The American journal of emergency medicine
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The end-tidal carbon dioxide (ETCO2) measurement was considered as an essential tool for the assessment of several conditions in emergency medicine. However, the diagnostic role of capnography in dyspneic patients still remains unclear. We aimed to analyze the alteration of the ETCO2 levels in chronic obstructive pulmonary disease (COPD) exacerbations and its role in the decision-making process. ⋯ End-tidal carbon dioxide levels were higher in admitted patients when compared with discharged patients on arrival to the ED. ETCO2 measurement has very little contributions while evaluating patients with COPD exacerbation in the ED.
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Abdominal apoplexy was reported by Barber in 1909, and the occurrence rate of the apoplexy is known to be quite rare, but the mortality is high if untreated. We report an unusual case of abdominal apoplexy due to spontaneous rupture of gastric artery. ⋯ The outcome of the patient was poor, and he died on the second day of admission. As in our case, the mortality can be high, so prompt restoration of circulation volume and early diagnosis should be made in similar cases.
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Case Reports
Successful treatment of ileocolic intussusception with air enema reduction in an adult patient.
Intussusception is a rare condition in adults, representing only 1% of all bowel obstructions. In adult cases, operative explorations are recommended to treat the bowel obstruction and to diagnose underlying diseases. The objective of the current case report was to describe the successful treatment of ileocolic intussusception with air enema reduction in an adult patient. ⋯ Three minutes after initiation of the air enema, when the patient experienced increasing abdominal pain and vomiting, the pressure was temporarily increased to greater than 100 mm Hg, and the air reached the terminal ileum. We considered the reduction successful and confirmed it with an abdominal ultrasound examination. We believe that air enema reduction is effective for treating idiopathic intussusception within 24 hours of symptom onset in young, previously healthy adult patients.
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Case Reports
Posterior reversible encephalopathy syndrome as the first presentation of chronic kidney disease.
Posterior reversible encephalopathy syndrome is a clinicoradiologic syndrome characterized by seizure, headache, nausea, vomiting, altered mental status, visual disturbance, or visual loss, together with radiologic findings. Herein we reported a patient who was a 27-year-old foreign workman brought to the emergency ward with blurred vision in both eyes, neck pain, somnolence, and altered mental status. He had no known medical or family history. ⋯ The findings from a complete blood count, biochemical testing, and renal, pelvic and abdominal ultrasound and also the calculated glomerular filtration rate values revealed that all were in favor of chronic kidney disease (hemoglobin level, 10.3 mg/dL; blood urea nitrogen, 90 mg/dL; Cr, 6.8 mg/dL; potassium, 5 mEq/L; sodium, 140 mEq/L; Cockcroft-Gault glomerular filtration rate, 15; weight, 65 kg). The hemodialysis was performed by which the sign and symptoms and radiologic findings resolved within 24 hours. Although PRES is described to be in association with many medical conditions, as mentioned in many available articles, we came to a conclusion that PRES could be the first presentation of a condition such as chronic kidney disease in our case.
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Acute lingual abscess is a rare yet life-threatening clinical entity. Lingual abscess must be appropriately diagnosed and treated in the emergency department to avoid acute airway compromise. A 68-year-old woman on immunomodulatory medication for rheumatoid arthritis presented to the emergency department with left facial pain and swelling. ⋯ Intravenous antibiotics are the primary treatment modality, with consideration given to adjunctive surgical drainage. We present this case to increase awareness surrounding this diagnosis among emergency physicians. Spontaneous lingual abscess should be considered in immunocompromised patients who present to the emergency department with tongue pain and edema even in the absence of lingual trauma.