The American journal of emergency medicine
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Over the past two decades, transesophageal echocardiography (TEE) has been used with increasing frequency to evaluate critically ill patients outside of traditional settings. The purpose of this study was to characterize the number of programs, users, practice characteristics, training and competency requirements and barriers for the current use of resuscitative transesophageal echocardiography (TEE) in Emergency Departments (EDs) in the United States and Canada. ⋯ This study provides a snapshot of the practice of resuscitative TEE in EDs in the United States and Canada revealing the existence of 33 programs using this emerging modality in the care of critically ill patients.
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Many complications are emerging from Coronavirus Disease 2019 (COVID-19), likely secondary to immune dysfunction and autoimmunity. While dermatologic changes have been reported, de novo guttate psoriasis, typically associated with streptococcal and other viral infections, secondary to COVID-19 infection has been minimally described. The authors report a case of a 34-year-old man who developed a diffuse rash 3 weeks following a COVID-19 infection found to have new onset guttate psoriasis who was responsive to topical corticosteroids and a vitamin D analog.
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Case Reports
Severe caffeine poisoning treated with intermittent hemodialysis under circulatory support: A case report.
Caffeine poisoning can cause fatal ventricular arrhythmias. In this report, we describe a case of severe caffeine poisoning with extraordinarily high blood caffeine levels. Despite developing refractory ventricular fibrillation, the patient was successfully treated with intermittent hemodialysis (IHD) under circulatory support by venoarterial extracorporeal membrane oxygenation (VA-ECMO). ⋯ Renal replacement therapy (RRT) including intermittent hemodiafiltration, continuous hemodiafiltration, and IHD was continued because of rhabdomyolysis with myoglobinuria and secondary caused acute kidney injury. The patient was weaned off VA-ECMO on hospital day 7, extubated on hospital day 18, weaned from RRT on hospital day 46, and was transferred to another hospital for physical rehabilitation on hospital day 113. IHD under circulatory support by VA-ECMO should be considered in severe caffeine poisoning causing potentially fatal arrhythmias.
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Case Reports
Acute treatment of intracranial hemorrhage complicated by hemophilia a and emicizumab therapy.
Among patients with hemophilia A with or without FVIII inhibitors, emicizumab prophylaxis has demonstrated significantly reduced bleeding events. However, emicizumab interferes with clotting-based assays used for monitoring FVIII activity, resulting in falsely elevated FVIII activity. This lack of accurate monitoring can complicate the dosing of intravenous therapeutic FVIII clotting factor concentrates in the treatment of critical bleeding events. This case report aims to inform providers who frequently treat hemophilia-associated hemorrhages about emicizumab's effect on clotting-based assays essential for monitoring factor replacement.