The American journal of emergency medicine
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Superficial neck infections including lymphadenitis and abscesses are commonly encountered in pediatric emergency departments (PEDs). It is often unclear which patients are likely to develop an abscess that necessitates surgical drainage. In evaluating these patients, computed tomography (CT) and ultrasound are often used to identify/confirm abscess formation. The criteria for determining the need for imaging studies are not well defined. ⋯ Pediatric patients who are more likely to have a neck infection that necessitates surgical drainage can be stratified based on clinical characteristics. This knowledge may allow physicians to better predict the resource needs including hospital admission and emergent imaging for neck infection.
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Endocarditis is a serious infection of the innermost muscle layer of the heart and can lead to significant mortality and morbidity. Echocardiography is instrumental to the timely diagnosis of this disease entity. We discuss the case of a patient presenting to the emergency department (ED) with fever of unclear etiology. ⋯ Focused cardiac ultrasound demonstrated a tricuspid vegetation. The patient was promptly treated for right-sided endocarditis. This case illustrates the use of focused cardiac ultrasound to facilitate the early diagnosis and management of endocarditis in the ED.
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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.