The American journal of emergency medicine
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Understanding biochemical concepts can assist in the diagnosis and treatment of certain presentations in the emergency department. Knowledge of the biochemistry responsible for certain presentations in the emergency department as well as behind various therapies also provides physicians better insight into the use of specific treatments. This review will focus on the biochemistry of numerous clinical syndromes, including methemoglobinemia, various poisoning presentations, including cyanide, methanol, and ethylene glycol--with an emphasis on the diagnostic and management considerations in these presentations.
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Aluminium (Al) is the most widely distributed metal in the environment. It is commonly used in daily life, which provides easy exposure to human. The exposure to this toxic metal occurs through air, food, and water. ⋯ Some epidemiologic studies have shown poor performance in cognitive tests and a higher prevalence rate of neurologic symptoms for workers occupationally exposed to aluminium. Although there are several reports about ventricular tachycardia in case of acute poisoning, there is no report about chronic poisoning. In this report, we presented a 20-year-old man who had recurrent ventricular tachycardia.
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Early recognition of left ventricular hypertrophy is important because antihypertensive treatment decreases morbidity and mortality. The ideal screening method for left ventricular hypertrophy in hypertensive emergency department (ED) patients has not been identified. Our objective was to determine the diagnostic accuracies of electrocardiogram (ECG) and N-terminal Pro-B-type natriuretic peptide (pro-BNP) for left ventricular hypertrophy individually and in combination in hypertensive ED patients. ⋯ The combination of ECG and pro-BNP is a promising screening algorithm for identification of hypertensive ED patients with left ventricular hypertrophy.
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A delay in diagnosis of sepsis and appropriate treatment increases subsequent mortality. An association with the degree of bandemia, or the presence of immature neutrophils in the white blood cell count, has not been explored in septic patients presenting to the emergency department (ED). We hypothesized that the presenting band levels would be higher in septic patients who die in hospital compared with survivors. ⋯ The band level on presentation was not found to be associated with inpatient mortality in ED patients with sepsis who are eligible for early goal-directed therapy.
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Case Reports
Delayed enterothorax and hepatothorax due to missed right-sided traumatic diaphragmatic rupture.
Traumatic diaphragma ruptures (DRs) are an unusual condition after blunt thoracoabdominal trauma, and there are some difficulties in the diagnosis, in the absence of the additional life-threatening injuries. Right-sided injuries are less frequent than left-sided injuries and may be missed easily. ⋯ Particularly, to our knowledge, progressive hepatothorax and enterothorax that develop over years are a very rare presentation of DR. Herein, we present a case of progressive thoracic herniation of the abdominal organs, diagnosed 22 years after the initial trauma.