J Emerg Med
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Auricular hematoma is a condition commonly seen in the emergency department among patients presenting with trauma to the ear. It may result in several complications such as perichondritis and cauliflower ear if not managed appropriately. ⋯ Emergency clinicians must be knowledgeable regarding the evaluation and management of auricular hematoma, including the various drainage techniques.
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Multicenter Study
Characteristics of Intracranial Hemorrhage and Acute Aortic Syndromes Resuscitated with Extracorporeal Cardiopulmonary Resuscitation (ECPR).
Intracranial hemorrhage (ICH) and acute aortic syndrome (AAS) are etiologies associated with unfavorable outcomes in patients with out-of-hospital cardiac arrest (OHCA), even with extracorporeal cardiopulmonary resuscitation (ECPR). ⋯ ICH and AAS should be considered potential causes of cardiac arrest, especially in cases with a nonshockable initial cardiac rhythm. However, differentiating them from cardiac causes of arrest remains challenging.
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Comparative Study
A Prospective Crossover Study Comparing Six Current Generation Supraglottic Airway Device's Ability to Seal During CPR in Human Cadavers.
Supraglottic airway (SGA) devices are frequently used during cardiopulmonary respiration (CPR), but little is known about their ability to consistently seal the airway during CPR. ⋯ In this human cadaver model, the ability to generate negative ITP varied with different SGAs during aCPR with an Impedance Threshold Device.
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Case Reports
A Novel Use of Terbutaline: Persistent Genital Arousal Disorder in the Emergency Department.
Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing, multifactorial disorder characterized by persistent unwanted physiologic genital arousal in the absence of sexual desire. This poorly understood disorder is thought to be derived from a complex dysregulation of biopsychosocial factors with common underlying neurological dysfunction that has yet to be adequately studied. With frequently evolving diagnostic criteria, lack of a standardized treatment algorithm, and few evidence-based treatment options, this disease is largely unrecognized and difficult to treat once identified. ⋯ A 25-year-old woman presented to the Emergency Department (ED) with persistent and refractory symptoms of genital arousal not responsive to previously documented treatments, and the novel use of a β-adrenergic agent, terbutaline, leading to cessation of symptoms. With her initial presentation, lorazepam, haloperidol, and viscous lidocaine intravaginally provided relief for approximately 24 h until the patient returned. At her subsequent presentation, the patient received additional doses of lorazepam and intravaginal lidocaine, as well as consults with Urology and Obstetrics and Gynecology. Her symptoms eventually ceased by administration of terbutaline. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although presentation of PGAD to the ED is rare, emergency physicians should be prepared with treatment options to assist patients with this distressing diagnosis. This case highlights the novel use of terbutaline, a β-agonist, in cessation of PGAD symptoms when first-line benzodiazepines and antipsychotics fail.
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Extreme temperature and particulate matter-2.5 (PM2.5) are known to affect the outcomes of out-of-hospital cardiac arrest (OHCA). However, studies that examine their effects at the exact time of OHCA occurrence are limited. ⋯ Extreme heat and PM2.5 were significantly associated with a decreased probability of survival to discharge in OHCA patients.