The American journal of emergency medicine
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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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Women with acute coronary syndrome appear to be treated less aggressively than men. However, little is known about potential sex biases in the evaluation of patients with low-risk chest pain admitted to emergency department (ED) chest pain units. ⋯ This study demonstrates no association between physician discretionary uses of stress testing based on sex. There is a need for further research on patient- or provider-specific factors that determine stress use and on how differences may affect clinical outcomes.
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Increased γ-glutamyl transferase (GGT) level is associated with increased oxidative stress, all-cause mortality, the development of cardiovascular disease, and metabolic syndrome. However, its role in acute pulmonary embolism (PE) is unknown. In this study, we aimed to investigate the relationship between GGT and early mortality in patients with acute PE. ⋯ We have shown that a high GGT level is associated with worse hemodynamic parameters, and it seems that GGT helps risk stratification in patients with acute PE.
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Very few cases of the use of extracorporeal membrane oxygenation (ECMO) in pregnant women have been reported to date. We report the first case of the use of ECMO for the treatment of cardiac arrhythmia with cardiogenic shock in a pregnant woman. A 28-year-old pregnant woman at 26 weeks of gestation presented with supraventricular tachycardia complicated with cardiogenic shock and fetal distress that was refractory to medication and electrical cardioversion. ECMO was applied, and it facilitated successful radiofrequency ablation.