The American journal of emergency medicine
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Case Reports
Right pneumothorax with the S1Q3T3 electrocardiogram pattern usually associated with pulmonary embolus.
An 18-year-old man presented with a spontaneous right pneumothorax. An initial electrocardiogram (ECG) showed an S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III. ⋯ Both right and left pneumothorax have been associated with ECG changes, including changes that mimic myocardial ischemia. Because the clinical presentation of pneumothorax may be similar to angina or pulmonary embolus, ECG changes with pneumothorax may lead to confusion in the diagnosis.
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A retrospective review of the medical records of blunt trauma patients with sternal fracture admitted to a level 1 trauma center from June 1990 to June 1993 was undertaken to determine the relationship between sternal fractures and clinically significant myocardial injury, and to assess the usefulness of cardiac evaluation and monitoring in these patients. Of 33 patients with sternal fracture, 31 were in motor vehicle crashes and 2 were pedestrians struck. All had Glasgow Coma Scale score = 15. ⋯ No CPK-MB fraction was >5%. These results show that sternal fracture is not a marker for clinically significant myocardial injury. The management of sternal fracture patients should be directed toward the treatment of associated injuries.
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The objective of this survey was to determine the percentage of unfunded studies published in the four major emergency medicine journals and to examine the sources in funded studies. This study was a retrospective survey of all issues of the four general emergency medicine journals in 1994. Funding was categorized as public national, private, international, institutional, or unfunded. ⋯ Overall, significantly more of the emergency medicine articles in the four journals were unfunded (63% unfunded [95% CI = 56.7-69.1]; 37% funded [95% CI = 30.9-43.3]). The sources of funding for each of the journals varied, with most being private (45%). In conclusion unfunded research remains a major source of emergency medicine literature in the four main emergency medicine journals.
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A 66-year-old man with a history of chronic alcoholism presented with Kussmaul respirations following several days of fasting accompanied by vomiting, in the presence of continued ethanol intake. He was subsequently found to have a serum glucose level of <20 mg/dL and an anion gap of 36. Despite his profound hypoglycemia, he was fully alert with no obvious neurological deficits. ⋯ He had no evidence of hypoxemia, hypotension, or other features of sepsis. Alcoholic ketoacidosis in the setting of hypoglycemia is discussed. If the serum glucose level is less than the anion gap, the diagnosis of alcoholic ketoacidosis should be considered.