The American journal of emergency medicine
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Cardiomegaly is a common but nonspecific finding in the emergency department. The etiology may be explained by left ventricular dilation, biventricular dilation, right ventricular dilation, or pericardial abnormalities, or it may be found to be spurious on the echocardiogram. Rarely, isolated abnormalities of the atrium, particularly the left atrium, may cause abnormalities on the chest radiograph but will not cause true cardiomegaly. ⋯ The diagnosis of a rare huge left atrial aneurysm was finally established by multidetector-row computed tomography, which had been seldom used as a diagnostic tool in the past. Patients with this cardiac anomaly usually are asymptomatic until the second or third decade of life, when the aneurysms can reach remarkable sizes and are often complicated with atrial tachyarrhythmia or thromboembolic events. Early surgical intervention is advised even in asymptomatic patients to prevent the occurrence of myocardial dysfunction, atrial fibrillation, and systemic embolism.
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Sedatives with a long duration are required for pediatric magnetic resonance imaging (MRI) in the emergency department. The success rate of chloral hydrate for pediatric sedation is 80% to 100% according to some studies. However, the success rate varies by age, weight, and underlying disease. ⋯ Patients 24 months of age who had a neurological problem (seizure disorder or developmental delay) had a success rate greater than 95%, but the adverse event rate increased after 24 months of age. Chloral hydrate sedation was appropriate for pediatric MRI in patients younger than 18 months. Although we observed no fatal adverse events, it is necessary to monitor patients until full recovery from sedation.
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Animal experiments and clinical studies have shown that vasopressin infusion in cases of uncontrolled hemorrhagic shock is a promising treatment. However, there are only a few studies regarding the application of terlipressin in hemorrhagic cases. This study was designed to evaluate the effects of terlipressin vs controlled fluid resuscitation on hemodynamic variables and abdominal bleeding in a rat model of uncontrolled hemorrhage via liver injury. ⋯ Compared with the control group, intravenous terlipressin bolus after liver injury contributed to an increase in MAP and survival rates without increasing abdominal bleeding.