The American journal of emergency medicine
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Emergency physicians commonly treat skin and soft tissue infections. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has become the prominent etiologic agent in these infections. The CA-MRSA is resistant to many antibiotics traditionally used to treat skin and soft tissue infections. ⋯ Many clinicians have changed their practice patterns to include antibiotics that usually display activity against CA-MRSA. However, cephalexin remains a popular agent used for these infections.
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Case Reports
Acute aortic dissection presenting as case of accidental falling with flaccidity of left lower extremity.
Aortic dissection is often a catastrophic, life-threatening condition that may not always present with symptoms. Without intensive treatment, the mortality within the first 2 weeks of onset is reportedly as high as 80%. Acute aortic dissection classically presents with the symptoms of abrupt chest pain that sometimes radiates to the back, abdominal pain, or back pain alone. ⋯ It can be associated with neurologic sequelae in as many as one third of all patients. Painless dissection occurs in approximately 5% of patients, and the diagnosis may often be delayed. We report a case of aortic dissection where the patient presented with a history of accidental fall and a new onset of flaccidity of the left lower limb.
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Case Reports
Sonographic detection of radio-occult interstitial lung involvement in measles pneumonitis.
We present the cases of 23- and 38-year-old healthy patients with clinical diagnosis of acute measles who experienced shortness of breath on exertion with nonproductive cough and showed signs of mild respiratory failure at presentation in the emergency department (ED) but with normal chest radiograph and auscultation. In both cases, bedside ultrasound of the lung showed the appearance of signs of interstitial diffuse involvement with vertical B lines spread all over the lateral and posterior chest wall. ⋯ Even without radiologic infiltrates and pulmonary sounds, based on sonographic and arterial gas signs, a diagnosis of measles pneumonitis was done and patients admitted to the ward for close follow-up and supportive care. We hypothesize a new diagnostic role of bedside lung sonography in screening patients presenting to the ED with initial lung involvement in measles who warrant close follow-up and hospital admission.
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The incidence of out-of-hospital and in-hospital cardiorespiratory arrest from all causes in the United States occurs not infrequently. Postresuscitation care should include the identification of the inciting arrest event as well as therapy tailored to support the patient and treat the primary cause of the decompensation. The application of one particular testing modality, cranial computed tomography (CT) of the head, has not yet been determined. We undertook an evaluation of the use of head CT in patients who were resuscitated from cardiac arrest. ⋯ In this subset of resuscitated patients with cardiac arrest, abnormalities on the head CT were not uncommon. Alterations in management did occur in those patients with abnormalities. The indications and impact of head CT in the population of resuscitated patients with cardiac arrest remain unknown, warranting further investigation.
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Pain relief is a key out-of-hospital patient care outcome measure, yet many trauma patients do not receive prompt analgesia. Although specialty critical care transport (CCT) teams provide analgesia frequently, successfully, and safely, there is still a population of CCT patients to whom analgesia is not offered. We report the factors associated with non-administration of analgesia and with analgesic effect in trauma patients cared for by CCT teams. ⋯ The identified factors may represent opportunities for CCT teams to optimize analgesic treatment.