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[Hepatic lesions after effective external cardiac massage--an iatrogenic complication not to be overlooked]
P Froment1, D Savioz, M Robertson
1Departement de Chirurgie, Hôpitaux Universitaires de Genève.
Insights
External cardiac massage can cause liver lacerations, leading to dangerous bleeding. Promptly addressing hepatic hemorrhage with blood volume and coagulation factors is crucial for patient recovery.
Area of Science:
- Emergency Medicine
- Cardiology
- Hepatology
Background:
- External cardiac massage (ECM) is a critical resuscitation procedure.
- Liver lacerations occur in 3-8% of patients post-ECM.
- Thrombolytic therapy is increasingly used in interventional cardiology.
Observation:
- A patient presented with severe hemodynamic instability after ECM and thrombolytic therapy.
- The instability was initially misdiagnosed as a cardiac complication.
- The actual cause was hepatic hemorrhage from ECM-induced liver lacerations.
Findings:
- Hepatic hemorrhage following ECM can mimic cardiac events.
- Restoring blood volume and coagulation factors stabilized the patient.
- Early recognition of abdominal injuries is vital.
Implications:
- Clinicians must consider liver lacerations in patients with hemodynamic compromise after ECM, especially with thrombolytic use.
- Prompt diagnosis and management of hepatic hemorrhage are essential for favorable outcomes.
- This case highlights the importance of a comprehensive diagnostic approach in critical care settings.
Abstract:
After external cardiac massage, 3-8% of patients present potentially dangerous liver lacerations. Here we discuss the case of a patient who presented a major haemodynamic instability following external cardiac massage and thrombolytic therapy. Falsely attributed to a cardiac complication, this was actually consecutive to a hepatic haemorrhage originating from liver lacerations caused by the cardiac massage. Haemodynamic stability was obtained by reestablishing blood volume and coagulation factors. Following this the patient evolved favorably. We discuss the importance of evoking the possible existence of abdominal lacerations after external cardiac massage and the therapeutic attitude which must be adopted towards these, particularly in the light of thrombolytic therapy used in interventional cardiology and its effect on these complications.