The American journal of emergency medicine
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Case Reports
Left atrial rhabdomyosarcoma diagnosed by Emergency Department point-of-care echocardiography.
We present a case of intracardiac rhabdomyosarcoma associated with cardiopulmonary instability which was diagnosed by emergency providers using point-of-care echocardiography. ⋯ A previously healthy 49-year-old man presented to the Emergency Department with progressive dyspnea and hypotension. Emergency providers identified a left atrial mass using point-of-care ultrasound. Expedited advanced imaging and surgical management showed a malignant cardiac rhabdomyosarcoma. Why should an emergency physician be aware of this? This case report highlights the utility of point-of-care ultrasound in the work-up of patients with undifferentiated dyspnea and hypotension, even in cases of rare diagnoses. Early diagnosis and management of both benign and malignant intracardiac tumors is essential to preoperative planning and patient prognosis. Ultrasound findings consistent with intracardiac masses should be recognized and used to guide further consultation, advanced imaging, and treatment.
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Drug induced acute respiratory distress syndrome (ARDS) is a common clinical condition. Patients typically present with noncardiogenic pulmonary edema. Large number of ARDS cases reported induced by antineoplastic drugs and other drug intoxications. ⋯ To the best of our knowledge, ARDS following normal doses of NSAID ingestion has not been reported previously. The case showed that ARDS may occur after ingestion of therapeutic doses of NSAID. NSAID ingestion should be considered in the differential diagnosis of patients with non-cardiogenic pulmonary edema.
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People identified as Very Important Persons (VIPs) often present or are referred to the Emergency Department (ED). Celebrities are a small subset of this group, but many others are included. ⋯ Treatment also provides challenges with the risks of over testing, overtreatment, over consultation, and over or under admission to the hospital. This article presents a practical and ethical framework for addressing the care of VIPs in the ED.
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There were few case reports discuss about iatrogenic chest wall hematoma. Although it is rare life threatening, it still can result in significant morbidity. A 68-year-old woman with histories of end-stage renal disease under regular hemodialysis and congestive heart failure was sent to our emergency department because of progression of ecchymosis over the anterior chest wall a few hours after hemodialysis. ⋯ Treating the underlying disease and discontinuing anticoagulation and antiplatelet agents should be considered. For iatrogenic chest wall hematoma, bleeding control should be the priority. Contrast-enhanced computed tomography could be arranged if there are no contraindications.