The American journal of emergency medicine
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Bolus-dose phenylephrine (BDPE) is routinely used to treat hypotension in the operating room. BDPE's fast onset of action and ability to be administered peripherally have prompted calls for its use in the Emergency Department (ED). There are few published data on the safety of BDPE use in the ED. Primary concerns include BDPE's potential to cause dangerous hypertension or reflex bradycardia. We hypothesize that BDPE is a safe short-term vasopressor choice for hypotensive ED patients. ⋯ BDPE does not appear to cause reflex bradycardia or hypertension requiring intervention among hypotensive ED patients. The apparent safety of BDPE should be confirmed in prospective trials.
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Acalculia is defined as the inability to mentally manipulate numbers for simple calculations. It may occur in dementia, central nervous system (CNS) neoplasm, and stroke (Bermejo-Velasco and Castillo-Moreno, 2006). ⋯ We report the case of a 63-year-old male with a 1 day history of isolated acalculia that was found to have a left parietal lobe infarct with several smaller infarcts in the left occipital lobe. The diagnosis of stroke should be considered in all patients experiencing acute difficulty with mathematics, reading, or writing, even in the absence of other deficits.
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Urinothorax was first described in 1968 by Corriere et al. as the presence of urine in the pleural cavity due to retroperitoneal leakage of accumulated urine. Herein, we present a female patient, who complained of dyspnea due to urinothorax. This is the first case of urinothorax that developed so tardive after radiotherapy and was diagnosed due to high clinical evidence despite the negative scintigraphy.
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Current AHA/ACC guidelines on the management of ST-elevation myocardial infarction (STEMI) suggest that an ECG is indicated within 10minutes of arrival for patients arriving to the Emergency Department (ED) with symptoms concerning for STEMI. In response, there has been a creep towards performing ECGs more frequently in triage. The objectives of this study were to quantify the number of triage ECGs performed at our institution, assess the proportion of ECGs performed within current hospital guidelines, and evaluate the rate of STEMI detection in triage ECGs. ⋯ This retrospective study of 538 triage ECG's performed over an 8day period identified no STEMIs and 16 NSTEMIs. A very large number of ECGs were done at triage overall and included patients who do not meet our own hospital criteria. Given the extremely low yield and high associated charges, current guidelines for triage ECG for identifying a possible STEMI should be reviewed.
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Spontaneous pneumocephalus is defined as the presence of air in the absence of intracranial factors. The management of spontaneous pneumocephalus can be conservative or surgical, and surgical intervention could be urgently required if clinical deterioration is rapid. Here, we report a case of pneumocephalus and subdural hemorrhage after sneezing. ⋯ Pneumocephalus and intracranial hemorrhage can occur without a history of trauma or surgery. Special attention is required if headache, dizziness, or other neurologic signs and symptoms occur immediately after sneezing. Intracranial hemorrhage and penumocephalus should be considered in the differential diagnosis.