Clinical practice and cases in emergency medicine
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Clin Pract Cases Emerg Med · Feb 2020
Case ReportsCarbon Monoxide Poisoning Effectively Treated with High-flow Nasal Cannula.
Carbon monoxide (CO) poisoning is typically treated by administration of oxygen via non-rebreather mask (NRB). High-flow nasal cannula (HFNC) is an alternative to NRB in a variety of disease states. ⋯ He was treated with HFNC, and COHb levels declined to 5.4% in 230 minutes. Given several theoretical advantages of HFNC relative to NRB, HFNC is a potential option for use in the treatment of CO poisoning.
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Clin Pract Cases Emerg Med · Nov 2019
Case ReportsPoint-of-care Transperineal Ultrasound to Diagnose Abscess in the Emergency Department.
Perineal and rectal pain are common presentations in the emergency department (ED). In the majority of cases, clinical examination is sufficient to detect local anorectal pathologies. ⋯ Recently, transperineal ultrasound has emerged as an optimal imaging modality for the diagnosis of perineal and perianal abscesses. We present a case in which point-of-care ultrasound accurately detected an intersphincteric abscess, and review the appropriate ultrasound technique to evaluate patients with suspected perianal and rectal abscesses.
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Clin Pract Cases Emerg Med · Nov 2019
Case ReportsFatal Tension Hemothorax Combined With Exanguination: A Rare Complication of Neurofibromatosis.
Neurofibromatosis (NF) is a common autosomal dominant disorder that can be subdivided into type 1, type 2, and schwannomatosis. Patients with NF1 typically develop café-au-lait spots, scoliosis, and benign neurofibromas. ⋯ Here, we report the case of an otherwise healthy 32-year-old man who developed a fatal tension hemothorax due to vertebral artery aneurysm rupture. Based on the available literature, we discuss the presentation, workup, and available therapeutic approaches to this complication of neurofibromatosis.
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Clin Pract Cases Emerg Med · Aug 2019
Case ReportsA Novel Technique to Reduce Reliance on Opioids for Analgesia from Acute Appendicitis: The Ultrasound-guided Erector Spinae Plane Block.
Single injection, ultrasound-guided nerve blocks have drastically changed the multimodal approach to pain management of the acutely injured patient in the emergency department (ED). Ultrasound-guided femoral nerve blocks in the ED have become standard aspects of multiple, hospital system pain management protocols, with early evidence demonstrating improved patient outcomes. ⋯ Here we describe a single injection, lower ESP block performed by emergency physicians that successfully alleviated pain from acute appendicitis in an ED patient awaiting definitive surgical treatment. Along with allowing clinicians to actively manage pain without reliance on opioids, this novel ED technique may improve patient care outcomes.
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Clin Pract Cases Emerg Med · Aug 2019
The Dangers of Barbecuing: An Interesting Case of a Foreign Body in the Throat.
Swallowing of foreign bodies (FB), and sensation of such in the throat, is a common complaint in the emergency department setting, with roughly 80,000 visits in 2010 for FB ingestion.1 Grill wire brushes are a rarely reported, accidental FB ingestion, although recent literature suggests that it is more common than initially thought.2 This is a report of a female with acute onset odynophagia after a meal, with a normal laryngoscopic exam that used flexible fiberoptics. Evidence of a metallic linear density was present in the retropharynx on computed tomography imaging, most consistent with a wire from a grill wire brush.