J Emerg Med
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Persistent left superior vena cava (PLSVC) is a congenital anomaly with an estimated incidence of 0.3-0.5% in the normal population. Its usual discovery is often made by an abnormally positioned catheter inserted in the left subclavian or left jugular vein. In this situation, an easy bedside approach to confirm an anatomic variation in the central venous system is helpful. In the majority of cases, the PLSVC drains to the coronary sinus. ⋯ In this brief report, we describe the contribution of echocardiography to the diagnosis of a PLSVC. Echocardiography is a reliable and easy diagnostic tool that allows a bedside approach in a patient in whom there is suspicion of a PLSVC, without administration of radiographic contrast.
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Early recognition of elevated lactate levels may hasten the detection of time-sensitive illness. We studied a method to measure lactate levels in septic patients using a point-of-care (POC) device at Emergency Department triage. A convenience sample of adult patients with sepsis was enrolled. ⋯ The time difference between POC test result and whole blood lactate result was 151 min (IQR 101-247). Triage POC fingertip lactate is a feasible method for reducing time to identification of lactate levels in patients with sepsis. Larger studies are needed to determine the ability of POC lactate measurement to aid in the risk stratification of septic patients.
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Case Reports
Internet suicide guidelines: report of a life-threatening poisoning using tobacco extract.
Severe nicotine intoxication occurred in a patient after ingestion of a tobacco extract made from a recipe found on a freely available Internet site. ⋯ Nicotinergic intoxication is not always easy to recognize, and without clues from the patient and the toxicologic analysis, might well have been missed in the present case.
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Methemoglobinemia is an uncommon cause of tissue hypoxia, but it can be life threatening if it is not identified and treated promptly. ⋯ Over-the-counter topical benzocaine should be used with caution, and the presence of methemoglobinemia must be promptly identified and treated.
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Multiple predictors have been proposed to assist in identifying patient features that would predict difficult airway management. The Mallampati score (MS) has been shown to be useful in the preoperative assessment of patients being intubated in the operating room. ⋯ We were unable to perform a Mallampati assessment in three-quarters of our patients requiring emergency intubation. These findings call into question the feasibility of the standard Mallampati assessment in the practice of Emergency Medicine.