The American journal of emergency medicine
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Bronchospasm is caused by reversible constriction of the smooth muscles of the bronchial tree. This causes obstruction of the lower airways, which is commonly seen at the emergency department (ED) in patients with acute exacerbation of asthma or chronic obstructive pulmonary disease. ⋯ In this case series, we would like to share our experience delivering inhaled volatile anesthetic gas via a conserving device for three patients with refractory bronchospasm at the ED. Inhaled anesthetic gas is safe, feasible and should be considered as an alternative rescue therapy for ventilated patients with severe lower airway obstruction.
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Complicated UTIs (cUTIs) are defined by a heterogenous group of risk factors that place the patient at increased risk of treatment failure in whom urine cultures are recommended. We evaluated the ordering practices for urine cultures for cUTI patients and patient outcomes in an academic hospital setting. ⋯ Over a quarter of cUTI patients in this study did not receive a urine culture. Further studies are needed to assess if improving adherence to urine culturing practices for cUTIs will impact clinical outcomes.
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We report the case of an 84-years old female patient who developed cerebral air embolism in association with the indwelling hemodialysis central venous catheter. Pneumocephalus, even though rare, should be included in the differential diagnosis of acute manifestation of neurologic deficits, especially in association with central venous access, surgical interventions or trauma, and requests prompt management. Brain computed tomography scanning remains the investigation of choice.
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Orbital cellulitis is an uncommon but serious condition that carries with it a potential for significant morbidity. ⋯ An understanding of orbital cellulitis can assist emergency clinicians in diagnosing and managing this sight-threatening infectious process.
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Local applications of tranexamic acid (TXA) have been effective in treating various hemorrhagic conditions. In patients with gross hematuria, the main treatment in the emergency department (ED) is continuous bladder irrigation (CBI). However, CBI has no pharmacological effects except blood clot removal from dilution. The aim of this study was to evaluate the impact of the intravesical TXA injection before CBI. ⋯ After the TXA intervention, reduction in the length of stay in the ED, the duration of Foley catheter placement, and the revisits after ED discharge was observed.