The American journal of emergency medicine
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Hiccups (singultus) is often a benign, common and self- limited condition. A case of profound electrolyte disturbances presenting with chief complaint of hiccups is presented in which chlorpromazine was not administered and could have been problematic had it been given. For those who present to the ED with chief complaint of hiccups, it is critical to consider a life threatening etiology as the cause of their symptom. This case presents a potential pitfall in the management of singultus.
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We illustrate the case a patient with left bundle branch block (LBBB) and electrocardiogram (ECG) changes consistent with those described in Wellens' syndrome. The characteristic ECG findings of Wellens' syndrome identify patients who have a particularly high rate of important coronary events in the near future, however these findings have previously been described only in the setting of normal conduction. A review of Wellens' syndrome, its criteria and pathophysiology, and its proposed appearance in the setting of LBBB is presented.
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Acute compartment syndrome is increased tissue pressure exceeding perfusion pressure in a closed compartment resulting in nerve and muscle ischemia. Common precipitating causes are crush injuries, burns, substance abuse, osseous or vascular limb trauma. This is a case of 42year old female with history of hypothyroidism who presented to emergency room with acute onset of severe pain and swelling in right lower extremity. ⋯ Management included emergent fasciotomy and initiating thyroid hormone replacement. This case represents a rare association between acute compartment syndrome and uncontrolled hypothyroidism. We also discuss the pathogenesis of compartment syndrome in hypothyroid patients and emphasize the importance of evaluating for less common causes, particularly in setting of non-traumatic compartment syndrome.
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Patients with mild traumatic brain injury (mTBI) with associated intracranial injury, or complicated mTBI, are at risk of deterioration. Clinical management differs within and between institutions. We conducted an exploratory analysis to determine which of these patients are unlikely to have an adverse outcome and may be future targets for less resource intensive care. ⋯ Our analysis highlighted three factors associated with adverse outcomes in persons who have complicated mTBI but a GCS of 15. Absence of these risk factors suggests low risk of adverse outcomes, and may suggest that a patient is safe for discharge home. Additional research is required before utilizing these findings in clinical practice.
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A meta-analysis of randomized controlled trials on evaluating the clinical efficacy of Xuebijing in treating patients with sepsis had been recently published in this journal, however, in our opinion, at least 6 questions or doubts existed about the content and methodology of the systematic review, thus, we write this letter to the journal to share these questions with the editor and readers with the hope of getting these questions solved and learning more about the true effects which Xuebijing should have on in treating patients with sepsis.