Letter to the Editor

Carotid Artery Puncture, Myocardial Injury, and Ventricular Arrhythmia

Authors: Vijay Arun Doraiswamy, MD, Vinayak Hegde, MD, Rajan Bhatt, MD, Jarrod Mosier, MD, Peter Ott, MD

Abstract

To the Editor:


A 51-year-old woman with a history of obesity (body mass index [BMI] of 40), alcohol abuse, and cirrhosis of the liver, came to our emergency room; she had lower left-sided chest pain, back pain, and hematuria resulting from an assault more than one week before. Initially, her vitals were stable. Her hemoglobin was 10.4 mg/dL, platelets 23,000 cells/dL, and international normalized ratio (INR) 1.8. On presentation and 8 hours later, her troponin-I values were <0.30 μg/L. An electrocardiogram (EKG) showed sinus tachycardia and no ischemic changes. Computed tomography (CT) scan showed rib fractures and splenomegaly with perisplenic hematoma, although no definite laceration was seen. In the intensive care unit (ICU) after transfusion, the patient's platelets increased to 82,000 cells/dL; INR dropped to 1.5.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348:1123–1133.
 
2. Karakitsos D, Labropoulos N, De Groot E, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 2006;10:R162.
 
3. Guilbert MC, Elkouri S, Bracco D, et al. Arterial trauma during central venous catheter insertion: case series, review and proposed algorithm. J Vasc Surg 2008;48:918–925.
 
4. Andrews RT, Bova DA, Venbrux AC. How much guidewire is too much? Direct measurement of the distance from subclavian and internal jugular vein access sites to the superior vena cava-atrial junction during central venous catheter placement. Crit Care Med 2000;28:138–142.