The American journal of emergency medicine
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Delayed diagnosis of blunt traumatic diaphragmatic rupture (BDR) is not uncommon in the emergency department (ED) despite improvement in investigative techniques. We reviewed a large case series of patients diagnosed with blunt traumatic diaphragmatic rupture in order to report demographics, clinical features, and mechanisms of injury of this important but challenging entity. ⋯ BDR constitutes a rare entity in thoracoabdominal trauma and most of these injuries were related to traffic collision. High index of suspicion was still the main factor to early diagnosis of this case. The mortality was related to initial shock , bilateral BDR and high ISS. Proper initial resuscitation and correction of other serious injuries may be more life-saving in patients with BDR.
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Case Reports
Purpura fulminans caused by community-associated methicillin-resistant Staphylococcus aureus.
Sepsis-induced purpura fulminans is a rare but life-threatening condition characterized by rapidly progressive hemorrhagic infarction of the skin due to dermal vascular thrombosis resulting in tissue loss and severe scarring. Although most commonly related to meningococcal or invasive group A streptococcal disease, it may also be caused by several other bacterial or viral pathogens including Pneumococcus and Varicella. ⋯ However, the syndrome is very unusual in children, and to our knowledge, only 2 cases of staphylococcal purpura fulminans have been reported in children, both due to methicillin-susceptible S aureus in the United Kingdom. We report the first well-described case of purpura fulminans due to community-associated methicillin-resistant S aureus in a child.
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Case Reports
Emergency cricothyrotomy for trismus caused by instantaneous rigor in cardiac arrest patients.
Instantaneous rigor as muscle stiffening occurring in the moment of death (or cardiac arrest) can be confused with rigor mortis. If trismus is caused by instantaneous rigor, orotracheal intubation is impossible and a surgical airway should be secured. Here, we report 2 patients who had emergency cricothyrotomy for trismus caused by instantaneous rigor. This case report aims to help physicians understand instantaneous rigor and to emphasize the importance of securing a surgical airway quickly on the occurrence of trismus.
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A 72-year-old man was brought to our emergency department (ED) because of upper abdominal pain. Initial vitals at the triage station were significant only for high blood pressure. Computed tomography (CT) of the abdomen with contrast enhancement revealed an intimal flap over his descending aorta, the infrarenal part. ⋯ A high aortic bifurcation at the level of the second lumbar vertebrae, in conjunction with bilateral common iliac arteries, appeared in pair, masquerading the CT image as infrarenal aortic dissection. Actually, that was a variant in human anatomy. A reconstructed sagittal view of the CT scan is mandatory for a patient with abdomen pain to avoid misinterpretation of the radiographic image.
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The aim of this study was to determine the clinical characteristics of, antibiotic therapy for, and clinical outcome of Pseudomonas aeruginosa infection among bacteremic adults who visit the emergency department (ED). ⋯ For bacteremic adults who visited the ED, P aeruginosa was associated with a high mortality rate and a high proportion of empirically inappropriate antibiotic therapy. Identification of clinical predictors of P aeruginosa bacteremia would improve the quality of care and the use of appropriate antibiotics in the ED.