Emergency medicine journal : EMJ
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To evaluate the convenience and utility of optic nerve ultrasonography (ONUS) in the evaluation of emergency patients with elevated intracranial pressure (EICP) due to traumatic or non-traumatic causes. ⋯ In detection and follow-up of EICP cases, such as cerebrovascular accident and trauma, ONUS is a practical, risk-free, inexpensive, convenient and, if performed by experts, reliable method. As a result, although CCT may be more useful in diagnosis, ONUS may be more efficient in detecting EICP. In those cases where CCT and other conventional imaging methods are not available, ONUS can facilitate the diagnosis and help in treatment.
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Case Reports
Case of the month: "Oh! Drat!--A case of transcutaneous superwarfarin poisoning and its recurrent presentation".
Superwarfarin poisoning is considered a significant public health problem in the US. In 2004, there were 16,054 cases of poisoning; most were accidental ingestions of rat bait by children but 4576 patients required hospital treatment, 23 patients had major adverse outcomes and 1 patient died. Similar information is unavailable for the UK. ⋯ Upon discharge, he required daily vitamin K and INR monitoring for a further month. The original inpatient team had not identified the specific poison (chlorophacinone). They were unaware that superwarfarins are more potent and longer acting than warfarin, with toxic effects for weeks or even months, and that large doses of vitamin K are often required.
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Boerhaave's syndrome is a transmural rupture of the oesopahgus. It is a rarer, and less well described complication of forceful emesis. The more common complication being a non-transmural Mallory-Weiss tear. ⋯ Initial examination was normal. He was subsequently diagnosed with Boerhaave's syndrome. This case highlights the varied presentation of this potentially fatal condition.