The American journal of emergency medicine
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The Wolff-Parkinson-White syndrome (WPW), estimated to occur in approximately 0.1% to 3% of the general population, is a form of ventricular preexcitation involving an accessory conduction pathway. The definition of WPW relies on the following electrocardiographic features: (1) a PR interval less than 0.12 seconds (2) with a slurring of the initial segment of the QRS complex, known as a delta wave, (3) a QRS complex widening with a total duration greater than 0.12 seconds, and (4) secondary repolarization changes reflected in ST segment-T wave changes that are generally directed opposite (discordant) to the major delta wave and QRS complex changes. The accessory pathway bypasses the atrioventricular (AV) node, creating a direct electrical connection between the atria and ventricles. ⋯ When symptoms do occur they are usually secondary to tachyarrhythmias; the importance of recognizing this syndrome is that these patients may be at risk to develop a variety of supraventricular tachyarrhythmias which cause disabling symptoms and, in the extreme, sudden cardiac death. The tachyarrhythmias encountered in the WPW patient include paroxysmal supraventricular tachycardia (both the narrow QRS and wide QRS complex varieties), atrial fibrillation, atrial flutter, and ventricular fibrillation. Diagnostic and urgent, initial therapeutic issues based on initial electrocardiographic information are presented via 5 illustrative cases.
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Pneumomediastinum, pneumothorax, and subcutaneous emphysema can occur occasionally after a surgical procedure. Facial swelling is a common complication of dental management. ⋯ We present a case with subcutaneous emphysema of the upper chest, neck, chin, and pneumomediastinum after a tooth extraction and discuss the possible mechanism of subcutaneous emphysema. To prevent these complications during dental procedures, dental hand pieces that have air coolant and turbines that exhaust air in the surgical field should not be used.
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Computed tomography (CT) imaging has been touted as one of the best techniques to detect body packets in body packers and stuffers. The majority of experience has been with body packers. We describe a case of a body stuffer who presented with abdominal pain after ingesting a large packet containing multiple small packets, with a falsely negative abdominal CT scan without contrast. This case raises questions regarding the best method of detection of body packets in body stuffers.
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This project was undertaken to assess academic emergency physicians' awareness of emergency department charges for routine care. A 60-item worksheet requiring estimates of patient charges for selected emergency department services, supplies, medications, and composite scenarios was used. The study was conducted at a university-affiliated academic emergency department and included 20 emergency medicine attendings and 20 emergency medicine residents. ⋯ The average absolute error for attendings and residents were 89% and 105%, respectively. The proportion of those overestimating and underestimating each category were virtually identical in the 2 groups. We conclude from this study that emergency medicine attending physicians and residents do not have a good appreciation of patient charges for routine emergency care.
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A 31-year-old woman presented with complaints of increasingly severe right lower quadrant discomfort that had occurred for several days each month over the course of the previous 6 months. A tender mass of the abdominal wall was palpated on physical examination, and subsequent ultrasonography and magnetic resonance imaging disclosed a discrete mass of the body of the right rectus abdominis muscle which was confirmed as endometrial tissue on biopsy. Rectus abdominis endometrioma is a relatively rare cause of abdominal pain which may mimic an acute abdomen. Clinical clues to the diagnosis include previous uterine or gynecological surgery/invasive procedure (with preservation of ovarian function), cyclical nature of the discomfort, and the presence of a palpable mass with or without associated skin color changes.