The American journal of emergency medicine
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We report the case of an 89-year-old female patient who presented to the emergency department after out-of-hospital cardiac arrest due to polymorphic ventricular tachycardia treated by public access defibrillation. The admission electrocardiogram (ECG) showed extreme QT prolongation (650 milliseconds) with recurrent episodes of nonsustained polymorphic ventricular tachycardia. ⋯ After history taking, it was found that the patient was on citalopram and that, 2 days prior to admission, she had begun treatment with levosulpiride. This drug combination resulted in marked prolongation of the QT interval that triggered the electrical storm.
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Review Case Reports
Pulmonary laceration secondary to a traumatic soccer injury: a case report and review of the literature.
Pulmonary lacerations are an uncommon injury typically associated with high-impact trauma. Most cases occur as a result of high-speed road traffic collisions. ⋯ There are only a few reported cases of significant pulmonary trauma associated with sports injuries, the majority of which have described pulmonary contusions occurring as a result of thoracic injury sustained while playing high-impact contact sports such as American football. Pulmonary laceration occurring as result of soccer-related thoracic trauma has never previously been reported.
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Case Reports
A unique presentation of renal cell carcinoma: both upper and lower gastrointestinal bleeding.
Renal cell carcinoma (RCC) constitutes 3% of all adult malignancies and may present with various symptoms due to local growth, metastasis, and paraneoplastic syndrome. Gastrointestinal hemorrhage because of RCC is a very rare event and more commonly seen as a recurrence of RCC many years after nephrectomy. Both upper and lower gastrointestinal bleeding due to direct invasion of RCC has not been reported yet in the literature. Herein, we report a case of 78-year-old man with both massive upper and lower gastrointestinal bleeding as a presenting symptom of RCC.
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The earliest definition of transfusion-related acute lung injury (TRALI) included all patients who developed acute respiratory distress, moderate to severe hypoxemia, rapid onset of pulmonary edema, mild to moderate hypotension, and fever within 6 hours of receiving a plasma containing blood transfusion. The definition excluded patients if they had underlying cardiac or respiratory disease. The mechanism is not known exactly but it causes morbidity and mortality. ⋯ A 78 year old female patient with history of myelodysplastic syndrome, coronary artey disease and hypertansion, was admitted to the hospital because of dyspnea after the blood transfusion. She was managed as TRALI after diagnostic workup and transported to the intensive care unit. In the following days her clinical status changed dramatically with complete recovery.
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Four to ten percent of patients evaluated in emergency departments (ED) present with altered mental status (AMS). The prevalence of non-convulsive seizure (NCS) and other electroencephalographic (EEG) abnormalities in this population is unknown. ⋯ The prevalence of EEG abnormalities in ED patients with undifferentiated AMS is significant. ED physicians should consider EEG in the evaluation of patients with AMS and a high suspicion of NCS/NCSE.