The American journal of emergency medicine
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Hypothermic infants are at risk for serious bacterial and herpes simplex virus infections, but there are no evidence-based guidelines for managing these patients. We sought to characterize variations and trends in care for these infants in the emergency department (ED). ⋯ Substantial hospital-level variation exists for managing hypothermic infants in the ED. Long-term trends are notable for changing practice over time, particularly with increased use of inflammatory markers. Prospective studies are needed to risk stratify and optimize care for this population.
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Differential diagnosis of myopericarditis (MPC) versus acute coronary syndromes (ACS) can be difficult in the emergency room (ER). Low density lipoprotein receptor-related protein-1 (LRP-1) is a transmembrane receptor with diverse biological functions. LRP-1 is increased after viral infections as a defense mechanism. sLRP-1 (soluble form) can be measured in the serum. We study the diagnostic sLRP-1 levels in patients with MPC, ACS and healthy controls. ⋯ sLRP-1 is a potential biomarker in the differential diagnosis of MPC versus ACS in ER. Future studies are needed to evaluate and develop the utility of sLRP-1 as a diagnostic and prognostic biomarker in MPC.
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Tension gastrothorax is a rare cause of obstructive shock induced by a distended stomach herniating into the thorax through a diaphragmatic defect. We report the process of diagnosis and emergency treatment for tension gastrothorax during cardiopulmonary resuscitation (CPR). A 71-year-old woman with multiple surgical histories had nausea and vomiting for two days. ⋯ Tension gastrothorax can be misdiagnosed as other conditions. A chest X-ray should be preceded in non-trauma settings, unlike the setting of a tension pneumothorax in trauma patients. Gastrointestinal decompression with NGT placement could be attempted quickly to improve the hemodynamic condition.
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Hyponatremia, defined as a serum sodium <135 mmol/L, is frequently encountered in patients presenting to the emergency department. Symptoms are often unspecific and include a recent history of falls, weakness and vertigo. Common causes of hyponatremia include diuretics, heart failure as well as Syndrome of Inappropriate Antidiuresis (SIAD) and correct diagnosis can be challenging. Emergency treatment of hyponatremia should be guided by presence of symptoms and focus on distinguishing between acute and chronic hyponatremia.
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Acute ataxia is commonly the chief complaint among patients visiting the emergency department (ED). It has multiple causes including infection and immunity-related, metabolic, vascular, and organic causes. Therefore, treating physicians should consider the severity and timing of onset in relation to the initial screening tests when making a differential diagnosis, and must be careful not to miss cases that require urgent treatment, such as stroke and drug-induced ataxia. ⋯ The plasma levels of phenytoin, carbamazepine, and valproic acid were 21.2 μg/mL (normal range: 7-20 μg/mL), 2.1 μg/mL (normal range: 5-10 μg/mL), and 33.5 μg/mL (normal range: 50-100 μg/mL), respectively. She was finally diagnosed with ataxia due to phenytoin toxicity. Her symptoms improved soon after the phenytoin dose was reduced and did not recur during a year of follow-up.