The American journal of emergency medicine
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The American Heart Association/American College of Cardiology Foundation recommends vitamin K1 for warfarin-related coagulopathy. In Japan, vitamin K2 is used more commonly for such purpose. The difference between vitamins K1 and K2 in reversing warfarin-related coagulopathy has not been discussed. Herein, we report a case that was reversed with vitamin K2; alterations in vitamins K1 and K2 levels and coagulation markers are also presented.
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A cervical hematoma secondary to the spontaneous rupture of an aneurysm is an uncommon but catastrophic life-threatening condition because it can potentially obstruct the airway. Inferior thyroid artery aneurysm and rupture is a very rare clinical entity and only a limited number of cases have been reported in the literature. ⋯ The diagnosis was confirmed by magnetic resonance angiography, and delayed surgery resulted in an uneventful outcome. We aim to draw the attention of emergency physicians to this rare condition.
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Acute otitis media (AOM) is a common diagnosis under age 5 years. The primary objective was to determine if the CellScope Oto (CSO) improves tympanic membrane (TM) visualization and diagnostic precision compared to traditional otoscope. The secondary objective was to determine physician, patient, and parent device preference. ⋯ CellScope Oto was preferred by physicians, patients, and parents. Use of the CSO changed final diagnosis a significant number of times, including clinically relevant changes to/from AOM.
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Case Reports
Isolated testicular pain mimicking ruptured abdominal aortic aneurysm in a nonagenarian.
Ruptured abdominal aortic aneurysm commonly presents as acute abdominal or lower back pain and hemodynamic instability. We discuss the case of a 90-year-old patient who presented to the emergency unit with a 3-day history of left testicular pain. Ultrasound scan demonstrated and a computed tomography scan confirmed a 6 cm in diameter ruptured abdominal aortic aneurysm with enlargement and hematoma of the left psoas muscle causing the symptoms. This atypical presentation highlights the need for clinical vigilance and emergency physician–performed ultrasound scan in the older patients with seemingly benign testicular symptoms.
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Case Reports
Reversible magnetic resonance imaging changes in a case of neuroleptic malignant syndrome.
Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of mainly typical antipsychotic drugs. It is characterized by fever, altered mental status, generalized rigidity, autonomic instability, myoclonus, raised creatine phosphokinase, rhabdomyolysis, and leukocytosis. Neuroimaging (brain computed tomography/magnetic resonance imaging [MRI]) is usually normal in most of the cases of NMS. ⋯ Very few cases have been reported worldwide. We herein, report a case of a 42-year-old patient of NMS, who presented to us with reversible changes in MRI brain. This case report highlights the possible MRI changes in NMS and their plausible mechanism.