The American journal of emergency medicine
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Regular, narrow complex tachycardia with a ventricular rate around 150 can be challenging. The differential includes sinus tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), and atrial tachycardia (focal or macro re-entrant - i.e. flutter). We present a case of a 90-year-old woman presenting with shortness of breath in which the ECG was not diagnostic, but the presence of regular neck pulsations helped secure the diagnosis of AVNRT. ⋯ When the right atrium attempts to contract against a closed tricuspid valve, an abrupt increase in venous pressure is encountered. This increase in venous pressure manifests as prominent neck pulsations termed "cannon A waves." The patient was ultimately successfully electrically cardioverted resulting in resolution of her presenting symptoms, neck pulsations, and tachycardia. While irregular "cannon A waves" can be seen in conditions of AV dissociation, regular "cannon A waves" strongly favor the diagnosis of AVNRT.
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Thyrotoxic periodic paralysis (TPP) is a relatively common complication seen in Asian hyperthyroid patients. However, it is a rare occurrence to find a TPP case comprised of acute hypercapnic respiratory failure in patients with painless thyroiditis. ⋯ It is important to note that potentially fatal complications such as acute hypercapnic respiratory failure might occur in acute attacks of TPP even in cases of TPP due to painless thyroiditis.
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Letter Multicenter Study
Emergency department utilization by newly pregnant adolescents: A community-based study.
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Comment Letter
Impact of prehospital airway management on combat mortality.