J Emerg Med
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Airway management in a trauma patient can be particularly challenging when both a difficult airway and the need for rapid action collide. The provider must evaluate the trauma patient for airway difficulty, develop an airway management plan, and be willing to act quickly with incomplete information. ⋯ Using a case-based approach, this article reviews initial trauma airway management strategies along with the rationale for evidence-based treatments.
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Recent expert guidelines recommend oral second-generation antipsychotics (SGAs) as first-line therapy for acute agitation in the emergency department (ED), with intramuscular (IM) SGAs as an alternative. However, little is known about how these meds are used in the ED or how often SGAs are prescribed. ⋯ Despite expert recommendations, SGAs are administered a minority of the time to ED patients. The rate is not increasing over time. When used, SGAs are most commonly given orally, are often administered with benzodiazepines, and are frequently administered to alcohol-intoxicated patients.
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The diagnosis of alcohol intoxication might not be considered in patients coming from locations where access to alcohol is severely restricted or not permitted. ⋯ Alcohol intoxication might be unexpected or not considered in patients that should have no access to common sources of ethanol. Awareness of methods of novel fermentation, even in incarcerated individuals, can assist in the differential diagnosis of patients presenting with altered mental status.
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Headache is a common complaint in emergency department (ED) patients. Nearly 15% of ED headache patients will have brain computed tomography (CT) done. One frequent finding on these scans is "chronic sinusitis." Assuming that "chronic sinusitis" is the cause of the patient's headache is a potential source of mis-diagnosis. ⋯ Prevalence of CT findings of sinusitis in ED patients with atraumatic headaches and mild head injury are similar. This strongly suggests that CT findings of chronic sinusitis in patients with atraumatic headache may be incidental, and are rarely the cause of a patient's acute headache.
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Case Reports
Myocardial Infarction in a Young Man Due to Coronary Artery Aneurysms after an Undiagnosed Kawasaki Disease.
Kawasaki disease usually affects infants and young children. It often goes unrecognized in adults due to varying symptoms and lack of definite diagnostic criteria. ⋯ Kawasaki disease can cause coronary complications in a teenager. A high level of suspicion in the ED can help in proper management of these patients.