The American journal of emergency medicine
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Case Reports
Prolonged cardiac arrest: successful resuscitation with extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation (CPR), but prolonged CPR may develop multiple organ failure, and neurologic death is a major complication. We present a case of a 35-year-old woman with fulminant myocarditis secondary to H1N1 influenza A infection, in which cardiac arrest was refractory to prolonged conventional CPR. Extracorporeal membrane oxygenation was initiated 250 minutes after prolonged CPR. Extracorporeal membrane oxygenation provided cardiopulmonary life support for prolonged CPR, achieving a sustained return of spontaneous circulation, which allowed further treatment and made a good recovery with intact cerebral performance.
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This study aimed to determine whether routine urinalysis may serve as a tool in discriminating between acute appendicitis and perforated appendicitis in children. ⋯ Routine urinalysis may serve to aid in discriminating between simple and perforated appendicitis. Clinically, we believe that these urine parameters may aid primary emergency physicians with decision making in patients with clinically suspected appendicitis.
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Case Reports
Takotsubo cardiomyopathy after anti-influenza vaccination: catecholaminergic effects of immune system.
Takotsubo cardiomyopathy (TTC) is a well-known condition, which leads to sudden transient regional systolic dysfunction. It mostly affects aging women and is usually precipitated by emotional or physical stress. ⋯ In our case, an elderly woman presented with an acute episode of TTC 24 hours after anti-influenza vaccination without any obvious stressor for sudden rise in the catecholamine level. Sudden postvaccination change in the cardiac sympathetic discharge is the most likely precipitant of TTC in this case.
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Bezold abscess is a rare complication of mastoiditis in which patients are often well appearing but require urgent intervention to prevent serious sequelae. We describe the case of a Bezold abscess in a 12-year-old girl.
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The purpose of our study was to assess the diagnostic values of laboratory tests to differentiate spontaneous intramural intestinal hemorrhage (SIIH) from acute mesenteric ischemia (AMI) after abdominal computed tomography (CT) survey in the emergency department (ED). ⋯ Abdominal pain patients with either SIIH or AMI are rare in the ED, but abdominal CT sometimes cannot help to differentiate them due to similar CT findings. Prolonged PT might help emergency physicians and surgeons differentiate SIIH from AMI in such cases.