NDLI: En mann i 50-årene med synkope og hypotensjon.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Mordal, Geir Christian Enli Hov, Karen Roksund Bjørnstad, Johannes Lagethon Meidell, Nina Knutrud
Description	Country affiliation: Norway Author Affiliation: Mordal GC ( Nyremedisinsk avdeling, Oslo universitetssykehus, Ullevål, Norway. geir.christian.e.mordal@ahus.no)
Abstract	A man in his fifties was admitted to our hospital because of syncope and hypotension. In the emergency room he reported abdominal pain, but focused assessment with sonography for trauma (FAST) was negative. His systolic blood pressure varied between 60 and 90 mmHg and an arterial blood gas revealed lactic acidosis with normal haemoglobin, which still might indicate acute bleeding. An ECG did not indicate myocardial infarction. In the absence of an obvious bleeding focus, the patient was urgently transported to a CT lab nearby, to identify possible bleeding and rule out other causes of circulatory shock, such as cardiac tamponade. Before radiologic scanning was initiated, the patient lost consciousness and displayed pulseless electrical activity. Resuscitation was initiated and pericardiocentesis was resultless. On vital indication and clinical suspicion of cardiac tamponade, an emergency median sternotomy was performed and a haematoma was evacuated from the pericardial space. The patient was stabilised and immediately taken to the operation theatre where a ruptured ascending aortic aneurysm was identified. The operation was successful, but following serious hypoperfusion, the patient suffered acute kidney failure requiring dialysis for several months, gram-negative septicaemia caused by a central venous catheter, cerebral infarction leading to hemiparesis and impaired vision, ventilator-associated pneumonia/acute lung injury and acalculous cholecystitis. This case report describes the findings on admission, the diagnostic process including surgical resuscitation and a complicated course of multi-organ failure. After almost 5 months, the patient was discharged from our hospital to another institution for further rehabilitation. He now has minimal sequelae and lives at home. Our take-home message is that seriously ill patients require fast, resolute and broad examination; they may need immediate surgical treatment including emergency intervention; and a good clinical outcome may be achieved in spite of serious complications.
File Format	HTM / HTML
ISSN	00292001
e-ISSN	08077096
Journal	Tidsskrift for Den norske legeforening
Issue Number	7
Volume Number	132
Language	Norwegian
Publisher	Norwegian Medical Association
Publisher Date	2012-04-17
Publisher Place	Norway
Access Restriction	Open
Subject Keyword	Discipline Medicine Aortic Rupture Hypotension Diagnosis Postoperative Complications Syncope Complications Surgery Diagnosis, Differential Multiple Organ Failure Therapy Radiography
Alternative Title	A man in his fifties with syncope and hypotension
Content Type	Text
Resource Type	Article Case study
Subject	Medicine

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