The American journal of emergency medicine
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Case Reports
Central scotoma without prodromal illness caused by Bartonella henselae neuroretinitis.
This case report describes Bartonella henselae neuroretinitis in a 26-year-old woman who presented to the emergency department with unilateral central scotoma and no prodromal symptoms, a unique presentation of this disease. B henselae, a gram-negative bacteria, is the cause of cat scratch disease. ⋯ The mostcommon ocular manifestations of cat scratch disease are Parinaud oculoglandular syndrome and neuroretinitis. All prior reported cases of CSD neuroretinitis presented with prodromal symptoms, not vision loss alone.
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Shock index (SI), the ratio of heart rate to systolic blood pressure, has found to outperform conventional vital signs as a predictor of shock. Although age-specific vital sign norms are recommended in screening for shock, there are no reported age- or sex-specific norms for SI. Our primary goal was to report age- and sex-specific SI normal values for a nationally representative population 10 years and older by 5-year age groups. A secondary goal was to report SI normal values for children ages 8 to 19 years by 1-year age groups. ⋯ This first report of age- and sex-specific normal values for SI indicates that SI norms vary by age and sex. Just as age-specific vital sign norms are recommended in screening for shock, our findings suggest that age- and sex-specific SI norms may be more effective in screening for shock than a single-value threshold.
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Takotsubo cardiomyopathy (TTC) is uncommon emergency condition usually precipitated by emotional or physical stress and is characterized by near-normal coronary arteries and regional wall motion abnormalities that extend beyond a single coronary vascular territory. Variants of TTC include classic apical ballooning syndrome and less commonly, mid, basal, and biventricular variants. Cardiac arrest is an uncommon complication of TTC. ⋯ All 3 patients had normal QTc interval and were found to have normal coronary arteries on cardiac catheterization at presentation. Mid ventricular TTC was confirmed on contrast left ventriculography and echocardiography. Cardiac arrest myocarditis was ruled out by myocardial biopsy in 2 deceased patients and by cardiac magnetic resonance imaging in the one who survived.
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Conducting a thorough after-action review (AAR) process is an important component in improving preparedness for mass casualty incidents (MCIs). ⋯ Conducting a structured AAR in all emergency departments after an MCI facilitates both learning lessons regarding the function of the medical staff and ventilation of feelings, thus mitigating anxieties and expediting a speedy return to normalcy.