The American journal of emergency medicine
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Case Reports
Cervicofacial emphysema and pneumomediastinum after a high-speed air drill endodontic treatment procedure.
Cervicofacial subcutaneous emphysema is defined as the abnormal introduction of air in the subcutaneous tissues of the head and neck. It is mainly caused by trauma, head and neck surgery, general anesthesia, and coughing or habitual performance of Valsalva maneuver. The occurrence of subcutaneous emphysema after dental treatment is rare, and diffusion of gas into the mediastinum is much rarer, especially when the procedure is a nonsurgical treatment. ⋯ We report a case of cervical subcutaneous emphysema and pneumomediastinum occurring after an endodontic treatment of right first molar using an air-tribune drill. We present here in a case of massive pneumomediastinum and cervicofacial subcutaneous emphysema that occurred after opening the access cavity for endodontic treatment. We describe its etiologies and guidelines for its prevention during nonsurgical endodontic treatment.
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Myelography has been of great use as a diagnostic modality, especially when other modalities were not conclusive. However, considering the invasive nature of myelography, it should receive the attention of medical personnel for them to be aware of its possible complications, especially when newer agents are applied as the contrast media. ⋯ These complications include lower-extremity myoclonic spasms, tonic seizure leading to status epilepticus, rhabdomyolysis, disseminated intravascular coagulation and anaphylactic shock. Having the knowledge of possible complications and available solutions, particularly fatal ones, could prepare medical staff beforehand for primary and secondary preventions.
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This study was performed to evaluate whether heart-type fatty acid-binding protein (H-FABP) could predict 28-day mortality in patients with severe sepsis and septic shock. ⋯ The H-FABP was an independent prognostic factor and could be a useful biomarker for 28-day mortality in patients with severe sepsis and septic shock.
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Reciprocal changes are frequent in patients with acute ST-segment elevation myocardial infarction (STEMI). However, their prognostic significance is not clear in patients undergoing immediate invasive intervention. ⋯ The data suggest that patients with STEMI with reciprocal electrocardiographic changes have unstable hemodynamic status and poorer outcomes. Further prospective studies using a larger patient population are needed.
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Randomized Controlled Trial
The effects of prewarming the I-gel on fitting to laryngeal structure.
The supraglottic airway, I-gel (Intersurgical, Wokingham, United Kingdom), has a noninflatable cuff, which softens at body temperature to fit to laryngeal structure. The present study was performed to investigate the hypothesis that the cuff of I-gel can fit to laryngeal structure faster when prewarmed to body temperature than kept at room temperature. ⋯ Prewarming the I-gel to body temperature did not have any significant benefits in comparison with the I-gel kept at room temperature.