J Emerg Med
-
Low-molecular-weight heparin (LMWH) is increasingly being prescribed for prophylaxis and treatment of thromboembolic diseases. Despite the fact that its therapeutic use is considered to be safe, it can be complicated by major hemorrhage and, in contrast to unfractionated heparin, it can only partially be neutralized by protamine. Recent reports of LMWH overdose illustrate the need for a consensus on its management. ⋯ In this case of massive tinzaparin overdose, conventional doses of protamine failed to rapidly normalize the deranged coagulation parameters. The favorable clinical outcome suggests that, regardless of the LMWH amount injected, no active treatment is needed in the absence of hemorrhage. This is in accordance with the limited published data concerning cases of overdose with other LMWHs.
-
Computed tomography (CT) scanning use for emergency department (ED) patients has increased exponentially since its inception. ⋯ This study elucidates patient preference and knowledge regarding CT scans. Overall, patients have a poor understanding of CT scan radiation, and desire to have risks explained to them as informed consent prior to the scan.
-
The most common cause of facial palsy is idiopathic or Bell's palsy. Although uncommon in the postantibiotic era, otomastoiditis should receive more attention as a cause of facial palsy, especially in young children. Delay of identification and treatment may result in permanent neurological sequelae. ⋯ We use this case to emphasize that otomastoiditis should be considered in the differential diagnosis of young children with facial palsy. Diagnosis may be difficult as signs and symptoms of otitis media in young children are often nonspecific and subtle, particularly in infants. Early diagnosis and careful investigation of middle ear regions should be performed to avoid permanent sequelae.
-
Luxatio erecta humeri or inferior dislocation of the glenohumeral joint is a rare presentation in the emergency department that is typically caused by a direct loading force on a fully abducted arm. This type of shoulder dislocation represents only 0.5% of all shoulder dislocations, making bilateral cases even more unique. ⋯ Although shoulder dislocations remain a commonly seen injury in the emergency department, it is important to consider that not all dislocations are simply anterior. Signature signs of luxatio erecta are fixed abduction at the shoulder with elbow flexion and forearm pronation. The humeral head should be palpable inferior to the glenoid fossa. The most effective treatments for this injury involve sufficient muscle relaxation for reduction, a methodical approach to reduction, and appropriate immobilization.