The American journal of emergency medicine
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Case Reports
Concurrent pulmonary embolism and acute coronary syndrome with dynamic electrocardiographic changes.
Concomitant occurrence of pulmonary embolism and acute coronary syndrome is rare. The early diagnosis and treatment of acute coronary syndrome with right ventricular myocardial ischemia during acute pulmonary embolism (APE) are crucial. The irreversible right ventricular myocardial dysfunction is a major risk factor for mortality from APE. In this case report, we present a 66-year-old female patient with APE who had a significant right coronary artery (RCA) lesion, which was successfully treated with angioplasty and stent implantation.
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Case Reports
Extreme QT prolongation during therapeutic hypothermia after cardiac arrest due to long QT syndrome.
During therapeutic hypothermia, QT interval is prolonged. In patients with congenital long QT syndrome (LQTs), a longer QT interval was associated with significantly increased risk of cardiac arrest (CA). Therefore, therapeutic hypothermia may have proarrhythmic effects in survivors of CA due to congenital LQTs. ⋯ Both patients were fully recovered from neurologic damage. During therapeutic hypothermia, QT interval was extremely prolonged, although TdP did not recur in 2 patients with congenital LQTs. Therapeutic hypothermia may be beneficial for comatose survivors of CA due to LQTs.
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A modified subcutaneous single-injection approach to achieve digital block using a tumescent technique is described. ⋯ The tumescent technique in digits to achieve a single-injection digital nerve block is an easy, safe and effective method for digital anesthesia. These data confirm the applicability of the tumescent technique in digits for patients with finger and thumb injuries or tumors that require minor surgical procedures.
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We report a case of rhabdomyolysis temporally related to the ingestion of a large amount of kava. Kava is a naturally occurring plant used in the United States and elsewhere in the world for its sedative properties. ⋯ It is not clear whether this is an action of the kava itself, perhaps, due to its action on voltage ion channels or, perhaps, due to an adulterant in the product. Our patient developed peak creatine phosphokinase levels in excess of 30 000 U/L but had no significant renal damage.
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Our objective was to determine if implementing a standard lights and sirens (L&S) protocol would reduce their use and if this had any effect on patient disposition. ⋯ Our protocol significantly reduced the use of L&S. Judicious use of L&S has significant implications for transport safety. By allowing for selective transport with L&S usage, we observed no impact in patient disposition.