J Emerg Med
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A thrombus straddling a patent foramen ovale (i.e., impending paradoxical embolism) is a very rare event. Most cases have been reported at autopsy only after finding a patent foramen ovale and arterial emboli. Patent foramen ovale in the population is common. ⋯ Early detection of an impending paradoxical embolism may result in an improved outcome. Treatment choices consist of anticoagulation, thrombectomy, or thrombolysis. Choice of treatment is difficult but should be made quickly to reduce the possibility of adverse patient outcomes.
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Contrast media used today is considered "low-osmolality." No study has evaluated the effect of intravenous contrast media on the measurement of the osmolal gap in adult patients. ⋯ Although the effect in our study was small, clinicians should be aware of the ability of contrast media to increase the osmolal gap.
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Case Reports
Portal venous gas on computed tomography imaging in patients with decompression sickness.
It has been reported that portal venous gas is rarely found on computed tomography (CT) imaging in patients with decompression sickness (DCS). However, we propose that this is not true because we have encountered several patients with DCS who presented with portal venous gas on CT before hyperbaric oxygen therapy (HBOT). Here, we review our charts and present these patients' characteristics. ⋯ Most patients with DCS do not require CT examination before HBOT. However, if all patients with DCS undergo abdominal CT, the presence of portal venous gas in these patients may no longer be a rare finding. Although routine CT is not required for patients with DCS, it might be helpful for diagnosis.
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Controlled Clinical Trial
Re-evaluating the diagnostic accuracy of the tongue blade test: still useful as a screening tool for mandibular fractures?
Mandibular fractures are one of the most frequently seen injuries in trauma. In terms of facial trauma, mandible fractures constitute 40%-62% of all facial bone fractures. The tongue blade test (TBT) has been shown to be a sensitive screening tool when compared with plain films. However, recent studies have demonstrated that computed tomography (CT) scan is more sensitive for determining mandible fractures than the traditionally used plain films. ⋯ Based on the test characteristics calculated (negative predictive value 0.92, sensitivity 0.95, likelihood ratio -0.07), the TBT is a useful screening tool to determine the need for radiologic imaging.
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Therapeutic hypothermia (TH) is one of the key treatments after cardiac arrest (CA). Selection of post-CA patients for TH remains problematic, as there are no clinically validated tools to determine who might benefit from the therapy. ⋯ These results imply that in addition to initial heart rhythm, pH level may be a good candidate for neurological outcome predictor even though previous research has found no correlation between initial pH value and neurological outcome.