The American journal of emergency medicine
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The purpose of this study is to determine if stable, well-appearing, drowning patients who have normal age-adjusted vital signs and pulse oximetry upon arrival to the emergency department may be safely discharged without a prolonged observation period. ⋯ The overall complication rate in initially stable, well-appearing drowning patients is low. An abnormal pulse oximetry reading at presentation may help predict subsequent complications. Those patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.
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Venous thrombosis is recognized as one of the most important complications of nephrotic syndrome (NS). In patients with NS, venous thrombosis may develop in the renal veins, the deep veins of the lower limb, and the inferior vena cava. Here, we describe a case report of an NS patient with multiple venous thrombosis in the right renal vein, the left iliac vein, the vena cava inferior, the right atrium, and the pulmonary arteries. Moreover, we describe the successful treatment of multiple venous thrombosis with prolonged thrombolytic treatment in spite of an increased risk of bleeding due to renal biopsy.
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The risk of thromboembolism is higher in those with carbon monoxide (CO) poisoning than in the general population. Pulmonary embolisms (PE) usually develop during admission for acute CO poisoning. We report the first case of a life-threatening PE that occurred immediately after acute CO poisoning and was treated with a thrombolytic agent. ⋯ She recovered after the treatment. We should consider that PE is also an important differential cause in patients with hypotension. In these patients, bedside ultrasound performed by emergency physicians can act as the only diagnostic examination.
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Case Reports
Vitamin B12 deficiency-induced neuropathy secondary to prolonged recreational use of nitrous oxide.
A 24-year-old female, otherwise healthy, presented to the Emergency Department (ED) with difficulty walking and bilateral leg pain. The patient was a recreational nitrous oxide (NO2) user, also known as "whippets" or simply nitrous. Neurologic examination demonstrated an unsteady gait and positive Romberg sign along with normal deep tendon reflexes and normal muscle strength in upper and lower extremities. ⋯ As in our case report, the toxic effects can be profound and mimic other emergent conditions like stroke. Emergency physicians should have a higher index of suspicion for the toxic effects of this common drug. Elderly, vegetarians and patients with Irritable Bowel Disease are at higher risk and may even experience toxicity from nitrous oxide used therapeutically during routine anesthesia.
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Letter Randomized Controlled Trial Comparative Study
A randomized, cross-over, pilot study comparing the standard cricothyrotomy to a novel trochar-based cricothyrotomy device.