J Emerg Med
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Review Case Reports
Seizure during hyperbaric oxygen therapy for carbon monoxide toxicity: a case series and five-year experience.
Hyperbaric oxygen (HBO) therapy is recommended to reduce the delayed neurologic sequelae resulting from carbon monoxide (CO) toxicity. Although HBO is generally well tolerated, there exists a risk of seizure in all patients that may be increased in patients with predisposing factors including: fever, hypothermia, prior seizure, or brain injury. ⋯ This facility's 5-year experience and a review of the germane literature are also presented to elucidate the risk factors and incidence of seizures in patients treated with HBO for CO toxicity.
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Pylephlebitis, which has high rates of morbidity and mortality, is thrombosis in the hepatic and portal veins. Hypercoagulability and intra-abdominal sepsis can lead to pylephlebitis, which can progress to liver abscess, mesenteric ischemia, and infarction. ⋯ Early diagnosis is essential for the treatment of pylephlebitis. Antibiotics and anticoagulants are the mainstay of treatment for pylephlebitis; although the use of anticoagulants remains controversial. In the present case, pylephlebitis was treated successfully without anticoagulants.
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Score systems for severity of illness and organ dysfunction have been validated and used as tools to predict the risk of death in intensive care unit (ICU) patients, but their usefulness in patients with suspected infection in the emergency department (ED) or hospital ward is unclear. ⋯ The reviewed literature did not provide enough information to assess the accuracy of the prognostic models in patients with suspected infection admitted to the ED and hospital ward. Some reports suggest a better accuracy with new scores like the MEDS (Mortality in Emergency Department Sepsis score), but the results are not consistent.