The American journal of emergency medicine
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Case Reports
Emergence and resolution of the electrocardiographic spiked helmet sign in acute noncardiac conditions.
Patients with acute abdominal or acute thoracic events occasionally develop a curious electrocardiographic ST-segment elevation, where the upward shift of the baseline starts before the onset of the QRS complex. The shape of the complexes resembles a German military spiked helmet. ⋯ Removal of a large epigastric content resulted in the prompt resolution of the spiked helmet sign in the inferior leads, whereas suctioning of a large pneumothorax lead to the gradual disappearance of the spiked helmet sign in the chest leads. These cases provide the first definitive proof of a mechanical, noncardiac etiology of the spiked helmet sign.
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Letter Randomized Controlled Trial Comparative Study
Quality of chest compression: comparison CardioPump cardiopulmonary resuscitation with standard basic life support in a single-rescuer scenario. A manikin study.
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Case Reports
Novel use of ultrasound in the ED: ultrasound-guided hematoma block of a proximal humeral fracture.
Proximal humeral fractures are a common injury after falls, particularly in the elderly population. An ultrasound-guided hematoma block is a novel technique for analgesia in cases when standard intravenous analgesia is not efficacious. We present a case in which ultrasound-guided hematoma block was the ideal method for adjunctive pain control in a patient with a comminuted humeral head fracture.
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A 48-year-old man presented with headache and extreme hypertension. Computed tomography showed diffuse brain stem hypodensity. ⋯ Because of its atypical location, the diagnosis can be challenging. Moreover, the coexistence of hypertension and brain stem edema could also direct clinicians toward a diagnosis of ischemic infarction, leading to a completely contradictory treatment goal.
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Our case describes an episode of fulminant pulmonary embolism (PE) due to thrombotic thrombocytopenic purpura, which was accompanied by cardiac arrest. A 33-year-old woman was transferred to intensive care unit who had severe dyspnea with microangiopathic hemolytic anemia. After intubated with ventilation support, the patient’s symptoms were exacerbated with cardiac arrest from the narrow QRS complex pulseless electrical activity. ⋯ The patient became awake and alert without any complication and sequel through successive treatment. We conclude that thrombotic thrombocytopenic purpura is a medical emergency with severe hematologic disorder with a high risk of PE especially within 24 hours after the episodes of hemolysis. Empiric thrombolysis during cardiopulmonary resuscitation in presumed fulminant PE can be highly beneficial with better survival rates and neurologic outcome.