The American journal of emergency medicine
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The recent outbreak of hantavirus in Yosemite National Park has attracted national attention, with 10 confirmed cases of hantavirus cardiopulmonary syndrome and thousands of more people exposed. This article will review the epidemiology, presentation, workup, and treatment for this rare but potentially lethal illness. The possibility of infection with hantavirus deserves consideration in patients with severe respiratory symptoms with rodent exposure or rural/wilderness travel. ⋯ The cardiopulmonary phase of the disease can progress rapidly with catastrophic decompensation in as little as a few hours. Patients require rapid intensive care unit admission for monitoring, mechanical ventilation, vasoactive agents, and possibly extracorporeal mechanical ventilation. Emergency physicians should be aware of outbreaks and vigilant for hantavirus exposures, especially during the summer and early fall months.
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We present the case of a 46-year-old woman with Prinzmetal's angina and syncope due to severe bradyarrhythmias. Dynamic electrical changes were documented on 12-lead 24-hour electrocardiographic (ECG) monitoring. We highlight the importance of continuous ECG monitoring in making the diagnosis and the indication for permanent cardiac pacing in this case.
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The widespread availability of microwave ovens has sparked interest in injuries resulting from their use. ⋯ To our knowledge, this is the first study to investigate microwave oven-related injuries on a national scale. Microwave ovens are an important source of injury in the home in the United States. The large increases in the number and rate of these injuries underscore the need for increased prevention efforts, especially among young children.
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An algorithmic approach to testing utilizing risk stratification and quantitative D-dimer has been considered an acceptable approach to ruling out pulmonary embolism (PE). When D-dimer is elevated, further testing for PE is indicated. ⋯ This case describes a patient who initially had an elevated D-dimer with negative workup for PE who, on repeat visit, had a decreasing D-dimer but was diagnosed with a PE. When evaluating patients after a negative workup for PE after an elevated D-dimer, a decrease in D-dimer cannot be used to rule out PE.
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Pigmented lymph nodes are traditionally associated with melanoma and metastatic malignancy. This report describes the case of 22-year-old white man, who presented with painful right groin lymphadenopathy. Groin ultrasound and computed tomography confirmed an enlarged (2 cm) right inguinal lymph node. ⋯ Although a suspicious finding, histologic examination demonstrated black pigment infiltration from a decorative tattoo on the right leg. Unresolving, painful, pigmented lymphadenopathy can result from decorative tattooing. Selective excision of the affected lymph node and histologic examination result in symptom resolution and can aide in appropriate diagnosis.