The American journal of emergency medicine
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Hanging is one of the most common causes of suicide world-wide, more prevalent in developing countries. There are no established protocols for early management of near-hanging patients who present to the emergency department (ED). The use of early intubation, strict blood pressure control and targeted temperature management has shown promise in small studies. ⋯ This novel early management protocol reduced mortality and increased the number discharged without neurological deficit in near-hanging patients in a single tertiary care center in India.
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Case Reports
Uveitis and acute glaucoma as first presenting symptoms of sarcoidosis in a healthy male.
Sarcoidosis is a disease that causes noncaseating granulomas in tissues such as the lungs, heart, skin, and eyes. Sarcoidosis is often found through chest x-ray or lesions in the skin and eyes. In over half of patients the disease is detected incidentally by radiographic abnormalities on a routing chest x-ray prior to development of any symptoms. ⋯ Multiple cases have been reported on sarcoidosis with eye involvement, especially uveitis. We present a healthy 36-year-old male with no past medical who initial presentation of sarcoidosis was uveitis with acute angle closure glaucoma. To our knowledge this is the first reported case of sarcoidosis with this presentation.
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Managing patients with open pelvic fractures continues to be challenging and requires a multidisciplinary approach. In this study, we examined the characteristics of patients with open pelvic fractures and strategies for managing such patients. ⋯ Active external hemorrhaging was initially controlled when managing patients with open pelvic fractures; however, most patients also required TAE for definitive hemorrhage control. Early TAE should be considered due to the high probability of concomitant internal and external hemorrhage. Close observation and further infection control are important following the hemostatic procedure.
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Class Ic antiarrhythmic agents flecainide and propafenone are amongst the drugs most frequently prescribed to control atrial arrhythmias, in particular atrial fibrillation (AF). Despite being cited in some guidelines as a warning when using 1c antiarrhythmic agents, atrial flutter (AFl) with 1:1 atrioventricular conduction is rare in adults, with only small series reported in the literature, mainly including patients having 1:1 AFl during physical activity, and often associated with a predisposing factor, namely a dual AV nodal conduction pathway. ⋯ After ED discharge, the patient was then evaluated in the Arrhythmologic Clinic of the Cardiology Department, and channellopaties were excluded. This case report should raise alertness in emergency physicians about this serious and potentially fatal side effect of flecainide, when using this drug for pharmacological cardioversion of AF.
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Multicenter Study
Association of fentanyl use in rapid sequence intubation with post-intubation hypotension.
The anesthesia literature has reported that pre-intubation fentanyl use is associated with post-intubation hypotension which is a risk factor of poor post-emergency department (ED) prognosis. However, little is known about the relations between fentanyl use for intubation and post-intubation hypotension in the ED. We aimed to determine whether pretreatment with fentanyl was associated with a higher risk of post-intubation hypotension in the ED. ⋯ In this prospective multicenter study of ED airway management, pretreatment with fentanyl in rapid sequence intubation was associated with higher risks of post-intubation hypotension.