The American journal of emergency medicine
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Acute aortic dissection may have variable presentations, making the diagnosis clinically challenging. Acute neurologic syndromes secondary to dissection of the aorta are uncommon. ⋯ Peripheral ischemic neuropathy as the result of vascular occlusion is uncommon. The pathophysiology and clinical manifestations of ischemic neuropathies in the setting of acute aortic dissection are discussed.
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It has been shown in dogs that mild hypothermia (34 degrees C) during or immediately after ventricular fibrillation cardiac arrest can improve cerebral outcome. The effect of mild hypothermia on outcome after 8 minutes of asphyxiation (5 minutes' cardiac arrest) was studied for the first time in rats. Restoration of spontaneous circulation was with external cardiopulmonary resuscitation and observation to 72 hours. ⋯ HDS correlated with OPC (r = .6, P < .05) and NDS (r = .7, P < .05). Mild hypothermia improved cerebral outcome after asphyxial cardiac arrest in rats, more when induced before than after arrest. The model's insult is within the therapeutic window, which makes it also suitable for screening other cerebral resuscitation potentials.
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The death of a pediatric patient in the emergency department generates an intense emotional response in the physician and staff. A majority of emergency physicians describe this as the most stressful event in emergency medicine. Few emergency physicians are instructed in the complexities of dealing with the death of a child. The authors have developed a teaching module that introduces aspects of pediatric death-telling through the eyes of parents who have personally experienced the death of a child.