The American journal of emergency medicine
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Cavitary lesions on a chest radiograph can be the manifestations of various diseases. The etiologies include abscess, mycobacterial infections, fungal infections, parasite infection, cavitary tumors, septic pulmonary embolism and vasculitis. While in comparison with the causes that could simultaneously develop a complete heart block, the differential diagnosis is limited. ⋯ Cardiac involvements are not rare in Wegener's granulomatosis, but are not usually clinically apparent. A complete atrioventricular block is a rare but treatable manifestation of cardiac involvement usually indicating early active systemic disease. Patients presenting with cardiac abnormalities and evidence of systemic inflammation should be screened for Wegener's by history, radiographic and laboratory assessment.
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ST elevation is usually treated in cardiac catheterization laboratory with an aim for myocardial salvage by restoration of adequate coronary blood flow enhancing both early and long-term survival. Maximum benefit is achieved if therapy is initiated in the first hour after treatment onset, thus ushering the concept of door-to-balloon time. We present an interesting case of a patient whose ST elevation resolved after bronchoscopy for a lung whiteout.
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Over the last decade, the importance of delivering high-quality cardiopulmonary resuscitation (CPR) for cardiac arrest patients has become increasingly emphasized. Many experts are in agreement concerning the appropriate compression rate, depth, and amount of chest recoil necessary for high-quality CPR. ⋯ Interruptions in chest compressions during CPR can negatively impact outcome in cardiac arrest; these interruptions occur for a range of reasons, including pulse determinations, cardiac rhythm analysis, electrical defibrillation, airway management, and vascular access. In addition to comparing cardiocerebral resuscitation to CPR, this review article also discusses possibilities to reduce interruptions in chest compressions without sacrificing the benefit of these interventions.
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Emergent cricothyroidotomy remains an uncommon, but life-saving, core procedural training requirement for emergency medicine (EM) physician training. We hypothesized that although most cricothyroidotomies for trauma occur in the emergency department (ED), they are usually performed by surgeons. ⋯ (1) Prehospital cricothyroidotomy results in serious complications. (2) Despite the ubiquitous presence of EM physicians in the ED, all cricothyroidotomies were performed by a surgeon, which may present opportunities for training improvement.
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Gastrostomy tube (g-tube) dislodgement is a common problem in special needs children. There are no studies on the frequency of complications after g-tube replacement for children in a pediatric emergency department (ED). ⋯ For children undergoing g-tube replacement in a pediatric ED, misplacement and associated complications were rare. Confirmatory imaging was associated with a considerably longer LOS. In the presence of clinical confirmation, confirmatory imaging may be judiciously used.