J Emerg Med
-
Observational Study
Mechanical Chest Compression Device for Out-Of-Hospital Cardiac Arrest: A Nationwide Observational Study.
There are few studies on the use of a mechanical chest compression (meCC) device during transport in patients with out-of-hospital cardiac arrest (OHCA). ⋯ The meCC device did not show better study outcomes than manual compression.
-
The categorization of pulmonary embolism (PE) as non-massive, sub-massive, and massive helps guide acute management. The presence of right ventricular (RV) strain differentiates sub-massive from non-massive PEs. Unlike laboratory markers and electrocardiogram changes, the classic parameters used in the echocardiographic diagnosis of RV strain have a technical component that is operator-dependent. ⋯ Along with other more qualitative echocardiographic parameters, TAPSE can be used as a simple quantitative measure of RV dysfunction for differentiating sub-massive from non-massive PEs. This categorization helps guide acute management and disposition.
-
Review Case Reports
A Curious Case of Ciguatera Fish Poisoning in the Midwest and a Review for Clinicians.
Ciguatera poisoning is one of the most prevalent types of fish poisoning, but it is often underreported, leading many health practitioners to be unfamiliar in correctly identifying and treating this toxicity. ⋯ We present a case of ciguatera toxicity encountered in an emergency department in a Midwest community hospital setting. A 56-year-old woman presented to the ED with symptoms of perioral numbness, generalized pruritis, and hot/cold temperature reversal. Through careful history taking it was determined that the patient had recently returned from vacationing in the Caribbean and had been consuming meals containing various types of fish. A clinical diagnosis of ciguatera toxicity was made, and the patient was treated supportively. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This topic is important in the realm of emergency medicine because it presents a known toxicologic pathogen in an unsuspecting geographic location. This case highlights the importance of maintaining broad differentials and considering a patient's travel and exposure history to make the clinical diagnosis of ciguatoxin as well as the importance of preventative management to avoid recurrence of symptoms. We review the etiology of this fascinating toxin as well as the clinical implications in the diagnosis and management of this toxicity.
-
Practice variation exists in pain management of children with long bone fractures (LBFs). ⋯ In our study, 28% of children with LBFs did not receive pain medications, especially during normal PED volumes. Additional studies are required to explore triage as a venue for analgesia delivery for LBFs.