The American journal of emergency medicine
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Many consider proton pump inhibitors (PPIs) to be devoid of adverse effects; however, PPIs can cause serious adverse effects. We report on the case of an emergency department patient with omeprazole-induced hyponatremic delirium and rhabdomyolysis. ⋯ This case is also unique because no publication has reported on both hyponatremia and severe myopathy after PPI therapy. The patient recovered completely after cessation of omeprazole and initiation of intravenous saline hydration and desmopressin infusion.
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This study aimed to analyze the prognostic value of the presence of ST elevation in lead aVR [aVR(+)] in initial standard electrocardiogram (ECG) performed on admission in combination with clinical variables and Thrombolysis in Myocardial Infarction (TIMI) risk score for unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). In 205 consecutive patients with UA/NSTEMI, we retrospectively evaluated admission ECG for aVR(+) of more than 0.5 mm. With the use of multivariate analysis, admission aVR(+) was found to be a strong and independent predictor of 30-day mortality. ⋯ In prespecified low-risk groups by clinical factors, those with aVR(+) had higher death rates than those without aVR(+): 16.1% vs 2.2% (P = .04), 13.9% vs 1.1% (P = .001), 12.4% vs 1.1% (P = .002), 9.6% vs 1.2% (P = .02), and 6.7% vs 0% (P = .05) for patients with negative troponin, heart rate of 110 beats per minute or less, systolic blood pressure greater than 90 mm Hg, Killip I class on admission, and age 70 years or younger, respectively. Patients with aVR(+) compared to patients without aVR(+) had higher death rates in the low- and intermediate-risk groups by TIMI risk score. Our findings suggest that aVR(+) has significant prognostic value in patients with UA/NSTEMI and may provide an additional prognostic value to the conventional cardiovascular risk factor, particularly in patients in the low-risk and intermediate-risk groups.
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The computed tomographic (CT) finding of pseudo-subarachnoid hemorrhage (SAH) mimics that of SAH. In brain swelling due to acute hypoxic anoxic encephalopathy, the increased attenuation in the basal cisterns and subarachnoid spaces on CT scans is a characteristic finding of acute SAH.
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Case Reports
Delayed hypersensitivity reaction from black henna tattoo manifesting as severe facial swelling.
We report on a 14-year-old boy who was presented to the emergency department with an acute swelling of the face and scalp 3 days after using a new hair dye. The patient had applied a black henna tattoo 1 year earlier. ⋯ It is important for emergency physicians to be aware of the possibility of a delayed type-IV hypersensitivity reaction from black henna tattoos manifesting as an acute contact dermatitis. These patients may have gross facial swelling but should not be treated for angioedema.
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Ovarian torsion occurs when an ovary twists about its vascular pedicle. The process causes abdominal pain and will result in ovarian tissue loss if not diagnosed and managed expeditiously. ⋯ She was ultimately found to have a very large cystic teratoma of the right ovary with concomitant ovarian torsion. There are no reported cases of ovarian cystic teratoma with acute torsion presenting with an abdominal mass suggestive of a gravid abdomen.