The American journal of emergency medicine
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Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare channelopathy involving cardiac calcium metabolism that often shows up at an early age with misleading clinical symptoms such as emotion or exercise-related syncope with a normal resting ECG, however, if misdiagnosed, CPVT can lead to cardiac arrest in children or young adults. We describe the case of a 27-year-old woman with several misdiagnosed syncopal episodes leading to out-of-hospital cardiac arrest (OHCA). Her previous medical history, combined with automatic external defibrillator records (AED) and clinical data, strongly suggested the diagnosis of CPVT. Thus beta blocker therapy was immediately started and targeted genetic test undertaken, revealing a previously unreported heterozygous variant in the ryanodine receptor-2 (RYR2) gene.
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Quality of cardiopulmonary resuscitation (CPR) contributes significantly to outcomes. Key determinants of CPR quality pertaining to chest compressions are compression rate, compression depth, duration of interruptions, and chest recoil. Several studies have demonstrated that real-time audiovisual feedback improves CPR quality. We hypothesize that a mobile application using sensor data from built-in accelerometers in smartphones can provide accurate chest compression quality feedback in real time. This study aims to develop and validate an application for smartphone which can provide real-time audiovisual and haptic feedback on determinants of CPR quality. ⋯ Smart device applications using acceleration sensor data derived from smart phones can accurately provide real-time CPR quality feedback. With further development and validation, they can provide a ubiquitously available CPR feedback tool valuable for out-of-hospital arrests and in-hospital arrests in under-privileged areas.
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Bromism is an unusual syndrome characterized by a variety of nervous system impairments such as ataxia, confusion, and delusions. Contemporaneous cases are rare as therapeutic use of bromide-containing medications has declined, but bromides can still be obtained as unregulated dietary supplements. Bromism from dietary supplements is not well-described. ⋯ He was treated with maintenance intravenous normal saline to promote excretion of the bromide ion and slowly returned to baseline over ten days. Bromism is an unusual but well-described constellation of neurologic impairments that presents insidiously and may be easily missed. The emergency physician should be aware of the dangers of bromide-containing dietary supplements and should educate patients taking these supplements of their risks.
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Case Reports
Post-concussive syndrome to primary central nervous system lymphoma: An insidious presentation.
Primary central nervous system lymphoma (PCNSL) and central neurogenic hyperventilation (CNH) are both rare occurrences, especially when associated with Epstein-Barr Virus (EBV). We report a case of an immunocompetent individual who presented to the emergency department (ED) with vague neurological symptoms found to have an EBV-associated PCNSL complicated by CNH. This rare occurrence had an insidious presentation initially mistaken for "post-concussive syndrome" at an outside ED. Insidious neurological malignancies, posterior strokes, intracranial hematomas, and other life-threatening pathologies should always be on the differential in patients presenting to the ED with falls with associated neurological symptoms, especially with unexplained blood gas abnormalities.