J Emerg Med
-
Pacemaker-induced right atrial thrombus is a rare condition that has not been described in the Emergency Medicine literature. This is a potentially fatal condition that is diagnosed with an echocardiogram and treated with surgical removal, thrombolytics, or long-term anticoagulation. ⋯ Emergency physicians should be aware of this life-threatening entity. Emergency bedside cardiac ultrasound or echocardiogram may be of value in its early identification.
-
The only data that currently exist on ramelteon (Rozerem(®); Takeda Pharmaceuticals North America, Inc., Deerfield, IL) ingestions is from clinical trials. To fill this gap, data on ramelteon ingestions reported to Texas poison centers during 2005-2009 were collected and analyzed. ⋯ The management strategies used by Texas poison centers for the 56 cases reported in this study were adequate.
-
Case Reports
Severe tricuspid regurgitation and atrioventicular block caused by blunt thoracic trauma in an elderly woman.
Symptomatic cardiac injury after blunt chest trauma is relatively rare, and valvular injury is even more rare. The valves most commonly affected are tricuspid. Automobile accidents are mostly responsible for this type of injury. ⋯ It is important to be aware of traumatic tricuspid regurgitation after non-penetrating chest trauma. Close follow-up may suffice in some patients with stable hemodynamic conditions, and regression of tricuspid regurgitation can be expected during follow-up.
-
The prevalence of drug or alcohol addiction among trauma patients approaches 40%, yet many require narcotics during admission for adequate pain control. Provider awareness is the most reasonable option to avoid the devastating consequence of narcotic tablet injection. ⋯ Patients with a history of substance abuse may be inclined to crush and inject oral narcotics. Narcotic injection should be considered in recently discharged patients who present with pulmonary failure. Patients with suspected narcotic addiction should be counseled before discharge on the risks of misusing oral medications in this fashion.
-
Every year, patients leave the Emergency Department against medical advice (AMA) and before an adequate evaluation can be performed. It is well known that many of these patients are at risk of subsequent complications. ⋯ The authors conclude that a properly executed discharge can provide significant legal protection from liability risks.