The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations.
Few studies were performed to compare ultrasound guided brachial plexus block with procedural sedation for reduction of shoulder dislocations in the Emergency Department (ED). This study was done to provide further evidence regarding this comparison. ⋯ Using ISBPB for reduction of anterior shoulder dislocations takes less time to discharge and may make it more feasible in conditions mandating faster discharge of the patient. However, since pain scores may be lower using PSA, this method may be preferred by many physicians in some other situations.
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In Japan, the number of patients with foreign body airway obstruction by food is rapidly increasing with the increase in the population of the elderly and a leading cause of unexpected death. This study aimed to determine the factors that influence prognosis of these patients. ⋯ The presence of a witness to the aspiration and removal of the airway obstruction of patients by bystanders at the accident scene improves outcomes in patients with foreign body airway obstruction. When airway obstruction occurs, bystanders should remove foreign bodies immediately.
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Treatment with low-potency anti-psychotic agents is an important risk factor in the development of pulmonary embolism (PE). We report a case of 74years old female patient receiving olanzapine for psychotic depression admitted to the emergency service with the complaints of chest pain and shortness of breath. She had tachypnea, hypotension and tachycardia. ⋯ As the only possible risk factor for PE was olanzapine, olanzapine treatment was terminated with pyschiatry consultation. During the 12-month follow-up of the patient; malignancy was not observed. Diagnosis and prevention of PE are the important goals to reduce morbidity and mortality in subjects receiving olanzapine.
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Point-of-care cardiac ultrasound (POCUS) is a common application in Emergency Medicine. Here we present a case of an incidentally discovered dilated right coronary sinus on ultrasound. This case involved a 55-year-old female who presented with chest pain, shortness of breath, and lightheadedness. ⋯ It is a tubular structure located at the posterior atrioventricular groove and it is generally not visible unless it is pathologically dilated. Identification of a dilated right coronary sinus can assist the clinician in making the diagnoses of CHF exacerbation, as well as alter the approach to specific procedures. To the best of our knowledge, this is the first case report describing the identification of a dilated right coronary sinus using POCUS.
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Observational Study
Effects of repeated epinephrine administration and administer timing on witnessed out-of-hospital cardiac arrest patients.
Repeated administration of epinephrine is associated with unfavorable cerebral outcome after out-of-hospital cardiac arrests (OHCA), but the timing of epinephrine administration has not been considered. ⋯ Repeated epinephrine administration improved CPC 1-2 outcome when epinephrine was administrated within 20min after an emergency call for witnessed cardiogenic OHCA.