J Emerg Med
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Randomized Controlled Trial
Effects of Using an Endotracheal Tube Introducer for Intubation During Mechanical Chest Compressions of a Manikin: Randomized, Prospective, Crossover Study.
Airway management methods during out-of-hospital cardiac arrest remain controversial. ⋯ The use of an endotracheal tube introducer as an adjunct to a Macintosh laryngoscope is not associated with higher first-pass success rates during mechanical chest compressions in adult simulations performed by final-year medical students. © 2020 Elsevier Inc.
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Children present to the pediatric emergency department (ED) with enlarged lymph nodes due to a broad spectrum of conditions ranging from benign causes like reactive lymph nodes to adverse conditions like malignancy. Identifying sonographic features typical of infection, inflammation, and neoplasms will help assist clinicians in deciding the disposition of the patients from the ED. Point-of-care ultrasound has become an essential adjunct for diagnostic assessment in pediatric emergency medicine. The wider accessibility of ultrasound along with greater resolution using high-frequency probes places this noninvasive, nonradiation-based bedside examination, an ideal tool for real-time examination of the lymph nodes in the EDs. ⋯ We present a series of cases in which the point-of-care ultrasound examination proved valuable in the timely diagnosis and expedited care of lymph node pathologies secondary to reactive, infectious, and malignant processes. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Point-of-care ultrasound will facilitate diagnosis in children with lymph node swelling and should be considered in children of all ages. While assessing the lymph node pathology at the bedside, describe the shape, size, internal echotexture, borders, vascularity, and the pattern of the perinodal soft tissue to differentiate between a normal, reactive, infectious, inflammatory, or malignant underlying pathology.
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Review Case Reports
Environmental Toxic Exposures Using Companion Animals as an Indicator of Human Toxicity: A Case Report and Discussion.
Hundreds of years ago, humans realized that animals could be used as surrogate indicators of toxic environmental exposures, as a tool to measure risk to human health. The classic example is coal miners bringing canaries into coal mines. The respiratory rate and metabolism of the animal resulted in toxic signs of injurious gases in the environment before humans were injured. Occasionally, modern diagnosis of cryptic toxic exposures can be aided by the discovery of such features in the history. ⋯ Companion animals, when similarly exposed to toxic substances as humans regarding route, dose, and chronicity often mount symptoms and signs in advance of humans. This phenomenon allows the clinician to identify occult exposure, test, and treat while human disease is mild or still subclinical.
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Stimulant poisoning frequently causes altered mental status (AMS) and can result in severe cerebral vascular complications. The role of noncontrast brain computed tomography (CT) in acute stimulant-poisoned patients presenting with AMS remains unclear. ⋯ Nontrauma stimulant-poisoned patients presenting with AMS and without focal neurologic symptoms were unlikely to have acute abnormalities on brain CT. Patients who underwent brain CT scans had worse consciousness and greater disease severity.
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Four-factor prothrombin complex concentrate (4F-PCC) is a blood coagulation product indicated for urgent reversal of warfarin. Currently there are no studies using 4F-PCC as a fixed dose to achieve hemostasis with warfarin as well as direct factor Xa inhibitors. ⋯ A fixed-dose regimen of approximately 2000 factor IX units of 4F-PCC may be a reasonable approach to achieve hemostasis in patients receiving warfarin or factor Xa inhibitors. Additionally, utilization of a fixed-dose regimen may lead to significant acquisition cost savings for facilities.