The American journal of emergency medicine
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Our patient is a 42-year-old woman with muscle paralysis, muscle weakness, and fever. On admission, a neurologic examination showed proximal and distal weakness in the leg. Serum creatine phosphokinase and serum myoglobin level were markedly increased (5600 UI/L and 5197 UI/L, respectively). ⋯ Serologic studies for virus titers showed the antibody immunoglobulin M cytomegalovirus. Muscle weakness and its paralysis, fever, and serum creatine kinase level gradually improved after the administration of methylprednisolone intravenous. Cytomegalovirus infection was thought to have played a central role in this case, leading to an acute but reversible peripheral muscle paralysis.
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Case Reports
Early left ventricular free-wall rupture in non-ST-elevation myocardial infarction: never to be neglected.
As the most dramatic and fatal complication, left ventricular free-wall rupture (LVFWR) used to present in approximately 3% of patients with acute myocardial infarction. After the introduction of primary percutaneous coronary intervention, the incidence of LVFWR decreased but remained approximately 1.7%. ⋯ Left ventricular free-wall rupture rarely occurs in patients with non-ST-elevation myocardial infarction, but the risk of it cannot be ignored. This case describes early development LVFWR after non-ST-elevation myocardial infarction to evoke high vigilance of clinicians to this condition.
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Although techniques for autoreduction of anterior shoulder dislocation have been developed, no reports have detailed an autoreduction method using the zero position and traction on the affected arm. Therefore, we developed a new autoreduction technique using the zero position and gentle autotraction. The objective of this study is to present our experience with a new method for autoreduction of anterior shoulder dislocation called the GONAIS (a backronym for “Grasp a waist-high object, Opposite arm assists, Nonsedated, Autoreduction/autotraction, Immobilize the grasped object, and Squatting and stooping”) method. ⋯ Here, our patient using the GONAIS method achieved shoulder autoreduction in a short time. The GONAIS method does not require lying down or sitting on the ground, does not necessarily require the opposite arm, and is minimally invasive. This method would likely be helpful for those who cannot quickly reach a hospital for treatment of anterior shoulder dislocation.
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Prehospital pediatric airway management is difficult and controversial. Options include bag-mask ventilation (BMV), endotracheal tube (ETT), and laryngeal mask airway (LMA). Emergency Medical Services personnel report difficulty assessing adequacy of BMV during transport. Capnography, and capnograph tracings in particular, provide a measure of real-time ventilation currently used in prehospital medicine but have not been well studied in pediatric patients or with BMV. Our objective was to compare pediatric capnographs created with 3 airway modalities. ⋯ Capnographs are generated during BMV and are virtually identical to those produced with ETT or LMA ventilation. Attention to capnographs could improve outcomes during emergency treatment and transport of critically ill pediatric patients requiring ventilation with any of these airway modalities.