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Massive hepatic hemorrhage associated with cardiopulmonary resuscitation
Insights
Severe abdominal pain after cardiopulmonary resuscitation (CPR) may indicate liver injury. Anticoagulation therapy increases this risk, necessitating prompt medical evaluation for hepatic laceration or hematoma.
Area of Science:
- Emergency Medicine
- Hepatology
- Trauma Surgery
Background:
- Cardiopulmonary resuscitation (CPR) can precipitate liver injuries.
- Myocardial infarction patients often receive anticoagulation therapy, such as heparin sodium.
- Hepatic laceration is a rare but serious complication.
Observation:
- Two patients presented with severe abdominal pain and hypovolemic shock post-CPR.
- Both patients had a history of myocardial infarction and were on heparin sodium.
- Antemortem diagnosis of liver laceration was made in both cases.
Findings:
- CPR-induced liver laceration can lead to massive hemorrhage and hypovolemic shock.
- Anticoagulation therapy exacerbates bleeding risk in hepatic injuries.
- Clinical presentation includes severe abdominal pain and hemodynamic instability.
Implications:
- Clinicians should consider hepatic laceration in patients with abdominal pain and shock after CPR.
- Vigilance is crucial for patients on anticoagulation therapy experiencing these symptoms.
- Early recognition and management are vital for improving patient outcomes in CPR-related liver trauma.
Abstract:
We treated two patients with laceration of the liver that was precipitated by cardiopulmonary resuscitation (CPR) and recognized antemortem. Both patients had myocardial infarctions and had received heparin sodium therapy. They had excruciating abdominal pain and bled massively, resulting in hypovolemic shock. When severe abdominal pain associated with hypovolemic shock occurs in a patient who has received CPR, hepatic laceration, hematoma, or both should be considered. This is even more imperative to recognize in the patient who has received anticoagulation therapy.