The American journal of emergency medicine
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Extrinsic esophageal compression leading to dysphagia is an uncommon and late presentation of large thoracic aortic aneurysm named dysphagia aortica. Herein, we report an 86-year-old man who presented with 1-week duration of chest pain, backache, and dysphagia and was eventually diagnosed as dysphagia aortica. Our patient developed progressive dyspnea due to tracheal compression and failed surgery. The case illustrates the importance of early identification of the rare entity of dysphagia especially in elderly cases with cardiovascular disease with complaint of undetermined dysphagia accompanied with chest pain and backache.
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Morel-Lavallee syndrome is a posttraumatic soft tissue injury in which the subcutaneous tissue is broken off from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter and, rarely, may also occur in the lumbal region. ⋯ The emergency physician and radiologist must keep this syndrome in mind because early diagnosis can enable conservative management, whereas delayed diagnosis may lead to surgical exploration. In this article,we present the clinical and radiologic features of 2 cases of lumbar Morel-Lavallee syndrome detected after trauma.
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Observational Study
Recognizing acute appendicitis criteria on abdominal computed tomography: do emergency physicians need a preliminary report?
Computed tomography (CT) is invaluable for the diagnosis of acute appendicitis (AA) in the emergency setting when used appropriately with proper risk stratification. The aim of this study is to investigate the capability and accuracy of emergency physicians (EPs) at recognizing AA criteria in intravenous contrast-enhanced abdominal CT and to investigate the level of interobserver agreement among them. ⋯ The recognition of the CT criteria for AA among EPs is substantial at best, and their ability to recognize the primary criteria for diagnosing AA is good. Emergency physicians have to gain a higher level of expertise to use this invaluable diagnostic tool more efficiently.
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Case Reports
Can Differential Regional Ventilation Protect the Spared Lung In Acute Respiratory Distress Syndrome?
Acute respiratory distress syndrome (ARDS) is a common clinical problem prevalent in intensive care settings. It can complicate many critical illnesses. The general treatment is mainly supportive. ⋯ Various interventions have been tested for the lethal condition including steroids, fluid restriction, statins, high-frequency ventilation, nitric oxide, and prone ventilation strategy. However, none has shown improvement apart from prone positioning and low tidal volume ventilation. We report our observation in a patient with ARDS, which may potentially show a new mechanism to protect normal alveoli in ARDS lung and thereby may improve survival.
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Case Reports
An alternative for rapid administration of medication and fluids in the emergency setting using a novel device.
Routes of administration for medications and fluids in the acute care setting have primarily focused on oral, intravenous, or intraosseous routes, but, in many patients, none of these routes is optimal. A novel device (Macy Catheter; Hospi Corp) that offers an easy route for administration of medications or fluids via rectal mucosal absorption (proctoclysis) has recently become available in the palliative care market; we describe here the first known uses of this device in the emergency setting. Three patients presenting to the hospital with conditions limiting more typical routes of medication or fluid administration were treated with this new device; patients were administered water for hydration, lorazepam for treatment of alcohol withdrawal, ondansetron for nausea, acetaminophen for fever, aspirin for antiplatelet effect, and methimazole for hyperthyroidism. Placement of the device was straightforward, absorption of administered medications (judged by immediacy of effects, where observable) was rapid, and use of the device was well tolerated by patients, suggesting that this device may be an appealing alternative route to medication and fluid administration for a variety of indications in acute and critical care settings.