The American journal of emergency medicine
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We describe the case of a 28-year-old otherwise healthy woman who presents to our emergency department with nausea for 2 days and severe vomiting for 1 day. She has no history of travel, and her medical history is unremarkable. ⋯ Hypochloremic alkalosis would be expected to be present in this patient. We explain how to correctly identify the rare cause of metabolic acidosis present in this patient using the physicochemical approach (Stewarts approach) for the analysis of human acid-base disorders.
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Troponin (I or T) is the principal marker of myocardial injury used in clinical practice. Although immune-based methods to determine troponin I levels are generally reliable, the presence of human antibodies interfering with the assays components could lead to erroneous results. In this report, we will discuss the case of a patient with misleadingly elevated troponin I due to high rheumatoid factor titer and provide an insight into the responsible molecular mechanisms.
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This study aimed to investigate sedation of elderly patients with acute behavioral disturbance (ABD) in the emergency department (ED), specifically the safety and effectiveness of droperidol. ⋯ Droperidol was effective for sedation in most elderly patients with ABD, and adverse effects were uncommon. An initial 5-mg dose appears prudent with the expectation that many will require another dose.
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To determine effect of first medical contact type on symptom onset-to-door time (SODT). ⋯ Patients whose first medical contact was a physician had greater pre-hospital delays and worse survival compared to those who sought emergent medical care directly. This pattern occurred more often during "on-hours." Educational efforts aimed at both patient and physician office practices are warranted.
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Case Reports
Putamen hemorrhage occurred simultaneously with Stanford type A acute aortic dissection: a case report.
This case report describes a 60-year-old man found unresponsive on the road. He was later admitted to our emergency department (ED) with consciousness disturbance and decorticate rigidity. Computed tomographic imaging revealed coexisting left putamen hemorrhage and Stanford type A acute aortic dissection. ⋯ Diagnosis for aortic dissection is difficult, especially when the patient has consciousness disturbance because of brain hemorrhage. Consequently, coexistence of these 2 conditions might be missed frequently in emergency settings. Therefore, wider knowledge of this case is important to inform others to suspect and investigate aortic dissection in cases of brain hemorrhage.