The American journal of emergency medicine
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A suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency department. ⋯ We experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line.
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Case Reports
Acute intractable headache and oculomotor nerve palsy associated with nicorandil: A case report.
Acute non-traumatic headaches with neurological deficits alarm emergency department (ED) physicians. Typically, a sudden headache with oculomotor nerve palsy involving a pupil indicates the possibility of a subarachnoid hemorrhage (SAH) due to an aneurysm originating from the posterior communicating artery. For the ED physician, thinking beyond the possibility of an SAH can be crucial. ⋯ Cerebrospinal fluid analysis was also unremarkable. The patient's headache and oculomotor nerve palsy improved completely after discontinuation of nicorandil for 3 days. To the best of our knowledge, this is the first case report on side effects of nicorandil presenting as a severe headache with reversible oculomotor nerve palsy involving a pupil, symptoms which mimicked a possible SAH due to aneurysm.
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To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age. ⋯ When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.
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We describe a patient with pneumocephalus following an epidural steroid injection (ESI) who presented with altered mental status, headache, focal neurologic findings and seizures. Pneumocephalus has rarely been described following ESI. A 34-year-old female presented with an altered level of consciousness worsening over approximately 18h following an ESI for lumbar back pain. ⋯ Case reports noting complications associated with this technique have been reported; rarely including pneumocephalus. Complications from the pneumocephalus are even less commonly reported. Though rare following an ESI and generally self-limited without complication, pneumocephalus should be considered in the differential diagnosis when evaluating a patient with neurologic deficits after instrumentation.
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To evaluate the impact of a rivaroxaban discharge initiative on the efficacy and safety of acute venous thromboembolism treatment in emergency department patients. ⋯ Home treatment of acute VTE, facilitated by medication dose pack, is a promising tactic to ensure both immediate and long-term treatment efficacy and safety. Further studies are warranted to demonstrate clinical superiority of this intervention.