The American journal of emergency medicine
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A patient's vital signs are all inextricably interrelated, and together provide critical information regarding hemodynamic and physiological status. Yet, the precise relationship between body temperature (T) and heart rate (HR) in adults remains a fundamental gap in our knowledge. ⋯ Among adult ED patients nationally, for every increase in T of 1 °C, the HR increases by approximately 7 bpm.
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Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI. ⋯ Troponin can be elevated in many critical settings. The causes of troponin elevation include cardiac and non-cardiac conditions. Clinicians must consider the clinical context and other factors, as an inappropriate diagnosis of OMI may result in patient harm and misdiagnosis of another condition.
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Airway management is a common procedure performed in the Emergency Department with significant potential for complications. Many of the traditional physical examination maneuvers have limitations in the assessment and management of difficult airways. Point-of-care ultrasound (POCUS) has been increasingly studied for the evaluation and management of the airway in a variety of settings. ⋯ Airway management is a core skill in the Emergency Department. POCUS can be a valuable tool with applications ranging from airway assessment to dynamic cricothyroidotomy. This paper summarizes the key literature on POCUS for airway management.
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Case Reports
Isotretinoin-induced pruritic erythematous lesions and acute chest pain in a 15-year-old girl.
Isotretinoin is widely used in the treatment of acne vulgaris for more than 30 years (1). In addition to its systemic side effects, isotretinoin may also cause mucocutaneous side effects including cheilitis, nasal hemorrhage, dry skin, itching, rash, pigmented purpuric dermatosis, dry nose, purpura, and photosensitivity. We report a case of a 15-year-old girl given isotretinoin for severe acne vulgaris who developed pruritic erythematous lesions and chest pain 5 min after taking the first dose 20 mg of isotretinoin.
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Case Reports
Pain in the hip: Spontaneous retroperitoneal hemorrhage in an elderly patient on apixaban.
As many as 5% of patients using oral anticoagulants suffer from a major bleeding event annually. Spontaneous retroperitoneal hemorrhage is a rare but serious complication, with a mortality rate as high as 20%. Oral anticoagulants were responsible for 2.83 million office visits per quarter in 2014 and use is increasing, therefore, rapid recognition of life threatening complications is critical. ⋯ While our patient presented with hip pain, other presentations include abdominal masses, back pain, or hypotension. Some patients may progress to hemodynamic instability, femoral neuropathy, or abdominal compartment syndrome requiring rapid intervention to prevent further morbidity. In patients with vague abdominal or pelvic complaints who have risk factors such as advanced age and the use of anticoagulation therapy, spontaneous retroperitoneal hemorrhage should be considered to allow for early diagnosis before severe complications arise.