The American journal of emergency medicine
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Hiatus hernia (HH) is a frequent condition and is asymptomatic most of the time. Common symptoms can include epigastric pain, postprandial fullness, and nausea. We report a case of postprandial acute right and left heart failure caused by an intrathoracic stomach in a previously asymptomatic woman. ⋯ To the best of our knowledge, ours is the first report of both acute right and left heart failure due to an HH. The prompt placement of a nasogastric tube was lifesaving. We believe that the diagnosis of HH ought to be taken into consideration by emergency physicians and included in the differential diagnosis for acute postprandial heart failure.
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The objective of this study was to assess the impact of an emergency department (ED)-only full-capacity protocol and diversion, controlling for patient volumes and other potential confounding factors. ⋯ Our predivert/full-capacity protocol is a simple and generalizable strategy that can be implemented within the boundaries of the ED and is significantly associated with a decreased diversion rate.
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The aim was to investigate the circadian and weekly variation in Chinese young patients with acute myocardial infarction (AMI). ⋯ There was a significant circadian variation with a peak from 00:01 to 06:00 in Chinese young patients with AMI. However, there was no significant weekly variation in these patients. The circadian periodicity may create new possibilities for disease prevention and medication prescription.
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Mild induced hypothermia (MIH) is recommended to treat neurologic injury after cardiac arrest (CA). However, clinical trials to assess MIH benefit after CA have been largely inconclusive. We investigated the subsequent changes in cerebrospinal fluid (CSF) biochemistry after MIH (33°C-34°C for 12 hours) and evaluated the importance of ongoing fever control. ⋯ Mild induced hypothermia mitigated and delayed the CA-induced increase of CSF glutamate. Therefore, our results suggest that clinically inducing hypothermia as soon as possible after CA, or prolonging the time of MIH in combination with controlling ongoing fever, may enhance hypothermic protective effects.
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Acute carbamate intoxication can cause cardiac manifestations. We present the case of a 53-year-old man who had been a heavy smoker, admitted to our hospital for recent anterior wall myocardial infarction complicated with congestive heart failure. Percutaneous transluminal coronary angioplasty with stent implantation, coronary artery bypass graft, and mitral annuloplasty were performed, but refractory heart failure and ventricular arrhythmia were still noted. ⋯ The donor was a 50-year-old man who had died of brain death due to carbamate intoxication, and the crossmatch before transplantation was negative. The recipient died 24 hours after the operation due to acute left ventricular dysfunction. This report reviews the cardiac manifestations of acute carbamate intoxication and the possibility of heart transplantations from donors who died of carbamate intoxication.