J Emerg Med
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Review Case Reports
Emergency department initiation of cardiopulmonary bypass: a case report and review of the literature.
Out-of-hospital cardiac arrest carries a dismal prognosis. Percutaneous extracorporeal membrane oxygenation (ECMO) has been used with success for in-hospital arrests, and some literature suggests improvement in long-term survival for out-of-hospital arrests as well. ⋯ ECMO is a novel adjunct for patients in cardiac arrest in whom the usual advanced life support techniques have failed.
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Review
Penetrating atherosclerotic ulcerative disease of the aorta: do emergency physicians need to worry?
In recent years, different aortic pathologies have been grouped together and described in terms of a spectrum of disease referred to as Acute Aortic Syndrome (AAS). Overlapping of these conditions has traditionally introduced discrepancy to the understanding of the pathophysiology and definitive care. Penetrating atherosclerotic ulcer (PAU), an ulceration of an atherosclerotic plaque, has been increasingly recognized as the individual cause of the acute aortic pathology. ⋯ The relative rarity of this disease, the difficulties in its detection, and the lack of precise guidelines about its management may result in diagnostic delays. Asymptomatic patients with well-controlled blood pressure are safely managed as outpatients in close consultation with vascular surgery.
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Acute upper gastrointestinal (UGI) bleeding manifests as hematemesis, melena, or hematochezia. Initial management is identical, irrespective of nasogastric (NG) aspirate results. Current practice includes early upper endoscopy. Significantly fewer high-risk bleeding lesions are found on endoscopy in patients with coffee grounds vs. bloody NG aspirates. ⋯ Although patients were admitted for UGI bleeding, the more significant associated diagnoses included acute myocardial infarction, urosepsis, small bowel obstruction, bilateral pulmonary emboli, and acute renal failure. Hemodynamically stable patients presenting with coffee grounds NG aspirate and no fall in hemoglobin/hematocrit should be evaluated for other non-GI bleeding-related conditions even as the GI bleed is being managed.
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Intestinal malrotation in the newborn is usually diagnosed after signs of intestinal obstruction, such as bilious emesis, and corrected with the Ladd procedure. ⋯ Although most cases of intestinal malrotation in infancy can be treated successfully, in some circumstances, patients' symptoms may not be detected early enough for effective treatment, and therefore may result in catastrophic midgut volvulus and death.
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Case Reports
5-oxoprolinemia causing elevated anion gap metabolic acidosis in the setting of acetaminophen use.
Anion gap metabolic acidosis is typically encountered in the emergency department (ED) setting as the result of shock, other endogenous metabolic derangements, or from exogenous toxicants. The differential diagnosis for toxicant-related acidosis (exemplified by common mnemonics) emphasizes acute overdose. ⋯ The ED differential diagnosis of AG metabolic acidosis in chronic APAP overuse, especially with concomitant nutritional compromise, should include 5-oxoprolinemia.