J Emerg Med
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The LUCAS (Lund University Cardiopulmonary Assist System; Physio-Control Inc./Jolife AB, Lund, Sweden) was developed for automatic chest compressions during cardiopulmonary resuscitation (CPR). Evidence on the use of this device in out-of-hospital cardiac arrest (OHCA) suggests that it should not be used routinely because it has no superior effects. ⋯ Use of the LUCAS system decreased survival rate in OHCA patients. Significantly higher 30-day mortality was seen in LUCAS-treated patients.
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Hypertrophic osteoarthropathy (HOA) is a musculoskeletal pathology that often occurs as a paraneoplastic syndrome. 90% of HOA cases occur secondary to malignancy. 60 to 80% of which are lung cancers. ⋯ We present a case of a 61-year-old man who had worsening knee pain. HOA was incidentally noted on extremity X-ray. The patient was found to have a soft-tissue attenuating mass on chest X-ray. The diagnosis of non-small cell lung cancer was made after bronchoscopy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: HOA can be an indication of malignancy, most commonly lung cancer, so it is important to recognize the key radiographic findings associated with HOA. When treating patients with bone pain and clubbed digits, emergency physicians should strongly consider screening for more severe primary pathology.
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An atrio-esophageal fistula is an exceedingly rare but devastating complication of atrial fibrillation (AF) ablation procedures. Delays to diagnosis and definitive treatment herald a poor prognosis, with the development of catastrophic neurological injury or death secondary to cerebral air emboli. A high level of suspicion is essential to improve recognition of this rare but devastating condition. ⋯ A 59-year-old man presented to the emergency department with an acute stroke and reduced consciousness. This presentation was preceded by an uncomplicated AF ablation 19 days prior and a subsequent emergency department attendance within a few days of his procedure, where he had presented with a history of new chest pain and reflux symptoms. Imaging revealed intra-cranial and intra-cardiac air, which was attributed to an uncontrolled atrio-esophageal fistula. Treatment options were limited by the patient's clinical instability and the patient was eventually palliated after developing catastrophic brain injury due to extensive cerebral air emboli. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients typically first present to the emergency department with new symptoms of either gastroesophageal reflux or chest pain, therefore, early recognition by emergency physicians is vital. Characteristic symptoms alongside a recent history of a cardiac ablation procedure should prompt additional diagnostic imaging to look for evidence of an atrio-esophageal fistula.
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Case Reports
Varicella Zoster Virus Meningoencephalitis With an Atypical Presentation of Chest Pain, Impaired Memory, and Seizure.
Neurologic complications of varicella zoster virus (VZV) reactivation can be associated with considerable mortality and morbidity. Aseptic meningitis associated with VZV infection is rare, occurring in 0.5% of immunocompetent individuals. One third of VZV-related neurologic disease occurs without the classic herpes zoster exanthema, making early recognition more difficult. ⋯ A 60-year-old man presented to the emergency department with chest pain and impaired memory that he attributed to a transient ischemic attack as suggested by an urgent care facility 1 day earlier. He suffered a seizure while in the emergency department and was admitted to the intensive care unit. A computed tomography scan of his head and a magnetic resonance imaging scan were both negative for acute findings. An abnormal electroencephalogram consistent with an encephalopathy together with his new-onset seizure triggered a lumbar puncture that was positive for VZV. He was placed on acyclovir and was discharged from the hospital 5 days after admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The typical presentation of a VZV central nervous system infection occurs with a sudden onset of fever, headache, nuchal rigidity, and focal neurologic signs. Our patient's recent impaired memory and subsequent seizure were likely manifestations of the developing VZV meningoencephalitis, while his chest pain may have correlated with subsequent development of a vesicular rash. Seizures are encountered in 11% of patients with VZV central nervous system infection, and VZV has recently been associated with cerebral vasculopathy. Awareness of alternative presentations for herpes zoster and meningitis is important in cases without classic symptoms to enable diagnosis and prevent delays in treatment.