Author/Editor		Žmavc, Andrej; Strouhal, P
Title		Ruptura želodca s pnevmoperitonejem - redkejša reanimacijska poškodba
Translated title		Stomach rupture and pneumoperitoneum - a rare resuscitation injury
Type		članek
Source		In: Bručan A, Gričar M, editors. Urgentna medicina: izbrana poglavja 3. Zbornik 4. mednarodni simpozij o urgentni medicini; 1997 jun 18-21; Portorož. Ljubljana: Slovensko združenje za urgentno medicino,
Publication year		1997
Volume		str. 299-302
Language		slo
Abstract		Resuscitation maneuvers are aggressive and frequently cause various injuries to resuscitated patients. The reason is unproper resuscitation technique mostly but even with the state of the art tecnique injuries can not be avoided. In our case a stomach rupture with massive pneumoperitoneum is described. 48 years old female suddenly lost consciousness during swimming in a swimming pool. A rescuer present at that time immediately started BLS. A local physician and the rescuer had been performing cardiac massage and bag-valve-mask ventilation until our ALS team arrived 17 minutes later. The patient's abdomen was apparently distended at that time. An ECG monitor showed no electrical activity. The emergency physician intubated the patient immediately, started ACD cardiac massage and administered epinephrine in boluses of 1mg and 4mg subsequently. The patient remained unresponsive and the resuscitation was terminated in 35th minute of cardiac arrest. An autopsy revealed a ruptured aneurysm of ascending aorta with massive pericardiac tamponade as a cause of death. Injuries caused by resuscitation were: fractured ribs III. - V. on both sides of the sternum, multiple lacerations of gastric mucosa at the minor curvature and rupture of gastric wall with great amount of free air in peritoneal cavity. According to data in the literature, and in our case as well, the stomach rupture is very likely caused by too aggressive cardiac massage. A predisponding factor is hyperinflated stomach due to incorerct ventilation during BLS (improper position of the head, high inspiratory pressures). Once a dilated stomach is noticed, an immediate decompression by NG tube or transabdominal needle aspiration is recommended.
Descriptors		RESUSCITATION STOMACH RUPTURE PNEUMOPERITONEUM HEART MASSAGE AUTOPSY