The American journal of emergency medicine
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Case Reports
Uncommon double fistula between sinus node arteries and right atrium in a patient with atypical chest pain.
The main coronary artery variants and anomalies are completely asymptomatic and are discovered incidentally or as they rise symptoms. Multidetector computed tomography coronary angiography represents an excellent technique for noninvasive assessment of the coronary tree mainly because of the multiplanar imaging modalities of computed tomography. Thin collimation permits to depict thin vessels such as the sinus node artery, as reported in this case. In this brief report, we describe a case of a rare anomaly of termination the coronaries, a double fistula between the sinus node artery, and the right atrium in a patient with atypical chest pain.
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The aim of this study was to evaluate the incidence of anxiety and rates of anxiety treatment in emergency department (ED) patients presenting with pain-related complaints. ⋯ Anxiety may be underrecognized and undertreated in patients presenting with pain-related complaints. Patients reporting severe anxiety were less likely to report satisfaction with the treatment of their pain, despite higher rates of analgesic administration.
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Wildland fires have significant ecologic and economic impact in the United States. Despite the number of firefighters involved in controlling them, little is known about the injuries that they sustain. We hypothesized that the mechanism of injury would predict injury characteristics and severity of fire-related injuries. ⋯ This study contributes important knowledge for implementing evidence-based injury prevention programs, for planning emergency medical responses on fire incidents and for provoking further inquiry into occupational risk factors affecting this high-risk occupational group.
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Low-dose ketamine (LDK) may be useful for treatment for opioid-tolerant patients. We conducted a survey of patients and their treating clinicians regarding LDK for analgesia. ⋯ Low-dose ketamine may decrease patients' perception of pain. Most were satisfied with LDK for this purpose and would use it again. Whites were least satisfied with the use of LDK for analgesia. Physicians believed that ketamine is underused.
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Leptospirosis is a common zoonotic infection worldwide and is recognized as an emerging public health problem. Although commonly thought of as a tropical disease, incidence in temperate climates is increasing, with recent outbreaks in the United States and Germany, among other countries. The disease presents with symptoms ranging from fever, headache, nausea, and vomiting to life-threatening multiorgan failure characterized by acute liver failure, nephritis, pulmonary hemorrhage, meningitis, and cardiac arrhythmia. ⋯ Given the nonspecificity of patient symptoms, early diagnosis of leptospirosis can be challenging. Diagnostic uncertainty may lead to delay in recommended intravenous antibiotic treatment. We present a case of severe leptospirosis treated exclusively with supportive measures and intravenous corticosteroids.