J Emerg Med
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Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences. ⋯ Coagulopathy-induced spinal hemorrhage should be included in the differential diagnosis for patients presenting with signs of acute spinal cord compression.
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Methemoglobinemia is a relatively common, potentially fatal syndrome resulting from oxidative stress. Of the numerous causes identified, toxins are the most common precipitating event. ⋯ This case describes an uncommon presentation of a common toxicologic condition and presents a discussion regarding the evaluation, management, and pathophysiology of methemoglobinemia.
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Prescription opioid products are often formulated with acetaminophen, but the pharmacokinetics of nasally administered acetaminophen are poorly characterized. We report a case of a potentially toxic acetaminophen concentration after nasal insufflation of oxycodone/acetaminophen tablets. ⋯ The pharmacokinetics of nasally administered acetaminophen have not been well studied, yet there is potential for significant exposure with prescription opioid abuse. Clinicians should be vigilant in evaluating patients for toxicity due to adjunct medications formulated in narcotic pain preparations used by routes other than ingestion.
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Case Reports
Postobstructive Pulmonary Edema in a 40-Year-Old Man after Suffocation by a Swimming Pool Cover.
Postobstructive pulmonary edema (POPE) is a form of sudden onset, noncardiogenic pulmonary edema that can occur after the relief of an upper airway obstruction. ⋯ Emergency physicians should consider the diagnosis of POPE in a symptomatic patient if there is evidence of pulmonary edema immediately after a history of hanging, suffocation, strangulation, choking, naloxone administration, or other forms of upper airway obstruction. Rapid initiation of NIPPV with or without diuretics, steroids, or fluid restriction can lead to symptom resolution within 24 to 48 h.
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Both ectopic pregnancy and appendicitis are surgical emergencies that should be considered in female patients who present with right lower-quadrant pain. Deciding on the appropriate imaging modality in the pregnant patient can be difficult. The challenge of diagnosis is compounded when one considers that both pathologies may be present simultaneously. ⋯ In a pregnant patient with right lower-quadrant pain, the differential diagnosis includes ectopic pregnancy, acute appendicitis, or in rare cases, both.