Background: Sickle cell disease (SCD) is a genetic disorder caused by a mutation in the β-globin gene, leading to systemic complications, including stroke, avascular necrosis, and acute chest syndrome. The disease is most prevalent in regions such as sub-Saharan Africa, the Mediterranean, and the Middle East, with Saudi Arabia showing significant variability in prevalence and severity across its provinces. Objectives: This study focuses on comparing the quality of CT pulmonary angiography (CTPA) and the rates of pulmonary embolism (PE) diagnosis between SCD and non-SCD patients, addressing discrepancies in detection sensitivity and clinical outcomes. Methods: We conducted a retrospective comparison between 60 adult SCD patients and 60 age-matched controls, all of whom were evaluated for suspected PE in our emergency department using an MDCT scanner. Data, including demographic and clinical information, as well as CT findings, were extracted from electronic health records. Results: In SCD patients, the rate of positive CT pulmonary angiograms was 13.3% (8/60), while in non-SCD matched controls, it was 18.3% (11/60). There was no significant difference in the rate of positive CTPA studies (p=0.453). SCD patients exhibited significantly lower enhancement in the main pulmonary artery (PA) (mean 249.9 HU) compared to control subjects (mean 283.7 HU) (p-value= 0.043). Moreover, hemoglobin levels were notably lower in SCD patients (p-value < 0.001). Conclusion: SCD patients demonstrated no significant difference in the rate of positive studies for acute PE when compared with controls undergoing CTPA. Furthermore, the lower main PA enhancement in SCD patients supports the hypothesis suggesting reduced sensitivity of CT angiography in detecting PE in this population. Quality improvement initiatives should concentrate on individualized protocol optimization to enhance enhancement quality and increase the likelihood of a definitive diagnosis.
Ventricular tachycardia (VT) is an abnormal heart rhythm that can lead to pump failure and hypoperfusion. Its causes, presentation, and treatment are well established in the literature. However, the VT treatment algorithm is based on non-traumatic patients. Due to different pathophysiology and presentation, treating VT in trauma patients should be different.The main purpose is to emphasize the approach to treating VT in severe head trauma patients.This case is a unique presentation of severe head trauma with a paucity of treatment approaches in the literature. In this article, we present a case of a middle-aged male patient presented to a level one trauma center with a history of falls from 2 stories height with a Glasgow Coma Scale (GCS) of 3/15. ATLS approach was followed in treating this patient, his rhythm strip showed a wide complex regular rhythm, likely representing a VT with a pulse. The patient was treated as unstable because of a decreased level of consciousness. A 100 J synchronized cardioversion was given without restoration of normal sinus rhythm, followed by Mannitol 1g/kg, treating the possibility of high intracranial pressure (ICP), after which his rhythm was restored to sinus.The restoration of sinus rhythm after treating the possibility of high ICP suggests that the cause of VT in this severe TBI patient was the high ICP.
Sickle cell disease (SCD) is a genetic disorder caused by a mutation in the β-globin gene, leading to systemic complications, including stroke, avascular necrosis, and acute chest syndrome. The disease is most prevalent in regions such as sub-Saharan Africa, the Mediterranean, and the Middle East, with Saudi Arabia showing significant variability in prevalence and severity across its provinces. This study focuses on comparing the quality of CT pulmonary angiography (CTPA) and the rates of pulmonary embolism (PE) diagnosis between SCD and non-SCD patients, addressing discrepancies in detection sensitivity and clinical outcomes. We conducted a retrospective comparison between 60 adult SCD patients and 60 age-matched controls, all of whom were evaluated for suspected PE in our emergency department using an MDCT scanner. Data, including demographic and clinical information, as well as CT findings, were extracted from electronic health records. In SCD patients, the rate of positive CT pulmonary angiograms was 13.3% (8/60), while in non-SCD matched controls, it was 18.3% (11/60). There was no significant difference in the rate of positive CTPA studies (p=0.453). SCD patients exhibited significantly lower enhancement in the main pulmonary artery (PA) (mean 249.9 HU) compared to control subjects (mean 283.7 HU) (p-value= 0.043). Moreover, hemoglobin levels were notably lower in SCD patients (p-value < 0.001). SCD patients demonstrated no significant difference in the rate of positive studies for acute PE when compared with controls undergoing CTPA. Furthermore, the lower main PA enhancement in SCD patients supports the hypothesis suggesting reduced sensitivity of CT angiography in detecting PE in this population. Quality improvement initiatives should concentrate on individualized protocol optimization to enhance enhancement quality and increase the likelihood of a definitive diagnosis.
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