The American journal of emergency medicine
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The black widow spider (BWS), which is a member of the arthropod family, is widely distributed on earth. Black widow spider bites can cause a wide variety of signs or symptoms in humans, but the cardiovascular manifestations are relatively rare except hypertension/hypotension and bradycardia/tachycardia. We report on a 65-year-old man who experienced myocarditis after BWS envenomation, which is extremely rare. ⋯ His ECG readings and cardiac enzymes returned to normal with supportive treatment, and he was discharged with complete recovery. To the best of our knowledge, the present case is the third in the literature reporting myocarditis and the first reporting ST-segment elevation and accompanying augmentation in T-wave amplitude after BWS envenomation. In addition to usual measures, we recommend ECG and cardiac-specific enzyme followup for every patient envenomated by BWS for potentially fatal cardiac involvement.
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Case Reports
Extrapontine myelinolysis after correction of hyponatremia presenting as generalized tonic seizures.
Central pontine myelinolysis and extrapontine myelinolysis are rare complications of rapid correction of chronic hyponatremia. Central pontine myelinolysis is more common and more predictable in presentation. ⋯ His presenting sign, generalized seizures, has not been previously reported. We summarize risk factors for myelinolysis, which may be more common than previously thought, as well as steps to minimize risk while managing vulnerable patients.
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Case Reports
Acute respiratory failure associated with polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty.
We report a case of symptomatic polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty to alert clinicians to this potential cause of pulmonary emboli. A 77-year-old woman developed acute respiratory failure after multilevel percutaneous vertebroplasty. She received mechanical ventilatory support and anticoagulation with low-molecular-weight heparin and warfarin. ⋯ Polymethyl methacrylate cement extravasation into the vertebral venous circulation is common during vertebroplasty. Pulmonary embolism caused by cement migration after this procedure is extremely rare, as reported in the literature to date. However, the frequency of this complication may increase secondary to the widespread use of percutaneous vertebroplasty and kyphoplasty for osteoporotic compression fractures.
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This study examined the variability of blood pressure measurements and prevalence estimates of elevated blood pressure in emergency department (ED) patients using 4 different methods of categorization. ⋯ Determination of elevated blood pressure in ED patients is largely dependent on the method of blood pressure categorization.
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Pneumothorax (PTX) after trauma is a preventable cause of death. Drainage procedures such as chest tube insertion have been traditionally advocated to prevent fatal tension PTX. We evaluated the safety of close observation in patients with delayed PTX complicating rib fracture after minor chest trauma. ⋯ Patients sustaining blunt chest trauma and minor rib fractures should be admitted for close observation when presenting with SubcEmph because of possible delayed presentation of PTX.