The American journal of emergency medicine
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Very few cases of the use of extracorporeal membrane oxygenation (ECMO) in pregnant women have been reported to date. We report the first case of the use of ECMO for the treatment of cardiac arrhythmia with cardiogenic shock in a pregnant woman. A 28-year-old pregnant woman at 26 weeks of gestation presented with supraventricular tachycardia complicated with cardiogenic shock and fetal distress that was refractory to medication and electrical cardioversion. ECMO was applied, and it facilitated successful radiofrequency ablation.
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Dislocations and subluxations at the metacarpal-phalangeal joint are rare and volar or palmar subluxations represent a small fraction of these. A 54-year-old man presented with an injury to his right hand; he had heard a pop while putting down a weight. He had normal vital signs, and his examination revealed a deformity at the third metacarpal-phalangeal joint. ⋯ Attempts at closed reduction in the emergency department were unsuccessful, and he was splinted with plans for follow-up. There are several characteristics of this injury that present a diagnostic challenge: most patients are able to make a fist due to intact flexor mechanism, the deformity is subtle and may be masked by swelling, and lateral radiographs tend not to image the joint well. Recognition of this injury and hand surgery consultation are essential because most described cases required open reduction.
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Case Reports
Delayed subdural hematoma after receiving enoxaparin for prevention of thromboembolic events from high-risk surgery.
Enoxaparin (Lovenox) is a low–molecular weight heparin used to prevent deep venous thrombosis in patients undergoing total hip or knee arthroplasty. Anticoagulation in a patient after trauma may be dangerous and lead to significant hemorrhage. An elderly man fell and sustained a concussion and a hip fracture. ⋯ He received enoxaparin perioperatively and developed a delayed extensive subdural hematoma. Although enoxaparin has been shown to be an effective and a safe drug for venous thromboembolism prophylaxis in orthopedic surgeries and trauma, severe bleeding may rarely occur, especially in the setting of head trauma. Other therapies for venous thromboembolic prophylaxis, such as mechanical thromboembolism prophylaxis methods, should be considered.
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Women with acute coronary syndrome appear to be treated less aggressively than men. However, little is known about potential sex biases in the evaluation of patients with low-risk chest pain admitted to emergency department (ED) chest pain units. ⋯ This study demonstrates no association between physician discretionary uses of stress testing based on sex. There is a need for further research on patient- or provider-specific factors that determine stress use and on how differences may affect clinical outcomes.
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Historically, pain has been poorly managed in the pediatric emergency department (ED) (PED), resulting in measurable psychosocial issues both acute and delayed. ⋯ Protocolized pain management reduces patients' memory of pain during PED visits but may not affect parental memory of perceived pain or parent- and patient-reported pain at discharge.