The American journal of emergency medicine
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Amyand hernia, named for the first person to describe an inguinal hernia containing the vermiform appendix, is an uncommon variant of an inguinal hernia. Presence of the appendix in the sac complicates the management of inguinal hernias. The appendix may be more prone to rupture when contained within a hernia sac, and herniation of an inflamed appendix into the scrotum can mimic an acute scrotum. ⋯ The patient taken to the operating room, and his appendix was removed. The hernia was coincidentally repaired, and the patient was discharged soon thereafter. In cases suggestive of acute appendicitis complicating an inguinal hernia, the diagnosis of this unusual variant must be considered.
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The epidemiology, pathophysiology, and clinical presentation of herpes zoster ophthalmicus in the emergency department is discussed with an emphasis on the identification of the numerous potential ocular complications. Emergency physicians need to be able to recognize the clinical features of herpes zoster ophthalmicus and initiate appropriate therapy and referral.
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Complete fracture-dislocation of thoracolumbar spine without significant neurologic deficits is a rare entity. The possible mechanism may result from the spontaneous decompressive fractures of the spinal elements with sparing of the spinal cord. Here, we report a case of a healthy 50-year-old man who presented with complete fracture-dislocation of T12 through L1 vertebrae without paraplegia. Early diagnosis and early surgery with decompression, reduction, and stabilization is the best policy in management of this unstable spine injury.
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Although acute pulmonary embolism (PE) may give rise to certain electrocardiographic (ECG) changes, most of these changes have low sensitivity and specificity and are of limited value alone in the diagnosis. Possible ECG changes with acute PE include S(1)Q(3)T(3) pattern, atrial tachyarrhythmias, incomplete right bundle-branch block, or negative T wave over right and midprecordial leads. Elevation of ST segment is a rare ECG manifestation with PE. ⋯ Thrombolytic therapy with tissue plasminogen activator was initiated, and symptoms subsided dramatically. We proposed that the ST elevation in anterolateral leads might be the reciprocal changes of myocardial strain in the interventricular septum or right ventricle lateral wall. In a patient with such a critical condition and a confusing ECG, echocardiography played an important role in the diagnostic procedure, enabling prompt therapeutic intervention.
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The aim of the present study was to assess whether a beta-adrenergic blocking agent such as atenolol, administered during cardiopulmonary resuscitation, would improve initial resuscitation success. ⋯ A beta-adrenergic blocking agent, when administered during cardiopulmonary resuscitation, significantly improves initial resuscitation success and increases blood and coronary perfusion pressures during cardiopulmonary resuscitation.