[Intra-abdominal bleeding after myocardial infarction with cardiopulmonary resuscitation and thrombolytic therapy].
Identifieur interne : 000980 ( PubMed/Corpus ); précédent : 000979; suivant : 000981[Intra-abdominal bleeding after myocardial infarction with cardiopulmonary resuscitation and thrombolytic therapy].
Auteurs : H A Adams ; C S Schmitz ; G. Block ; C. SchlichtingSource :
- Der Anaesthesist [ 0003-2417 ] ; 1995.
English descriptors
- KwdEn :
- Abdomen, Adult, Anesthesia, Cardiopulmonary Resuscitation (adverse effects), Electrocardiography, Fibrinolytic Agents (adverse effects), Fibrinolytic Agents (therapeutic use), Humans, Male, Middle Aged, Myocardial Infarction (complications), Postoperative Hemorrhage (chemically induced), Postoperative Hemorrhage (etiology), Postoperative Hemorrhage (physiopathology).
- MESH :
- chemical , adverse effects : Fibrinolytic Agents.
- adverse effects : Cardiopulmonary Resuscitation.
- chemically induced : Postoperative Hemorrhage.
- complications : Myocardial Infarction.
- etiology : Postoperative Hemorrhage.
- physiopathology : Postoperative Hemorrhage.
- chemical , therapeutic use : Fibrinolytic Agents.
- Abdomen, Adult, Anesthesia, Electrocardiography, Humans, Male, Middle Aged.
Abstract
Adverse effects of resuscitation due to closed-chest cardiac massage are common, and the incidence is increased when an incorrect technique is used. Nevertheless, thrombolytic therapy of a myocardial infarction can become necessary even after cardiopulmonary resuscitation (CPR). In these patients, the risk of thrombolytic therapy-induced bleeding is immanent. CASE REPORTS. Within 9 months, two male patients aged 44 and 52 years were admitted to the intensive care unit after out-of-hospital CPR for myocardial infarction with cardiac arrest. In both cases, thrombolytic therapy was undertaken due to the cardiovascular situation or echocardiographic results. Thrombolytic therapy was successful with regard to the ECG changes, but a few hours later both patients demonstrated increasing cardiovascular instability. After abdominal sonography, intra-abdominal bleeding was suspected. Emergency laparotomy became unavoidable, although the coagulation profile was severely impaired in both patients (Tables 1 and 2). Anaesthetic management was characterised by introduction of central venous and intra-arterial catheters, replacement of volume and oxygen carriers using large-bore IV lines, restoration of coagulation factors with fresh frozen plasma, and the choice of "modified neuroleptanaesthesia" with blood pressure-adjusted, small doses of fentanyl, midazolam, and pancuronium. Intraoperatively, a liver injury due to closed-chest cardiac massage was found in both cases. The postoperative courses were complicated by respiratory problems, which led to prolonged mechanical ventilation, but both patients survived without remarkable neurological deficits. CONCLUSION. In patients with thrombolytic therapy after CPR and persisting cardio-vascular instability, a resuscitation injury with consequent haemorrhagic shock should be suspected. For diagnosis, chest X-ray films and abdominal and thoracic sonography are useful and practicable, even at the bedside. Anaesthetic management should focus on adequate monitoring, replacement of volume and oxygen carriers, fast restoration of plasma coagulation, and careful, blood pressure-adjusted maintenance of anaesthesia.
PubMed: 7573908
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pubmed:7573908Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">[Intra-abdominal bleeding after myocardial infarction with cardiopulmonary resuscitation and thrombolytic therapy].</title><author><name sortKey="Adams, H A" sort="Adams, H A" uniqKey="Adams H" first="H A" last="Adams">H A Adams</name><affiliation><nlm:affiliation>Abteilung für Anaesthesie und Intensivmedizin, Marienkrankenhaus Trier-Ehrang.</nlm:affiliation></affiliation></author><author><name sortKey="Schmitz, C S" sort="Schmitz, C S" uniqKey="Schmitz C" first="C S" last="Schmitz">C S Schmitz</name></author><author><name sortKey="Block, G" sort="Block, G" uniqKey="Block G" first="G" last="Block">G. Block</name></author><author><name sortKey="Schlichting, C" sort="Schlichting, C" uniqKey="Schlichting C" first="C" last="Schlichting">C. Schlichting</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="1995">1995</date><idno type="RBID">pubmed:7573908</idno><idno type="pmid">7573908</idno><idno type="wicri:Area/PubMed/Corpus">000980</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000980</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">[Intra-abdominal bleeding after myocardial infarction with cardiopulmonary resuscitation and thrombolytic therapy].</title><author><name sortKey="Adams, H A" sort="Adams, H A" uniqKey="Adams H" first="H A" last="Adams">H A Adams</name><affiliation><nlm:affiliation>Abteilung für Anaesthesie und Intensivmedizin, Marienkrankenhaus Trier-Ehrang.</nlm:affiliation></affiliation></author><author><name sortKey="Schmitz, C S" sort="Schmitz, C S" uniqKey="Schmitz C" first="C S" last="Schmitz">C S Schmitz</name></author><author><name sortKey="Block, G" sort="Block, G" uniqKey="Block G" first="G" last="Block">G. Block</name></author><author><name sortKey="Schlichting, C" sort="Schlichting, C" uniqKey="Schlichting C" first="C" last="Schlichting">C. Schlichting</name></author></analytic><series><title level="j">Der Anaesthesist</title><idno type="ISSN">0003-2417</idno><imprint><date when="1995" type="published">1995</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Abdomen</term><term>Adult</term><term>Anesthesia</term><term>Cardiopulmonary Resuscitation (adverse effects)</term><term>Electrocardiography</term><term>Fibrinolytic Agents (adverse effects)</term><term>Fibrinolytic Agents (therapeutic use)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Myocardial Infarction (complications)</term><term>Postoperative Hemorrhage (chemically induced)</term><term>Postoperative Hemorrhage (etiology)</term><term>Postoperative Hemorrhage (physiopathology)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Fibrinolytic Agents</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Cardiopulmonary Resuscitation</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Postoperative Hemorrhage</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Myocardial Infarction</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Postoperative Hemorrhage</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Postoperative Hemorrhage</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Fibrinolytic Agents</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Abdomen</term><term>Adult</term><term>Anesthesia</term><term>Electrocardiography</term><term>Humans</term><term>Male</term><term>Middle Aged</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Adverse effects of resuscitation due to closed-chest cardiac massage are common, and the incidence is increased when an incorrect technique is used. Nevertheless, thrombolytic therapy of a myocardial infarction can become necessary even after cardiopulmonary resuscitation (CPR). In these patients, the risk of thrombolytic therapy-induced bleeding is immanent. CASE REPORTS. Within 9 months, two male patients aged 44 and 52 years were admitted to the intensive care unit after out-of-hospital CPR for myocardial infarction with cardiac arrest. In both cases, thrombolytic therapy was undertaken due to the cardiovascular situation or echocardiographic results. Thrombolytic therapy was successful with regard to the ECG changes, but a few hours later both patients demonstrated increasing cardiovascular instability. After abdominal sonography, intra-abdominal bleeding was suspected. Emergency laparotomy became unavoidable, although the coagulation profile was severely impaired in both patients (Tables 1 and 2). Anaesthetic management was characterised by introduction of central venous and intra-arterial catheters, replacement of volume and oxygen carriers using large-bore IV lines, restoration of coagulation factors with fresh frozen plasma, and the choice of "modified neuroleptanaesthesia" with blood pressure-adjusted, small doses of fentanyl, midazolam, and pancuronium. Intraoperatively, a liver injury due to closed-chest cardiac massage was found in both cases. The postoperative courses were complicated by respiratory problems, which led to prolonged mechanical ventilation, but both patients survived without remarkable neurological deficits. CONCLUSION. In patients with thrombolytic therapy after CPR and persisting cardio-vascular instability, a resuscitation injury with consequent haemorrhagic shock should be suspected. For diagnosis, chest X-ray films and abdominal and thoracic sonography are useful and practicable, even at the bedside. Anaesthetic management should focus on adequate monitoring, replacement of volume and oxygen carriers, fast restoration of plasma coagulation, and careful, blood pressure-adjusted maintenance of anaesthesia.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">7573908</PMID><DateCreated><Year>1995</Year><Month>10</Month><Day>27</Day></DateCreated><DateCompleted><Year>1995</Year><Month>10</Month><Day>27</Day></DateCompleted><DateRevised><Year>2006</Year><Month>11</Month><Day>15</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0003-2417</ISSN><JournalIssue CitedMedium="Print"><Volume>44</Volume><Issue>8</Issue><PubDate><Year>1995</Year><Month>Aug</Month></PubDate></JournalIssue><Title>Der Anaesthesist</Title><ISOAbbreviation>Anaesthesist</ISOAbbreviation></Journal><ArticleTitle>[Intra-abdominal bleeding after myocardial infarction with cardiopulmonary resuscitation and thrombolytic therapy].</ArticleTitle><Pagination><MedlinePgn>585-9</MedlinePgn></Pagination><Abstract><AbstractText>Adverse effects of resuscitation due to closed-chest cardiac massage are common, and the incidence is increased when an incorrect technique is used. Nevertheless, thrombolytic therapy of a myocardial infarction can become necessary even after cardiopulmonary resuscitation (CPR). In these patients, the risk of thrombolytic therapy-induced bleeding is immanent. CASE REPORTS. Within 9 months, two male patients aged 44 and 52 years were admitted to the intensive care unit after out-of-hospital CPR for myocardial infarction with cardiac arrest. In both cases, thrombolytic therapy was undertaken due to the cardiovascular situation or echocardiographic results. Thrombolytic therapy was successful with regard to the ECG changes, but a few hours later both patients demonstrated increasing cardiovascular instability. After abdominal sonography, intra-abdominal bleeding was suspected. Emergency laparotomy became unavoidable, although the coagulation profile was severely impaired in both patients (Tables 1 and 2). Anaesthetic management was characterised by introduction of central venous and intra-arterial catheters, replacement of volume and oxygen carriers using large-bore IV lines, restoration of coagulation factors with fresh frozen plasma, and the choice of "modified neuroleptanaesthesia" with blood pressure-adjusted, small doses of fentanyl, midazolam, and pancuronium. Intraoperatively, a liver injury due to closed-chest cardiac massage was found in both cases. The postoperative courses were complicated by respiratory problems, which led to prolonged mechanical ventilation, but both patients survived without remarkable neurological deficits. CONCLUSION. In patients with thrombolytic therapy after CPR and persisting cardio-vascular instability, a resuscitation injury with consequent haemorrhagic shock should be suspected. For diagnosis, chest X-ray films and abdominal and thoracic sonography are useful and practicable, even at the bedside. Anaesthetic management should focus on adequate monitoring, replacement of volume and oxygen carriers, fast restoration of plasma coagulation, and careful, blood pressure-adjusted maintenance of anaesthesia.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Adams</LastName><ForeName>H A</ForeName><Initials>HA</Initials><AffiliationInfo><Affiliation>Abteilung für Anaesthesie und Intensivmedizin, Marienkrankenhaus Trier-Ehrang.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schmitz</LastName><ForeName>C S</ForeName><Initials>CS</Initials></Author><Author ValidYN="Y"><LastName>Block</LastName><ForeName>G</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Schlichting</LastName><ForeName>C</ForeName><Initials>C</Initials></Author></AuthorList><Language>ger</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D004740">English Abstract</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><VernacularTitle>Intraabdominale Blutung nach Myokardinfarkt mit kardiopulmonaler Reanimation und Thrombolysetherapie.</VernacularTitle></Article><MedlineJournalInfo><Country>Germany</Country><MedlineTA>Anaesthesist</MedlineTA><NlmUniqueID>0370525</NlmUniqueID><ISSNLinking>0003-2417</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D005343">Fibrinolytic Agents</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000005" MajorTopicYN="N">Abdomen</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000758" MajorTopicYN="N">Anesthesia</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016887" MajorTopicYN="N">Cardiopulmonary Resuscitation</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005343" MajorTopicYN="N">Fibrinolytic Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009203" MajorTopicYN="N">Myocardial Infarction</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019106" MajorTopicYN="N">Postoperative Hemorrhage</DescriptorName><QualifierName UI="Q000139" MajorTopicYN="N">chemically induced</QualifierName><QualifierName UI="Q000209" MajorTopicYN="Y">etiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>1995</Year><Month>8</Month><Day>1</Day></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>1995</Year><Month>8</Month><Day>1</Day><Hour>0</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>1995</Year><Month>8</Month><Day>1</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">7573908</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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