The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Airway scope vs Macintosh laryngoscope during chest compressions on a fresh cadaver model.
This study compared the Airway scope (AWS) to the Macintosh laryngoscope (ML) during chest compressions on a fresh cadaver. ⋯ Considering the lack of experience with the AWS, AWS could be an alternative intubation device during chest compressions after practices with AWS.
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Maintenance of spontaneous effective ventilations can present unique challenges to emergency physicians directing procedural sedation in patients with underlying anatomic or physiologic upper airway pathology. In a morbidly obese patient requiring electrical cradioversion, use of bilevel positive airway pressure facilitated deep sedation while averting any adverse respiratory complications. Noninvasive pressure support ventilation may present another emergency department adjunct for difficult procedural sedation cases.
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Case Reports
Postural hypotension as the initial presentation of fulminant right ventricular myocarditis.
Myocarditis can be totally asymptomatic or can manifest with chest pain syndromes, ranging from mild persistent chest pain of acute myopericarditis to severe symptoms that mimic acute myocardial infarction. About 60% of patients may have antecedent arthralgias, malaise, fevers, sweats, or chills consistent with viral infections 1 to 2 weeks before onset. Here, we report a postpartum young woman who developed postural hypotension as the first manifestation of fulminant myocarditis with initially acute "cold and dry" right-sided heart failure and cardiogenic shock. ⋯ Myocardial inflammation more frequently affects localized areas of the left ventricle free wall, rarely right ventricle (RV). However, predominant RV involvement with acute right-sided heart failure and low cardiac output syndrome can be easily overlooked due to lack of typical heart failure signs. On reviewing medical literatures, we had found no report regarding the RV involvement with acute right-sided heart failure as the initial presentation of fulminant myocarditis.
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Virtually all emergency department (ED) patients receive an ED triage assessment that determines their priority to be seen by a physician. Previous research found that half of patients who are having an acute myocardial infarction (AMI) are given a low priority triage score, which is associated with delays in electrocardiogram (ECG) acquisition and reperfusion therapy. We sought to determine some of the reasons why ED triage is failing in these patients. ⋯ Low acuity ED triage of AMI patients may be predicted by several patient- and hospital-level characteristics. Focusing future interventions on these factors may improve ED triage and, subsequently, time to initial ECG and reperfusion, in this patient group.
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Randomized Controlled Trial
Phloroglucinol as an adjuvant analgesic to treat renal colic.
We tested whether the addition of phloroglucinol to piroxicam could improve pain relief in patients with acute renal colic visiting the emergency department. ⋯ There was no evidence that the addition of phloroglucinol improved the efficiency of piroxicam to relieve pain in acute renal colic.