The American journal of emergency medicine
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Wide complex tachycardia is defined as a cardiac rhythm with a rate greater than 100 beats/min (bpm) and a QRS complex duration greater than 0.10 to 0.12seconds (s) in the adult patient; wide complex tachycardia (WCT) in children is defined according to age-related metrics. The differential diagnosis of the WCT includes ventricular tachycardia and supraventricular tachycardia with aberrant intraventricular conduction, including both relatively benign and life-threatening dysrhythmias. This review focuses on the differential diagnosis of WCT with a discussion of strategies useful in making the appropriate diagnosis, when possible.
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of propofol versus alfentanil for moderate procedural sedation in the emergency department.
To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol. ⋯ We found a similar frequency of airway and respiratory adverse events leading to intervention between alfentanil and propofol used for moderate procedural sedation. Both agents appear safe for moderate procedural sedation.
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Observational Study
Motocross-associated head and spine injuries in adult patients evaluated in an emergency department.
Motor vehicle-related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States. ⋯ Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%.
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Case Reports
The misleading electrocardiogram - Midventricular Takotsubo masquerading as anterior wall STEMI.
Midventricular Takotsubo cardiomyopathy (TC) is a relatively rare variant of stress induced cardiomyopathy, wherein there is akinesis of only the mid-ventricular segment with or without hyperkinesis of apical and basal ventricular segments. The ECG findings of TC typically do not include ST segment elevation in V1-V2 and are unlikely to be associated with reciprocal changes in inferior leads. ⋯ In our patient, the ECG had changes strongly suggestive of STEMI, however had normal coronaries on cardiac catheterization. This case highlights the importance of carefully analyzing the ECG in emergency situations for differences between TC and STEMI and when in doubt, cardiac catheterization should be pursued.
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Horton's disease is a systemic inflammatory vasculitis, usually found in persons over 50years old. It affects medium and large-sized arteries stemming from the external carotid, especially the superficial temporal arteries. It can affect extracranial large vessels but only rarely the aorta. Diagnosis of aortitis is difficult and its incidence is probably underestimated. ⋯ In the present case, this patient had Horton's disease, based on 3 criteria of The American College of Rheumatology (age, temporal artery abnormalities and inflammatory syndrome) associated with aortitis. However, aortitis is a rare complication of Horton disease and is a major cause of mortality inasmuch as it can be complicated by aneurysm and dissection. It is unusual to diagnose Horton's disease from aortitis symptoms without complications. The aorta represents the most severe localization of Horton's disease. It should not be ignored in etiological hypotheses regarding febrile abdominal pain in the elderly. Corticosteroids should be started rapidly at high doses and temporal artery biopsy should be planned.