The American journal of emergency medicine
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Necrotizing fasciitis is an uncommon but life-threatening condition with a high associated mortality and morbidity. Most infections are polymicrobial, another distinct form of necrotizing fasciitis that occurred by penetrating freshwater trauma, such as fishing or wading in wet fields. Aeromonas species are responsible. ⋯ An apparent superficial cellulitis that fails to respond to standard therapy must raise suspicion of a more extensive underlying subcutaneous infection. Aggressive surgical debridement and antibiotic coverage for gram-negative rods are the essential features of treatment. Delay caused by a mistaken diagnosis of cellulitis and subsequent inadequate debridement would likely prove fatal.
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The prognostic role (if any) of lactate for early mortality in patients with ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) is so far not elucidated. We therefore assessed whether lactic acid (LA) was a prognostic predictor for early mortality in 807 patients with STEMI submitted to primary PCI consecutively admitted to our intensive cardiac care unit (ICCU) from January 1, 2006, to December 31, 2009. ⋯ In patients with STEMI submitted to primary PCI, blood lactate is a prognostic marker for early mortality only in the subgroup with advanced Killip class. The degree of hemodynamic impairment (as indicated by Killip class), of myocardial ischemia (as inferred by troponin I), and glucose values are the main factors influencing lactate concentrations in the early phase of STEMI.
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A 65-year-old man with recently diagnosed urinary tract infection treated with ciprofloxacin (Cipro) presented to our institution with recurrent seizure-like activity. His rhythm revealed torsade de pointes, which required defibrillation. ⋯ This case highlights a rare but potentially fatal side effect of quinolone antibiotics, especially in combination with other QT-prolonging medications. Review of the literature with regard to prevalence, mechanism, and assessment and treatment of this potentially fatal incidence is provided.
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Review Case Reports
Pulseless electrical activity in cardiac arrest: electrocardiographic presentations and management considerations based on the electrocardiogram.
Pulseless electrical activity (PEA), a cardiac arrest rhythm scenario with an associated poor prognosis, is defined as cardiac electrical activity without a palpable pulse. Considering both outpatient and inpatient cardiac arrest presentations, PEA as a rhythm group has been increasing over the past 10 to 20 years with a corresponding decrease in the "shockable" rhythms, such as pulseless ventricular tachycardia and ventricular fibrillation. This review focuses on electrocardiographic findings encountered in PEA cardiac arrest presentations with an emphasis on recognition of patients with a potential opportunity for successful resuscitation.