The American journal of emergency medicine
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To reduce the time required for suture closure for central venous catheterization, a new procedure was developed using a continuous suture technique. The present study was conducted to investigate the usefulness of this method. ⋯ We found that the new one-time method provided faster and more convenient central catheterization and catheter securement than the conventional methods.
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Poisoning caused by calcium-channels blockers (CCB) can cause refractory vasoplegic shock, resulting in multiple-organ failure and death despite maximal therapy including high doses of vasopressors. We report one CCB-induced refractory shock complicated with lactate acidosis despite very high doses of epinephrine and norepinephrine. The hemodynamic status of the patient dramatically improved after intermittent boluses of terlipressin, which corrected the acidosis.
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Case Reports
Taking varenicline for smoking cessation: A rare cause of pulmonary thromboembolism with infarction.
Varenicline (Champix®, Chantix®) is a partial agonist of the α4β2 nicotinic acetylcholine receptor (nAChR) and a full agonist of the α7 nAChR. It has been used for smoking cessation since 2006. ⋯ However, among the adverse CV events, the issue related to the varenicline-induced pulmonary thromboembolism (PTE) has not being addressed. We report a case of PTE with pulmonary infarction presenting as right flank pain that resulted from the use of varenicline (the total score of adverse drug reaction probability scale, 6; probable association between varenicline and pulmonary PTE) in a patient without underlying CV disease and in whom low probability of PTE (Wells score was zero) was identified.
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Lyme carditis poses a challenge to physicians given dramatic clinical presentations like the one presented in this case. Quite frequently, these young patients are implanted with permanent pacemakers; given lack of knowledge on the transient nature of the cardiac conduction system inflammation. This is the first case in the literature that has captured the electrocardiographic evolution of Lyme carditis, day by day until complete resolution.
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Characteristic ECG changes with hypercalcemia include shortening of the QoT, QaT, and QeT intervals which are measured from the beginning of the QRS complex to the origin (O), apex (A), and end (E) of the T wave respectively. At very high serum calcium levels ECG changes include slight prolongation of the PR and QRS intervals, T wave flattening or inversion, and the appearance of a J wave at the end of the QRS complex. ⋯ Cardiac troponin testing was negative, however, laboratory testing revealed a serum calcium level of 15mg/dL (normal 7.3-10.5mg/dL). We review the published literature regarding the link between hypercalcemia and the appearance of ST elevation.