The American journal of emergency medicine
-
Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. If we hope to increase the survivability of this condition, it is imperative that alternative methods of treatment are given due consideration. Balloon occlusion of the aorta can be used as a method of circulatory support in the critically ill patient. ⋯ Animal research has demonstrated improvements in cerebral and coronary perfusion pressure during ACLS that lead to statistically significant differences in mortality. Several case series in humans have replicated these findings, suggesting the efficacy of this procedure. The objectives of this review are to: 1) introduce the reader to REBOA 2) review the physiology of NTCA and examine the current limitations of traditional ACLS 3) summarize the literature regarding the efficacy and feasibility of aortic balloon occlusion to support traditional ACLS.
-
Letter Comparative Study
Comparison of Macintosh and Intubrite laryngoscopes for intubation performed by novice physicians in a difficult airway scenario.
In the difficult airway, the intubation skills are critically important. In selected cases, particularly in airway edema, laryngeal or tongue edema, endotracheal intubation can turn out very difficult, and repeated attempts may even worsen the airway edema, causing trauma and bleeding, and finally leading to complete airway obstruction and inability to ventilate the patient. ⋯ During the simulation study, the novice physicians were able to perform endotracheal intubation at the same time using both the Macintosh and Intubrite videolaryngoscope. However, the efficacy of the first intubation attempt was higher for MAC. Further studies are needed to confirm the results.
-
Controlled Clinical Trial
Developing a standardized measurement of alcohol intoxication.
We assessed multiple examinations and assessment tools to develop a standardized measurement of alcohol intoxication to aid medical decision making in the Emergency Department. ⋯ HII examination, paired with either a VAS or HII assessment tool, yielded valid and reliable measurements of alcohol intoxication.
-
Numb chin syndrome (NCS) is a rare yet potentially ominous sensory neuropathy in the distribution of the mental or inferior alveolar nerve characterized by unilateral hypoesthesia over the lower lip, chin and occasionally gingival mucosa. Recognizing NCS is clinically important as this may be a subtle sign of occult malignancy progression or heralding the relapses. ⋯ Current expert opinion is that patients with NCS without apparent cause should be assumed to have a malignant etiology until proven otherwise Lossos and Siegal (1992) [1]. Here we report a relapse of Non-Hodgkin lymphoma with NCS with no evidence of metastasis.
-
Authors and clinicians advocate lipase as the preferred serological test for the diagnosis for acute pancreatitis. While acute pancreatitis is among the differential diagnosis for elevated lipase levels, several other causes of elevated lipase levels have been identified including several reports Salmonella species as a causative agent. ⋯ However, Salmonella infections may induce elevated pancreatic enzyme levels without clinical pancreatitis or morphological pancreatic abnormalities through a variety of proposed mechanisms. The following is a case that describes a patient who developed Salmonella colitis and demonstrated elevated serum lipase levels without clinical pancreatitis.