The American journal of emergency medicine
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Randomized Controlled Trial
Intravenous fluids for migraine: a post hoc analysis of clinical trial data.
A total of 1.2 million patients present to US emergency departments (EDs) annually with migraine headache. Intravenous fluid (IVF) hydration is used to treat acute migraine commonly. We were unable to identify published data to support or refute this practice. The goal of this analysis was to determine if administration of IVF is associated with improved short-term (1 hour) or sustained (24 hours) migraine outcomes. ⋯ Intravenous fluid did not improve pain outcomes among patients with acute migraine who were treated with intravenous metoclopramide.
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Dabigatran etexilate is a novel oral anticoagulant indicated for anticoagulation in the management of atrial fibrillation and venous thromboembolism. Before its approval by the US Food and Drug Administration, warfarin, a vitamin K antagonist, was one of few oral anticoagulant options. The burden of therapeutic drug monitoring, dietary restrictions, and various drug interactions associated with warfarin have countered its extensive history of efficacy. ⋯ After admission to the intensive care unit and 7 U of fresh frozen plasma, the patient remained hemodynamically unstable due to blood loss. Other observations were made that are poorly characterized in medical literature related to dabigatran: refractory hemorrhagic shock after 7 U of fresh frozen plasma, rapid correction of coagulation parameters (international normalized ratio, 1.7, and activated partial thromboplastin time, 44 seconds) achieved 4 hours after 26 U/kg of 4-factor prothrombin complex concentrate (Kcentra; CSL Behring, King of Prussia, PA), and with subsequent achievement of hemostasis. The patient was discharged to home 7 days later without sequelae.
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Case Reports
Laparoscopic management for spontaneous rupture of left gastroepiploic vessel after forceful retching.
Spontaneous rupture of the left gastroepiploic vessel causing abdominal apoplexy or spontaneous hemoperitoneum is extremely rare. Such ambiguous condition can delay diagnosis, resulting in hypovolemic shock. Reporting such rare cases is valuable to clinicians. ⋯ He was diagnosed with diffuse hemoperitoneum and large amount of hematoma in left side of lesser sac due to spontaneous rupture of left gastroepiploic vessel. The patient underwent emergency exploratory laparoscopy. Bleeding was controlled by clipping the teared vessel.
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Observational Study
Interaction of the diabetes mellitus and cardiac diseases on survival outcomes in out-of-hospital cardiac arrest.
Diabetes mellitus (DM) and cardiac disease (CD) both likely effect out-of-hospital cardiac arrest (OHCA) survival, but the effect of their relationship on survival outcomes is unclear. This study aims to investigate whether the association of DM and OHCA outcomes differ in patients with and without CD. ⋯ Diabetes mellitus had a significant negative association with survival to discharge and neurologic recovery among patients with CD, but the association was not significant in patients without CD.
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Case Reports
Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma: report of a case.
Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62%. ⋯ Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.