J Emerg Med
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Atraumatic subarachnoid hemorrhage (SAH) is a deadly condition that most commonly presents as acute, severe headache. Controversy exists concerning evaluation of SAH based on the time from onset of symptoms, specifically if the headache occurred > 6 h prior to patient presentation. ⋯ The probability of SAH above which emergency clinicians should perform a lumbar puncture is 1.0%. This threshold is essentially the same as the estimated probability of SAH in patients with a negative head CT obtained more than 6 h from symptom onset. Emergency physicians might reasonably decide to either perform or forego this procedure. Consequently, we contend that the decision whether to perform lumbar puncture in these instances is an excellent candidate for shared decision-making.
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The limitations of resuscitative thoracotomy (RT) after penetrating trauma have been well documented, but there is a paucity of data on the effect age has on mortality. This begs the question as to the utility of RT in an aging patient population. We investigate the significance of age as a predictor for failure to rescue after RT in penetrating trauma. ⋯ Age does not appear to be an independent predictor of failure to rescue after RT in penetrating trauma and should not be a sole determinant in procedural decision making.
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Case Reports
Migratory Fish Bone Presented With Extensive Surgical Subcutaneous Emphysema: A Case Report.
Fishbone ingestion represents a common cause for emergency department (ED) referral. In the majority of cases, an observed fishbone can be easily retrieved in the clinic setting. An impacted fishbone in the throat, albeit uncommon, carries potential risks of life-threatening events. Unusual complications caused by a migrated fishbone, including deep neck abscess, airway obstruction, and major vessels injury, are greatly influenced by the type of ingested fishbone and time between onset and presentation. ⋯ Here we report an unusual case of surgical subcutaneous emphysema after multiple attempts of purging to remove an ingested fishbone. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fishbone foreign body is a common presentation to the ED. A thorough history and examination for the migratory foreign body is essential, as the complications are consequential.