The American journal of emergency medicine
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To assess stress-echo (SE) diagnostic performance in patients presenting to the emergency department (ED) with spontaneous chest pain, especially in subgroups in which exercise ECG diagnostic performance has been questioned (women, elderly, history of coronary artery disease). ⋯ SE had a very good diagnostic performance in ED patients with suspected Isch, both overall and in selected high-risk groups.
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Sildenafil is a drug used for male erectile dysfunction. Sildenafil's fatal cardiac effects except due to hypotension with simultaneous nitrate use have not been reported. ⋯ Electrocardiogram showed inferoposterior ST-segment elevation. In angiography, total circumflex artery occlusion has been seen.
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Acute cerebellitis is a rare inflammatory disease involving the cerebellum and is characterized by acute compromise of cerebellar functions. It most frequently originates from infectious causes, although cases of cerebellitis associated with other causes have also been reported. ⋯ There are no previous reports of cerebellitis after tricyclic antidepressant. This case shows that cerebellitis can develop in patients with poisoning of this kind.
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Airway management is a key competence in emergency medicine. Patients heavily differ from those in the operating room. They are acutely ill by definition and usually not fasting. Evaluation of risk factors is often impossible. Current literature primarily originates from countries where emergency medicine is an independent specialty. We evaluated intubations in a high-volume emergency department run by internists and comprising its own distinctive intensive care unit. ⋯ Airway management at the emergency department possesses a high potential of failure. Experience seems to be the key to success.
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Case Reports
Irreversible third-degree heart block and pacemaker implant in a case of flecainide toxicity.
An 82-year-old white woman was seen in the emergency department (ED) after ingesting 400 mg of flecainide in an attempt to treat an episode of dizziness and palpitations that occurred while she was gardening. Consequently, she developed bradycardia, hypotension, and complete heart block. ⋯ After further evaluation, a permanent pacemaker was implanted during her admission. External pacing wires may be useful in the treatment of complete heart block in cases of flecainide poisoning when a patient is unresponsive to drug therapy provided in the ED.