateraly. The patient was in her bed , dyspneic, awake and alert. During the physical exam, the patient lost her consciousness, and became apneic and pulseless. The patient was immediately moved from the bed to the floor and CPR was started and iv lines were placed. Defibrillator pads (AED) were placed and the recorded rhythm was recognized as ventricular fibrillation (VF). DC shock of 150J was delivered. After defibrillation cardiac monitor registered short asystole and later on short self terminated atrial fibrillation. The patient was lethargic for very short period of time, there were visible spontaneous respirations. Her pulse was palpable and her blood pressure was 135/65. The patient was immediately transferred to clinical center. While being transported to hospital, the patient was given 6 L of oxygen by nasal canula and NS 500 ml. During the patients transport an ECG showed sinus rhythm of 85 bpm with ST segment elevation of 2 mm in III and avF and ST segment depression of 2 mm in I, avL.At the hospital, the patient was transfered to CCU. CONCLUSION: Early CPR and early defibrillation are very important to preserve brain function and function of the other organs. As we can see, immediate CPR followed by early defibrillation dramatically improves survival and favorable neurological outcomes

Stress induced cardiomyopathy (Takotsubo cardiomyopathy)

Stress induced cardiomyopathy is clinical syndrome characterized by chest pain, ECG changes - ST elevation or T wave inversion, transitional dysfunction of the apical and/or midsegments of left ventricule and elevated cardiac biomarkers. This syndrome mimics acute coronary syndrome but it is characterized by absence of significant changes in coronary arteries. The symptoms are triggered by intense emotional or physical stress. Thanks to very characteristic ehocardiographic changes the syndrome is called Takatscubo-Japanese name for an octopus trap (which has a shape of cone with narrow neck and wide base). In majority of cases, after severe presentation often complicated by acute coronary weakness, recovery is full. Treatment is symptomatic and supportive. In hospital mortality is less than 1%, but long term prognosis is not well known

Pulmonary embolism as a cause of cardiac arrest: Hypothermia in post-resuscitation period (cooling therapy)

Introduction. Pulmonary embolism as a possible cause of acute heart failure is a potentially fatal condition that can cause death in all age groups. Patients successfully resuscitated after cardiac arrest have a high risk of increased mortality and their poor long­term outcome is often associated with severe neurological complications. Case Outline. This is a case report of a 67­year­old man after a successful cardiopulmonary resuscitation (CPR) which was followed by therapeutic hypothermia (TH). The patient visited the dermatological outpatients’ department with clinical presentation of pain and swelling of the right leg, shortness of breath and chest pain. During examination the patient lost consciousness, stopped breathing and had cardiac arrest. ECG was done which registered asystole. We began CPR. After 59 minutes of resuscitation return of heartbeat was achieved. The patient was transported to the Emergency Department. On admission, after computerized tomography (CT) of the chest confirmed massive pulmonary embolism (PE), the patient was administered thrombolytic therapy with Metalyse (tenecteplase) and anti­coagulation therapy (heparin). After stabilization, therapeutic hypothermia was applied. Combination of EMCOOLSpad on the chest and abdomen and cold Ringer lactate 500 ml at 4°C was flushed. Temperature was decreased to 33°C and kept stabile for 24 hours. After eight days the patient was conscious with a minimal neurological deficit. Conclusion. As shown in this case report, and according to the rich experience elsewhere, cooling therapy after out­of­hospital cardiac arrest and successful CRP may be useful in preventing neurological complications

Pneumothorax, significance of X-ray in ER: Report of two cases

INTRODUCTION: Pneumothorax is abnormal collection of air in the pleural space occurring when there is discontinuity between visceral and parietal pleura. When communication between bronchi, alveololi and pleural cavity occurs, atsmopheric and intrapleural pressure are being equalized, which lead to decrease in lung compliance thus causing collapsed lung. Collapsed lung can be partial and complete. Pneumothorax can be primary spontaneous, secondary spontaneous and traumatic. CASE PRESENTATION: We have shown two patients, bot with primary spontaneous pneumothorax, without previous chest trauma, without primary pulmonary disease, that were diagnosed with pneumothorax radiographically in ER. In first case, 20 y/o male presented in ER with chest pain and dyspnoea. He was smoker. Said symptoms occurred for the first time. Auscultatory, breath sounds were inaudible. After x-ray of the chest were performed, there were detected presence of gas collection in the left apical zone, with collapsed lung parenchyma. Toracal drainage catheter were inserted, thus making possible for reexpansion of collapsed lung and patient, with stable condition, was transferred to the internal medicine ward.In the second case, patient 56 y/o was presented, who had spontaneous recurrent pneumothorax and called for an ambulance because of breathing difficulty which he had had for two days. Auscultatory, breath sounds were diminished. Righ-sided pneumothorax was detected after chest x-ray was performed in ER. Thoracic drainage catheter was inserted, collapsed lung reexpanded and in stable condition, patient was discharged after five days. CONCLUSION: Cases that were demonstrated can point out the fact that auscultatory findings can not with certainty indicate pneumothorax. Radiography, which can reveal partial or complete collapsed lung, along with blood gas analysis which are important for evaluation of the disturbed lung functions, are of the great importance for the treatment of this condition