The American journal of emergency medicine
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Case Reports
Unusual etiology of bilateral acute visual impairment: Optochiasmatic cavernoma haemorrhage.
Optochiasmatic cavernoma haemorrhage is unusual etiology of bilateral acute visual impairment. This vascular hamartoma is extremely rare with a prevalence rate of 0.4-0.9% of the general population. They are frequently revealed by an optochiasmal apoplexy. ⋯ So our attitude was to carry out a close follow-up. After one year the visual evolution was satisfactory, no clinical worsening has been noticed and the MRIs examinations showed the same aspect with the same size. The aim of this observation is to evoke the diagnosis of an optochiasmatic cavernoma haemorrhage in case of acute chiasmal compression syndrome within patients in the third and fourth decades.
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Increasing the size of the central veins is required to increase the success rate of central line placement and decrease complication risk. Right-sided approach for the central veins, Valsalva maneuver, and Trendelenburg position have been recommended, but these may not be available for some cases. This study aimed to determine a more convenient patient position that can result in the largest central vein diameter. ⋯ The LE without leg elevation produced a greater and more significant increase in central vein diameter than the supine position and may be useful for central line placement.
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We studied the impact four new urgent care centers (UCCs) had on a hospital emergency department (ED) in terms of overall census and proportion of low acuity diagnoses from 2009 to 2016. We hypothesized that low acuity medical problems frequently seen in UCCs would decrease in the ED population. Since Medicaid was not accepted at these UCCs, we also studied the Medicaid vs non-Medicaid discharged populations to see if there were some differences related to access to urgent care. ⋯ With the introduction of four new urgent care centers (UCCs) within 5 miles of the hospital, the ED diagnoses of pharyngitis and bronchitis, two of the most common diagnoses seen in UCCs, decreased significantly. Significantly more Medicaid discharged patients presented to the ED with pharyngitis than in the non-Medicaid discharged group, likely because Medicaid patients had no access to UCCs.
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Mean platelet volume (MPV) is an inflammatory marker. Recent studies have shown that there is a negative correlation between platelet count (PC) and MPV and that the ratio of these two values may be more meaningful. The aim of our study was to investigate the diagnostic value of MPV and the MPV/PC ratio in acute appendicitis. ⋯ In our study, MPV and the MPV/PC ratio were not useful in the diagnosis of acute appendicitis.
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Although ultrasound-guided peripheral nerve block (UGPNB) has recently been introduced into pediatric emergency departments (EDs), knowledge of its use is still limited among pediatric emergency physicians. Ultrasound-guided ulnar nerve block (UGUNB) is a form of peripheral nerve block available for controlling the pain caused by phalangeal injuries, but studies of its use in pediatric patients are still scarce. The aim of this case series was to describe the experience of UGUNB use for pediatric phalangeal fractures in a pediatric ED setting. ⋯ Approximately 0.1-0.2 mg/kg of 1% lidocaine was used as the nerve block. The procedure was effective for pain control, and fracture reduction was successfully performed without the need for rescue analgesia. This case series demonstrated that UGUNB has the potential to be a useful alternative to conventional pain management in pediatric fifth digit injuries.