Missouri medicine
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Non-traumatic subarachnoid hemorrhage (SAH) represents approximately 5-6% of all strokes. Morbidity and mortality rates remain high, but accurate diagnosis using clinical assessment and neuroimaging, critical care management, and early treatment using either surgical or interventional techniques have improved overall outcomes. This, the fifth in a Missouri Medicine series on stroke, summarizes the clinical and imaging aspects of making the diagnosis of SAH, critical care management of the patient, treatment options, and factors important in prognosis.
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The 1999 Institute of Medicine (IOM) report estimated that as many as 98,000 medical error related deaths occur each year in the United States; and although some argued the accuracy of the number, few denied the gravity. Medical error produces more fatalities than motor vehicle accidents, or other more publicized nonmedical disasters, and is one of the leading causes of death.
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This report describes a 22-year-old male who presented with penetrating trauma to the left second intercostal space. He was found to be clinically stable; however, Focused Assessment with Sonogrpahy in Trauma (FAST) exam revealed large pericardial effusion suspicious for cardiac injury. ⋯ This report supports delayed thoracotomy in the appropriately selected patient as safe. It avoids the morbidity and unnecessary dangers incumbent in emergency department (ED) thoracotomy.