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Emergent Surgery (emergent + surgery)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Descending thoracic aortic blood flow parameters during emergent surgery in anesthetized critically ill dogs

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2002
Richard J. Mills DVM
Abstract Objective: To explore the potential value of transesophageally-determined descending thoracic aortic blood flow parameters in critically ill dogs undergoing surgery. Design: Observational case series. Setting: Private small animal referral hospital. Animals: Ten anesthetized critically ill dogs that underwent emergent surgery. Interventions: Placement of the ultrasonic transesophageal probe. Measurements and main results: Transesophageally-determined descending thoracic aortic blood flow, stroke volume, blood velocity, blood acceleration, left ventricular ejection time interval, and heart rate parameters were recorded every minute. Systolic and mean arterial blood pressures were non-invasively determined and recorded at 1,5 minute intervals. The anesthetist and surgeon were blinded to the descending thoracic aortic blood flow parameters. All dogs received fluid challenges as part of their management, and 2 dogs received dopamine. The variability of the descending thoracic aortic blood flow parameters within each dog was greater than has been reported in non-critically ill anesthetized dogs. Consistent trends in descending thoracic aortic blood flow parameters after fluid challenges were not found. An escalating dopamine infusion was, however, accompanied by increasing aortic blood flow, stroke volume, acceleration, and peak velocity. Conclusions: Descending thoracic aortic blood flow parameters may eventually be useful for evaluating the responses to and suggesting the need for cardiovascular interventions during emergent surgeries in anesthetized critically ill canine patients. For this to occur, more experience with this technology will be required. [source]

Role of Contrast Echocardiography in the Assessment of Myocardial Rupture

ECHOCARDIOGRAPHY, Issue 1 2003
Sumit Mittle M.D.
Left ventricular free wall rupture is known to complicate acute myocardial infarction and is the second most common cause of inhospital mortality in this patient population. Contrary to widely held medical belief, this does not always result in immediate fatal pericardial tamponade with hemodynamic collapse. Up to 40% of such occurrences are subacute and may evolve over hours or even days. A high index of suspicion and accurate diagnostic tests are required to identify and treat these patients with emergent surgery. Echocardiography has emerged as an important diagnostic modality to identify this catastrophic condition. Although the literature has scattered reports on the role of transesophageal and transthoracic echocardiography in diagnosing free wall rupture, to date, only one report in the literature used ultrasound contrast agents to better delineate echocardiographic findings. We will present two cases in which echocardiography with use of intravenous ultrasound contrast agents was instrumental in helping to exclude rupture in one case and help identify rupture in another. (ECHOCARDIOGRAPHY, Volume 20, January 2003) [source]

Utility of an Initial D-dimer Assay in Screening for Traumatic or Spontaneous Intracranial Hemorrhage

ACADEMIC EMERGENCY MEDICINE, Issue 9 2001
Mark E. Hoffmann MD
Abstract Objective: To evaluate the sensitivity of a D-dimer assay as a screening tool for possible traumatic or spontaneous intracranial hemorrhage. If adequately sensitive, the D-dimer assay may potentially permit omission of a more expensive computed tomography (CT) scan of the head when such hemorrhage is clinically suspected. Methods: Prospective, consecutive, blinded study of patients (age > 16 years) requiring a CT scan of the head for suspected intracranial hemorrhage over a five-month period at a university, Level I trauma center. All study patients had a serum D-dimer assay obtained prior to their CT scans. Sensitivity and specificity, with 95% confidence intervals (95% CIs), of the enzyme-linked immunosorbent assay (ELISA) D-dimer assay for the detection of intracranial hemorrhage were calculated. Results: Of the 319 patients entered in the study, 25 (7.8%) had a CT scan positive for intracranial hemorrhage. Patients with intracranial hemorrhage were more likely to have a positive D-dimer assay (chi-square ? 13.075, p < 0.001). The D-dimer assay had 21 true-positive and four false-negative tests, resulting in a sensitivity of 84.0% (95% CI ? 63.7% to 95.5%) and a specificity of 55.8% (95% CI ? 55.5% to 55.9%). The four false-negative cases included one small intraparenchymal hemorrhage, one small subarachnoid hemorrhage, one moderate-sized intraparenchymal hemorrhage with mid-line shift, and one large subdural hematoma requiring emergent surgery. Conclusions: Due to the catastrophic nature of missing an intracranial hemorrhage in the emergency department, the D-dimer assay is not adequately sensitive or predictive to use as a screening tool to allow routine omission of head CT scanning. [source]