The American journal of emergency medicine
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We hypothesized that the oro-pharyngolaryngeal axes, occipito-atlanto-axial extension (OAA) angle and intubation distance would be influenced by the height of headrests. ⋯ We conclude that compared with no or 12-cm headrest, 6-cm headrest could facilitate more alignment of these axes, increase the OAA angle, and enlarge the intubation distance.
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Case Reports
Sonographic evaluation of a paralyzed hemidiaphragm from ultrasound-guided interscalene brachial plexus nerve block.
The ultrasound-guided interscalene brachial plexus is becoming increasingly popular for anesthesia in the management of upper-extremity injuries by emergency physicians. Traditional high-volume injections of local anesthesia will also affect the phrenic nerve, leading to temporary paralysis of the ipsilateral hemidiaphragm. ⋯ However, the risk of incidental paralysis of the hemidiaphragm is still not eliminated with low-volume intraplexus injections. This case highlights this common complication of interscalene brachial plexus nerve blocks and demonstrates how emergency physicians can easily use B-mode and M-mode ultrasound to evaluate the paralysis of the hemidiaphragm.
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Several risk scores are available for prognostic purpose in patients presenting with chest pain. ⋯ The FPR effectively succeeds in ruling out coronary events in patients categorized with overall low risk score. Exercise ECG, nonetheless being an independent predictor of coronary events could be considered questionable in this subset of patients.
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A 23-month-old boy was brought to the emergency department of an adult and pediatric tertiary care center 1 hour after an inadvertent “double dose” of 120 mg flecainide (9.2 mg/kg). His electrocardiogram revealed sinus rhythm with a terminal R wave in aVR greater than 7 mm, a bifascicular block, and prolonged QRS and QTc intervals. ⋯ This case demonstrates that flecainide can cause significant cardiac conduction disturbances in doses much lower than previously described. All supratherapeutic ingestions should be assessed in hospital.
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Recent work has shown that two-thirds of patients report functional disability 1 week after an emergency department (ED) visit for nontraumatic musculoskeletal low back pain (LBP). Nearly half of these patients report functional disability 3 months later. Identifying high-risk predictors of functional disability at each of these 2 time points will allow emergency clinicians to provide individual patients with an evidence-based understanding of their risk of protracted symptoms. ⋯ Patients in the ED with worse baseline functional impairment and a history of chronic LBP are 2 to 4 times most likely to have poor short- and longer-term outcomes.