The American journal of emergency medicine
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A prospective, observational study of immunizing over 6,000 active-duty troops against smallpox in a 4-week time period was conducted. It focused on the complications of the vaccine and lost workdays. Comparison is made to the complication rates of earlier smallpox immunization programs. ⋯ The immunization program produced an additional 156 medical visits (2.6% of patients required one visit). A total of 0.55% of immunized individuals lost one or more work days. In conclusion, a mass smallpox vaccination program can be effectively administered in a forward-deployed military setting despite high tempo military operations with minimal operational impact.
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Echocardiography has been used to diagnose acute right-sided dysfunction arising from pulmonary embolism (PE). Rarely, it can visualize the embolic material in the right heart cavities. We report a case of acute PE that was seen in the right ventricle and right pulmonary artery using bedside transthoracic echocardiography in the ED. ⋯ Serial echocardiographs confirmed the response to therapy and the dissolution of thrombi. In this report, echocardiographic findings of acute PE and indications of thrombolytics in PE are also reviewed from the literature. Based on available evidence, those patients who present with cardiogenic shock from PE, and young patients with acute PE leading to right ventricular dysfunction benefit the most from early thrombolytic therapy.
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The purpose of this study is to evaluate the usefulness of combined computed tomography venography and pulmonary angiography (CTVPA) in the diagnosis of venous thromboembolic (VTE) disease in the emergency department (ED). CTVPA images and clinical data of 73 nonselected patients with suspected pulmonary embolism (PE) and/or deep venous thrombosis (DVT) were retrospectively assessed. CTVPA correctly identified 33 of 34 patients with VTE disease, including 7 patients with PE alone, 11 patients with DVT alone, and 16 patients with both PE and DVT. ⋯ CTVPA showed high accuracy in the diagnosis of both PE and DVT, in comparison with lower extremity venous sonography and ventilation-perfusion scintigraphy. In 26 (66%) of the 39 patients without of evidence VTE, CTVPA provided important ancillary information that suggests additional or alternative diagnoses. CTVPA is therefore an appropriate single diagnostic tool for evaluation VTE disease in the ED.
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There has been a marked increase in the use of unpowered scooters over the past few years. Along with this, there has been an increase in injuries related to their use. The objective of this study was to review the unpowered scooter-related injury reports compiled by the United States Consumer Product Safety Commission (CPSC) and to describe the scope and type of injuries sustained. ⋯ Although most injuries were relatively minor, there were 15 deaths reported. Although most injuries occurred in older children and young adolescents, the very young and adults were not immune from injuries. The risk of injury from unpowered scooters and the need for safety awareness should be stressed to all individuals including the very young and adults.
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Letter Case Reports
Ecstasy overdose: rapid cooling leads to successful outcome.