THE UNEXPECTED HEMATOMA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cardiopulmonary resuscitation (CPR) is a lifesaving procedure often performed in the intensive care unit (ICU). Post-cardiac arrest centers on supportive as well identifying and treating underlying etiology of cardiac arrest. Consideration myocardial infarction, pulmonary embolism ongoing atrial fibrillation may prompt provider to initiate anticoagulation which lead further complications post-arrest period following high-quality CPR. CASE PRESENTATION: A 75-year-old female with history paroxysmal fibrillation, prior stroke, morbid obesity BMI 73 chronic respiratory failure status post tracheostomy due prolonged course pneumonia was brought hospital after being found be at her nursing home. Patient underwent CPR for greater than 30 minutes until she finally stabilized admitted ICU. Resuscitative efforts were complicated by right sided pneumothorax that required chest tube placement. Once stabilized, patient noted subtherapeutic INR CHA2DS2-VASc 7. heparin infusion started anticoagulation. Over next 24 hours, patient's hemoglobin drop from 9.3 g/dL admission 6.9 g/dL. There no signs gastrointestinal bleeding or tube. CT angiogram revealed large left wall hematoma measuring up 17.4 cm active hemorrhage adjacent intercostal artery. Interventional radiology consulted possible embolization but focused area did not show evidence contrast extravasation. After few days, without need transfusions. Following course, eventually transitioned comfort withdrawn. DISCUSSION: Heparin infusions are used ICU treatment infarction embolism. The incidence thoracic injuries varies widely determined modality CPR, population studied, type imaging detect injuries. In above case, we present who only sustained injury, also developed significant initiation emphasizing an additional consideration initiating period. Given clinical poor prognosis presentation, risk likely outweighed benefits stroke prevention. CONCLUSIONS: Initiation other blood thinners requires careful unknown have occurred. These put increased complications. REFERENCE #1: Baubin, M., Rabl, W. Hoke, R.S., 2007. Complications Cardiac arrest: science practice medicine (pp. 792-808). Cambridge University Press, New York. #2: Buschmann, C.T. Tsokos, 2009. Frequent rare attempts. Intensive medicine, 35(3), pp.397-404. #3: Miller, A.C., Rosati, S.F., Suffredini, A.F. Schrump, D.S., 2014. systematic review pooled analysis CPR-associated cardiovascular Resuscitation, 85(6), pp.724-731. DISCLOSURES: No relevant relationships Shannon Burke, source=Web Response Abigail Go, Ghassan Kamel,