The American journal of emergency medicine
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Case Reports
Spontaneous brain arteriovenous malformation rupture with atrioventricular block in a pediatric patient.
This case reports 9 year-old-female with atrioventricular block and seizure. Careful evaluation, including electrocardiogram (ECG) and computerized tomography (CT) revealed a high-grade atrioventricular block and spontaneous brain arteriovenous malformation (AVM) rupture. The patient had complete resolution of her bradycardia and AV block following atropine. This case is to our knowledge the first description of a pediatric spontaneous brain AVM rupture presenting with high degree AV block responsive to intravenous atropine.
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Neurally mediated syncope (NMS) is a disorder of autonomic nervous system (ANS) regulation. Orthostatic stress is one of the most common causative factors seen in clinical practice. Analysis of heart rate variability (HRV) is a non-invasive method that is used to assess ANS regulation. In this study, we investigated the pathophysiology of NMS using HRV in our emergency department. ⋯ The sympathetic and parasympathetic nervous systems were both suppressed in patients with NMS. In post-syncope, parasympathetic withdrawal, rather than sympathetic reactivation, was responsible for the increased HR after syncope. CVRR may serve as a new clinical biomarker in the emergency department.
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To evaluate the feasibility of point-of-care knee ultrasonography (POCUS) compared with knee magnetic resonance imaging (MRI) for diagnosing anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in patients with acute knee trauma. ⋯ POCUS demonstrates excellent precision as compared to MRI in the diagnosis of ACL and PCL tears. The findings of POCUS could be used for immediate diagnosis and further pre-operative imaging in patients with acute knee trauma.
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The objective of this study was to investigate the significance and prevalence of lactic acidosis in pediatric diabetic ketoacidosis (DKA) presenting to the emergency department. ⋯ Lactic acidosis is a common finding in pediatric DKA patients presenting to the emergency department. Serum lactate alone should not be used as an outcome predictor in pediatric DKA.