The American journal of emergency medicine
-
Neuromuscular paralysis without sedation is an avoidable medical error with negative psychologic and potentially physiologic consequences. We determine the frequency of long-acting paralysis without concurrent sedation among patients intubated in our emergency department (ED) or before arrival. ⋯ Absence of concurrent sedation was common among patients receiving long-acting neuromuscular paralysis before arrival or at our ED, despite implementation of a guideline to improve practice.
-
Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients. ⋯ The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients with stroke in an urban environment and may improve the access to thrombolysis.
-
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.
-
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.
-
The domesticated pig or boar is ubiquitous to agriculture around the world and is an important food product in most countries. The males that are able to grow tusks that can approach 5 in are the primary contributor to morbidity and mortality from boar attacks. ⋯ There are no published cases of domesticated boar attacks that describe successful bacterial postexposure prophylaxis. We present a case report of an attack on an adult female by a domesticated boar.