The American journal of emergency medicine
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Review Case Reports
A rare seizure: Tumor lysis syndrome after radiation therapy of a solid tumor.
Tumor lysis syndrome (TLS) is an uncommon but life threatening condition seen in oncology patients. Due to its underlying pathophysiology, it is classically associated with hematologic malignancies following chemotherapeutic treatment. In this article, we present a case of TLS in the setting of two rare features: a solid tumor malignancy and the absence of recent chemotherapy. We briefly review risk factors and the diagnosis of this potentially fatal but treatable condition.
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Observational Study
Simple method for obtaining the optimal laryngoscopic view in children: A prospective observational study.
Head and neck positioning has an important effect on laryngeal visualization during laryngoscopy. For small children and infants, a head-flat position is traditionally assumed; however, during laryngoscopy, the optimal head position may result in a superior laryngeal view in certain patients. ⋯ Positioning of the head in order to align it with the external auditory meatus and sternal notch was associated with superior laryngoscopic visualization in pediatric patients. This resulted, in a more straightforward laryngoscopic procedure.
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Observational Study
Temperature variability during targeted temperature management is not associated with neurological outcomes following cardiac arrest.
Recent studies on comatose survivors of cardiac arrest undergoing targeted temperature management (TTM) have shown similar outcomes at multiple target temperatures. However, details regarding core temperature variability during TTM and its prognostic implications remain largely unknown. We sought to assess the association between core temperature variability and neurological outcomes in patients undergoing TTM following cardiac arrest. ⋯ In this study, individual core temperature variability during TTM was not associated with poor neurological outcomes or death at hospital discharge.
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Observational Study
Evaluating the value of dynamic procalcitonin and presepsin measurements for patients with severe sepsis.
This study comparatively evaluated the value of dynamic procalcitonin (PCT) and presepsin measurements in assessing therapeutic efficacy and prognosis for patients with severe sepsis. ⋯ Dynamic monitoring of presepsin and PCT demonstrated that both presepsin and CR of presepsin are continuous and better markers than are PCT and CR of PCT for evaluating the therapeutic efficacy and prognosis of patients with severe sepsis.
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Case Reports
Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.
Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. ⋯ When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy.