J Emerg Med
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Review Case Reports
Reexpansion pulmonary edema: a case report and review of the current literature.
This case report illustrates the presentation and course of reexpansion pulmonary edema (REPE) in a young man with spontaneous pneumothorax. REPE is considered relatively uncommon by most accounts, but in certain clinical circumstances the incidence is much higher. ⋯ In patients with these risk factors, the thoracostomy tube should be initially left off suction in an effort to prevent REPE primarily. When REPE is encountered, therapy is supportive.
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Numerous factors affect decision making in the prehospital provision of resuscitative care. This study was undertaken to determine current practices involved in the initiation, continuation and termination of resuscitative efforts, and the impact of advance directives, in the prehospital resuscitation setting. This cross-sectional mailed questionnaire surveyed 3807 members of the National Association of Emergency Medical Technicians. ⋯ More experienced providers stated that they withhold resuscitative efforts more often in futile situations, or in the presence of unofficial advance directives. Advance directives should be utilized more uniformly among patients who wish to forgo resuscitative efforts in the event of cardiac arrest. Because many local protocols are judged to be inadequate, we support the institution of improved clinical guidelines regarding the prehospital termination of resuscitative efforts.
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Patients who present to the Emergency Department (ED) with chest pain associated with cocaine use are a common problem. The incidence and predictors of underlying significant coronary disease in patients with and without myocardial infarction (MI) has not been well described. Patients who underwent coronary angiography within 5 weeks of an ED evaluation for cocaine-associated chest pain were studied. ⋯ Only 7 of the 39 patients (18%) without myonecrosis or a history of coronary disease had significant disease on angiography. In conclusion, significant disease is found in the majority of patients with cocaine-associated MI or troponin elevations. In contrast, only a minority of those without myonecrosis have significant coronary disease.
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Narrow QRS complex tachycardia is a common dysrhythmia in Emergency Medicine practice. Diagnosis and mechanism often can be made by 12-lead electrocardiographic (EKG) analysis but may subsequently require electrophysiologic testing. The clinical manifestations are varied and dependent upon heart rate, prior cardiac disease, and general physiologic status. ⋯ Patients are often admitted to the hospital but selected patients can be safely discharged from the Emergency Department for outpatient evaluation and management. Pediatric and pregnant patients are, in general, treated the same as adults. Several case examples and EKGs are presented.
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Odontoid dysplasias are considered rare but are becoming increasingly recognized. Patients may have no symptoms, localized neck pain, or neurologic symptoms. Because patients with odontoid anomalies have the potential for craniovertebral instability, recognition of the entity is essential. A discussion of the axis, its development and anomalies follows.