The American journal of emergency medicine
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The use of ondansetron in children with vomiting after a head injury has not been well studied. Concern about masking serious injury is a potential barrier to its use. ⋯ Ondansetron use in children with a CT scan who are dispositioned home is relatively safe, does not appear to mask any significant conditions, and significantly reduces return visits to the PED.
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End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis.
Exhaled end-tidal carbon dioxide (ETCO(2)) concentration is associated with lactate levels in febrile patients. We assessed the association of ETCO(2) with mortality and lactate levels in patients with suspected sepsis. ⋯ We observed a significant association between ETCO(2) concentration and in-hospital mortality in emergency department patients with suspected sepsis across a range of disease severity.
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Churg-Strauss syndrome (CSS) is a rare vasculitic disorder characterized by chronic rhinosinusitis, asthma, and persistent eosinophilia. Although not a usual prominent initial presentation, cardiac involvement is a major cause of morbidity and mortality in patients with CSS. We report a case of a 72-year-old white man who presented with chest pain and was subsequently diagnosed with CSS with biopsy-proven eosinophilic myopericarditis. We have also included a review of the literatures on cardiac involvement in CSS.
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Discoloration of urine can be alarming and may indicate a serious underlying pathology. However, majority is benign and occur as a result of ingestions of substances such as medications or food dye or trauma postinstrumentations. ⋯ Unfortunately, most clinicians including the frontline clinicians are not aware of this syndrome, and despite the striking features, purple urine bag discoloration may be overlooked and not be given appropriate treatment. We present a case of this rare phenomenon with urosepsis that was not diagnosed on 2 occasions when the patient presented to the accident and emergency department.
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Reactive arthritis is an inflammatory condition with multiorgan system disease potential. Because the standard constellation of symptoms in Reiter syndrome (arthritis, conjunctivitis, and urethritis) is not typically present in all patients, the disease can be easily overlooked if clinical suspicion is not high upon presentation. To highlight the importance of recognizing the potential of this disease in patients with a history of either gastrointestinal or genitourinary illnesses, we present the case of a young healthy male presented on multiple occasions later diagnosed with Reiter syndrome in the setting of a recent diagnosis of prostatitis. ⋯ He was treated with nonsteroidal anti-inflammatory drugs during a brief hospital stay and did well. Although reactive arthritis is an easily managed disease, it is easily missed particularly in young otherwise healthy patients who may not present with classic symptoms. Vigilance with regard to patients with vague seemingly unrelated complaints particularly with a history of gastrointestinal- or genitourinary-related illnesses deserves consideration for this disease process.