The American journal of emergency medicine
-
To identify a biomarker panel with sufficient sensitivity and negative predictive value to identify children with abdominal pain at low risk for acute appendicitis in order to avoid unnecessary imaging. ⋯ This panel may be useful in identifying pediatric patients with signs and symptoms suggestive of acute appendicitis who are at low risk and can be followed clinically, potentially sparing them exposure to the ionizing radiation of CT.
-
Ruptured celiac artery aneurysm is a rare cause for epigastric pain and is usually detected incidentally. Atypical presentation with postemetic epigastralgia and pleural effusion usually leads physicians to make the diagnosis of Boerhaave syndrome. Herein, we report a 32-year-old woman who was diagnosed with Boerhaave syndrome initially after presenting with acute postemetic epigastralgia and predominant left side pleural effusion. ⋯ The chest computed tomographic scan showed no evidence of esophageal rupture. However, a ruptured celiac artery aneurysm with retroperitoneal hematoma extending to the posterior mediastinum and bilateral pleural space was found incidentally. Although ruptured celiac artery aneurysm is an uncommon cause for postemetic epigastralgia, acute vascular events such as the previously stated cause should be the first impression rather than Boerhaave syndrome if the patient also presents with isolated pleural effusion containing unelevated amylase.
-
The objective of the study is to determine the safety of intravenously administered combination sedatives in the emergency department (ED). ⋯ Combination sedatives appear to be safe when administered intravenously in the ED. Combination sedatives may be more effective than single-agent sedatives in agitated alcohol-intoxicated patients.
-
To investigate the relationship between early use of computed tomography (CT) and complications associated with esophageal foreign body impaction in adults. ⋯ Esophageal foreign bodies were associated with a high incidence of complications in adults. CT could detect foreign bodies accurately in the early stages, and then FBs could be removed as early as possible, which may reduce the incidence of complications. Moreover, the great majority of complications were of lower grades. Thus, CT may be a useful first-line radiological tool for the early diagnosis of esophageal foreign bodies in adults.
-
Case Reports
Complication after treatment for resistant supraventricular tachycardia: the Bezold-Jarisch reflex.
The Bezold-Jarisch reflex may become clinically relevant in times of profound relative hypovolemia. This results in uncoupled cardio inhibition leading to the triad of hypotension, bradycardia and vasodilation.