Can J Emerg Med
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Review Case Reports
Burns associated with e-cigarette batteries: A case series and literature review.
Electronic cigarettes, often referred to as e-cigarettes, have established a considerable market in North America over the last decade. In parallel to this trend, there has been a surge of e-cigarette battery explosions reported in the general media. ⋯ This report presents two cases of burn injuries from e-cigarette battery explosions requiring surgical management. The accompanying comprehensive literature review highlights the emerging importance of e-cigarettes as an aetiology of burn injury.
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Cardiac emergencies in pregnancy and the postpartum period are rare but often life-threatening. An emergency physician's differential diagnosis for chest pain in the peripartum patient often includes serious etiologies such as pulmonary embolism or myocardial infarction (MI). A lesser-known but important consideration on the differential for MI is that of a spontaneous coronary artery dissection (SCAD). ⋯ Failure to immediately address this condition can lead to acute heart failure, cardiogenic shock, and death. Thrombolytic treatment may be harmful and is not recommended, and percutaneous coronary intervention can result in the iatrogenic propagation of further coronary dissection. As a result, the management for suspected SCAD involves emphasis on urgent transfer and urgent coronary artery angiography to determine appropriate treatment modalities.
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The causes of high anion gap metabolic acidosis (HAGMA) are well described in the literature. However, sometimes more frequent causes of HAGMA cannot explain its occurrence. In the case of HAGMA and severe neurological depression in the absence of other causes of HAGMA, clinicians should consider an intoxication with gamma-hydroxybutyrate (GHB) as a possible cause. ⋯ Synthetic GHB was initially used as an anesthetic but is now only licensed for medical use in a limited number of indications such as the treatment of narcolepsy. Because of its euphoric effects, it became popular for recreational use under the street names: Liquid Ecstasy, Georgia Home Boy, and Liquid G. We describe the clinical case of a patient who suffered from severe neurological depression and HAGMA.
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We describe the successful use and complications of bolus-dose alteplase to treat strongly suspected pulmonary embolism (PE) with cardiac arrest in a patient initially presenting as ST-elevation myocardial infarcation (MI). Case description is followed by a review of the indications, safety, and dosing of systemic thrombolytic therapy for high-risk PE in the emergency department (ED). Diagnostic and therapeutic approach to PE in critically ill patients is also considered, including the potential utility of point-of-care ultrasound (PoCUS) in the ED.