The American journal of emergency medicine
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Before the era of therapeutic hypothermia, a practice parameter including absent or extensor motor response at day 3 and the presence of myoclonus status epilepticus within 24 hours was used to assist prognostication of poor neurologic outcomes. There are conflicting results concerning whether hypothermia influences the reliability of the predictors and the accurate predictors and optimal timing for assessing neurologic recovery are largely unknown. ⋯ However, life support was reported to be withdrawn within 3 to 5 days in 25% to 50% cardiac arrest survivors treated with hypothermia when grave prognosis was predicted. The clinical course of the patient raises some important questions concerning the accuracy of current predictors, the optimal observation period for neurologic recovery, and the appropriate timing to determine withdrawal of life support in cardiac arrest victims receiving therapeutic hypothermia.
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There are several causes of ST-segment elevation (STE) besides acute myocardial infarction (MI). ⋯ The diagnosis of false-positive STEMI is not uncommon. Detailed clinical evaluation and electrocardiogram interpretation may avoid partly unnecessary catheterization laboratory activation.
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This is a report of a 4-year-old Hispanic boy who presented with skin changes to the lips and oral cavity, a generalized rash, edema of hands and feet, and peeling of the periungual areas of the fingers as well as to the groin and perianal areas. Fourteen days earlier, his 19-month-old brother was diagnosed and treated for Kawasaki disease. Upon laboratory investigation, our patient was found to have an elevated sedimentation rate, C-reactive protein, and serum γ-glutamyl transferase. Infectious disease and cardiology consultations subsequently diagnosed and treated our patient for incomplete Kawasaki disease.
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Management of cardiac arrest due to severe diabetic ketoacidosis (DKA) using bicarbonate therapy and extracorporeal life support (ECLS) remains controversial. We report a case of a 24-year-old man with insulin-dependent type 1 diabetes mellitus who survived without any neurologic complications after prolonged ECLS (including fluid resuscitation and insulin but no aggressive bicarbonate) for cardiac arrest due to severe DKA. In post-DKA cardiac arrest, insulin and fluid resuscitation is the mainstay of treatment, but ECLS should be considered when prolonged cardiac arrest is expected.
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Case Reports
Ischemic stroke presenting as fluctuating focal weakness in an otherwise healthy young man.
A 32-year-old man presented to our emergency department (ED) with no complaints after paramedics responded to a fall. Medics noted left-sided weakness on scene. ⋯ An acute middle cerebral artery ischemic stroke was diagnosed, and tissue plasminogen activator was administered. Despite a fluctuating course of symptoms, our patient ultimately achieved a complete recovery.