The American journal of emergency medicine
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Spontaneous intramedullary hematoma (IMH) is a rare condition. The initial clinical manifestations are variable. Early symptoms of high thoracic IMH include thoracocervical pain that can be mistaken for emergent cardiopulmonary conditions such as myocardial infarction, pulmonary embolus, and aortic dissection. ⋯ Two hours after admission, correct diagnosis of IMH was based on the repeated neurologic examination and spine magnetic resonance imaging study. The patient underwent emergency surgical decompression and hematoma removal. We draw the misdiagnosis to the attention of the emergency physicians because early recognition of spontaneous IMH is very important for early surgical decompression to improve the prognosis.
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Frontal lobe seizures are a common form of epilepsy. It has a variable presentation and can often be missed in the emergency department (ED). ⋯ Knowledge of the anatomy behind the development of partial seizures and the best testing modality can aid in the diagnosis. In this review, we attempt to discuss the pathophysiology of frontal lobe epilepsy and what physical examination findings and testing will best lead to a diagnosis.
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Hamate fractures represent only 2% to 4% of all carpal bone fractures because they require a large degree of force to the hand or wrist. This is a case report of a patient with hamate and capitate fractures after a punch injury. It details the minute change seen in routine 3-view radiographic imagery and indications for computed tomography. ⋯ The risks to not detecting a hamate body fracture are nonunion of the bone, posttraumatic arthritis, decreased grip strength, and decreased range of motion of the hand. Because of rarity, there is no criterion standard therapy, but the general approach is open reduction and internal fixation using Kirschner wires and wrist immobilization for a minimum of 8 weeks. A high degree of clinical suspicion on examination is required for the proper approach to confirm a hamate fracture.
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Comparative Study
Comparison of the therapeutic effect between sodium bicarbonate and insulin on acute propafenone toxicity.
Unlike other sodium-channel-blocking antiarrhythmic agents, propafenone has β-blocking effects and calcium-channel-blocking effects. Yi et al recently studied insulin's treatment effect on acute propafenone toxicity in rats. However, because the degree of effectiveness of insulin compared to the previously known antidote sodium bicarbonate (NaHCO3) was not studied, the 2 treatment methods were compared for propafenone intoxication in rats. ⋯ Insulin treatment was more effective than NaHCO3 on acute propafenone toxicity in rat. Therefore, when propafenone-induced cardiotoxicity occurs, which is unresponsive to current treatment methods, glucose-insulin infusion may be considered.