J Emerg Med
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Internal jugular vein thrombosis is an uncommon entity with high morbidity and an increased risk of mortality. Spontaneous clotting of the internal jugular vein without any known risk factors is virtually unheard of, and intravenous drug use is the most common cause for thrombosis. ⋯ We present the case of a patient who, after in vitro fertilization, developed ovarian hyperstimulation syndrome and clotted the internal jugular vein. In the setting of the Emergency Department, the norm should be to "rule out internal jugular venous thrombosis" in pregnant patients who have undergone in vitro fertilization and present with neck pain, with or without swelling or distended collaterals.
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Multicenter Study
Prehospital transport time intervals for acute stroke patients.
Recognizing factors that cause prehospital stroke delays may improve time of presentation to the Emergency Department (ED) and allow earlier treatment of acute stroke patients. ⋯ Prehospital scene time and run times for acute strokes are less when there is diagnostic concordance between dispatchers and paramedics. Time intervals did not differ between missed and recognized strokes.
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Among the causes of non-accidental head injury (NAHI), shaken baby syndrome (SBS) is difficult to diagnose and is associated with retinal hemorrhages (RH). ⋯ SBS remains a difficult cause of NAHI to diagnose. Ophthalmologic examination can provide critical diagnostic and prognostic information in cases of suspected SBS. Child abuse should be highly suspect in children with RH and a parental explanation of accidental head injury, especially if the RHs are found to be bilateral, flame-shaped, or to extend through to all layers of the retina.
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Impaired consciousness without a history of trauma is a common reason for emergency department (ED) visits. Among critically ill patients with a history and physical findings suggestive of a cerebrovascular accident (CVA), it may be difficult to differentiate between a structural and a non-structural cause for their condition. ⋯ In critically ill patients with acutely altered levels of consciousness but without a history of trauma, a CSF-LDH value < or = 40 IU/L is associated with non-structural pathology.