The American journal of emergency medicine
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Heatstroke is one of the most common clinical emergencies. Heatstroke that occurred in a dry-heat environment such as desert is usually more seriously effective and often leads to death. However, the report of the pathophysiologic mechanisms about heatstroke in dry-heat environment of desert has not been seen. ⋯ We have successfully established the rat heatstroke model of dry-heat environment of desert. We have identified heatstroke rats that presented changing characteristics on physiological indicators and varying degrees of organ damage, which are aggravated by the evolution of heatstroke in dry-heat environment of desert. We have preliminarily discussed the mechanism of heatstroke in dry-heat environment of desert.
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Methylene blue is the first-choice treatment of methemoglobinemia, but it is not readily available in most Korean emergency departments because of an import suspension. An 84-year-old woman with dapsone-induced massive methemoglobinemia visited our emergency department for unclear mentality and cyanosis. ⋯ Vitamin C (10 g intravenously) administered 6 hourly successfully treated the dapsone-induced methemoglobinemia and did not adversely affect renal functions. Thus,we recommend that if methylene blue is unavailable, 6 hourly intravenous administrations of 10 g of VC should be considered for dapsone-induced methemoglobinemia.
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We encountered a case of severe acute respiratory distress syndrome in late pregnancy due to influenza (H1N1) with refractory hypoxemia to conventional mechanical ventilation. Ventilation in prone position rescued this patient by maintaining oxygenation and sustaining improvement thereafter. ⋯ It requires frequent monitoring of possible complications due to prone position and highly dedicated supporting staffs. More data are required on safety of proning in the late pregnancy.
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Case Reports
Spontaneous hepatic rupture caused by hemolysis, elevated liver enzymes, and low platelet count syndrome.
The causes of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome or hepatic hemorrhage as a serious complication of HELLP are not known. Although spontaneous hepatic rupture associated with HELLP syndrome is a rare complication of pregnancy, hepatic rupture results in life-threatening complications. ⋯ Hepatic rupture in HELLP syndrome should be considered a differential diagnosis in pregnant patients with sudden onset of abdominal pain or hypotension. We report a case of 30-year-old primigravida female with spontaneous hepatic rupture caused by HELLP syndrome as a presenting symptom of right upper quadrant abdominal pain.
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Case Reports
Spontaneous carotid-cavernous fistula: challenges in clinical and radiologic diagnosis.
We present a 47-year-old female patient with spontaneous carotid-cavernous fistula without comorbidities. The symptoms of a carotid-cavernous fistula may be confused with other pathology in the region of the orbit and cavernous sinus such as cavernous sinus thrombosis. Carotid-cavernous fistulas most commonly result from direct injury to the internal carotid artery, as with skull base or surgical trauma, but it can also result from weakness in the arterial wall, as with an aneurysm. ⋯ Magnetic resonance angiography sequence can reveal aneurysms communicating with the cavernous sinus, and magnetic resonance venography will define thrombosis within the cavernous sinus. Differentiating between cavernous sinus thrombosis and carotid-cavernous fistula can be clinically difficult, and a team approach including emergency physicians, neurosurgeons, ophthalmologists, and otolaryngologists will be called upon to assist in diagnosis. Prompt diagnosis and management can allow for potentially vision and lifesaving interventions.