J Emerg Med
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Lemierre Syndrome (LS) is a highly aggressive rare disease process with a predilection for young, healthy adolescents. Often beginning with a primary cervicofacial infection, LS rapidly progresses to thrombophlebitis of the cerebral vasculature, metastatic infection, and septicemia. Untreated LS can be rapidly fatal. Thrombus within the cerebral vasculature can have devastating neurological effects. Advances in antibacterial therapy have resulted in a global decline in the incidence of LS, and clinicians may not consider LS early in the disease process. Although the mortality of LS has declined, the morbidity associated with the disease has increased, particularly the neurological sequelae. ⋯ This case highlights the importance of early recognition of LS in the setting of a community-acquired MRSA infection as the unifying condition in a young patient with multiple acute neurologic impairments.
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As part of a quality improvement initiative to reduce Emergency Department (ED) length of stay (LOS) for surgical consult patients, we e-mailed performance metrics to key stakeholders on a daily basis. ED and Surgery leadership used these daily metrics to identify and remedy contributing factors for increased ED LOS in patients who received surgical consults. ⋯ ED LOS and time to consultation were decreased for surgical consult patients after initiation of daily performance metric e-mails.
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Clenbuterol is an orally administered long-acting beta-2 adrenergic agonist closely related to albuterol that, in recent years, has become a substance of abuse in the bodybuilding and athletic community. ⋯ Emergency physicians should be aware of the clinical presentation of clenbuterol abuse and overdose, and the possibility of related cardiac ischemia and rhythm disturbances. Suggested treatment includes intravenous fluids, oxygen, aspirin, beta-blockers, and benzodiazepines, although efficacy remains unproven.
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Urgent decisions in the Emergency Department allow for only a short history and physical examination. ⋯ Even in the emergency setting, thorough history-taking and physical examination remain fundamental, and it is necessary to "think outside the box."
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Spontaneous coronary artery dissection is a very rare event and is more common in women than in men. Pregnancy and the early puerperium stage have been recognized as predisposing factors for this condition. ⋯ In this report, we have underlined the importance of considering coronary artery dissection in the differential diagnosis of young women who present to the ED with chest pain, an ECG with ST-segment elevation, and very few cardiac risk factors.