The American journal of emergency medicine
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Aortic intramural hematoma is a contained aortic wall hematoma without a demonstrable intimal flap. It is similar to aortic dissection, but the pathology and pathophysiology are different. We report a patient with a chronic descending thoracic aortic intramural hematoma presenting with acute rupture and periaortic hematoma along with concomitant acute ST-elevation myocardial infarction that proved to be catastrophic without intervention. We discuss the diagnostic and therapeutic dilemma.
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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.
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Human serum albumin (HSA) is used as a plasma expander; however, albumin is readily eliminated from the intravascular space. The objective of this study was to establish the effects of various-sized polymerized HSAs (PolyHSAs) during small-volume resuscitation from hemorrhagic shock on systemic parameters, microvascular hemodynamics, and functional capillary density in the hamster window chamber model. Polymerized HSA size was controlled by varying the cross-link density (ie, molar ratio of glutaraldehyde to HSA). ⋯ Pharmacokinetic analysis of PolyHSA(60:1) indicates reduced clearance and increased circulatory half-life compared with monomeric HSA and other PolyHSA formulations. In conclusion, HSA molecular size and solution viscosity affect central hemodynamics, microvascular blood flow, volume expansion, and circulation persistence during small-volume resuscitation from hemorrhagic shock. In addition, PolyHSA can be an alternative to HSA in pathophysiological situations with compromised vascular permeability.
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We present a case of 2-dimensional ultrasound-assisted confirmation of nasogastric tube (NGT) placement using both soft tissue neck and epigastric sonographic imaging. Given our findings and review of the literature, we suggest that bedside ultrasound evaluation of NGT placement is a straightforward, rapid, and novel alternative method to the “gold standard” of a portable chest radiograph in the emergency department (ED).
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Use of online formulas to treat hyponatremia is a common practice. We report here that while using the same goal of correction and type of infusate to treat a patient with hyponatremia, a large discrepancy in infusion rate is obtained from using the 2 commonly available online equations. ⋯ When the therapy fluid is hypertonic saline (3%), these formulas may result in overly rapid correction. We should, thus, never use these formulas blindly in the management of patients with hyponatremia.