The American journal of emergency medicine
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Alcohol use is widespread, and withdrawal symptoms are common after decreased alcohol intake. Severe alcohol withdrawal may manifest with delirium tremens, and new therapies may assist in management of this life-threatening condition. ⋯ Alcohol withdrawal syndrome can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Benzodiazepines are the predominant medication class utilized, with adjunctive treatments including propofol or phenobarbital in patients with withdrawal resistant to benzodiazepines. Dexmedetomidine and ketamine require further study.
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Review Case Reports
Open physeal fracture of the distal phalanx of the hallux: Case study, diagnosis and management.
Open physeal fractures of the distal phalanx of the hallux are the lesser described counterpart to the same fracture of the finger, known by its eponym as a "Seymour fracture". Displaced Salter-Harris phalangeal fractures present with a concomitant nailbed or soft tissue injury. Often these fractures occur in the summer months when open-toe footwear can be worn, however, they may occur indoors as well. ⋯ In this article, we present a 12year-old male who sustained an open physeal fracture of the distal phalanx when he "stubbed" his great toe on a bed post. His injury was initially misdiagnosed at an urgent care facility, thereby delaying appropriate intervention and necessitating an operative surgical procedure. Additionally, we review the existing literature discussing these infrequently reported injuries, as well as present key points as they pertain to the diagnosis and management of this injury in the emergency department.
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With an elderly and chronically ill patient population visiting the emergency department, it is important to know patients' wishes regarding care preferences and advanced directives. Ohio law states DNR orders must be transported with the patient when they leave an extended care facility (ECF). We reviewed the charts of ECF patients to evaluate which patients presenting to the ED had their DNR status recognized by the physician and DNR orders that were made during their hospital stay. ⋯ Hospital staff did a poor job of noting DNR preferences and ECFs were inconsistent with sending Ohio DNR forms.
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Several chemotherapeutic agents are known to be cardiotoxic. One of them, 5-fluorouracil (5-FU), has been associated with coronary ischemia and reversible vasospasm. In this report, we describe a 54-year-old man with rectal cancer who developed chest pain during 5-FU infusion. ⋯ The final diagnosis was coronary artery spasm with moderate global left ventricular dilatation suggestive of nonischemic cardiomyopathy. During 3days of hospitalization, the patient remained pain free and therefore was discharged. To our knowledge, this is the first case report in the emergency medicine literature demonstrating a coronary vasospastic event associated with 5-FU cardiac toxicity.
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Observational Study
Validity of ultrasound in diagnosis of tendon injuries in penetrating extremity trauma.
Tendon ruptures are common musculoskeletal injuries all around the world. Correct and timely diagnosis of tendon injuries is obviously important for improving the treatment and minimizing the community costs. Ultrasound is now being considered as one of useful modalities in this area. ⋯ Our results were similar to previous findings. Ultrasound can effectively differentiate injured from intact tendons in penetrating extremity trauma.