The American journal of emergency medicine
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Observational Study
Effect of hypertension across the age group on survival outcomes in out-of-hospital cardiac arrest.
There are few studies on the effects hypertension has on survival outcomes in out-of-hospital-cardiac arrest (OHCA) patients, although hypertension is a major risk factor for the incidence of cardiac arrest. This study aims to investigate whether hypertension is associated with survival outcomes in cardiac arrest patients across age groups. ⋯ Hypertension does not imply poor survival outcomes independently for all ages, as those over 80 years of age can have rather good neurological outcomes.
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The density ratio of gray matter (GM) to white matter (WM) on brain computed tomography (CT) (gray-to-white matter ratio, GWR) helps predict the prognosis of comatose patients after cardiac arrest. However, Hounsfield units (HU) are not an absolute value and can change based on imaging parameters and CT scanners. We compared the density of brain GM and WM and the GWR by using images scanned with different types of CT machines. ⋯ In this study, the HU values of GM and WM in the normal adult brain differed up to 23% among scanners. Unfortunately, the GWR may not compensate for the HU difference between GM and WM occurring between scanners. Therefore, rather than applying consistent GWR cut-offs, the protocol or manufacturer differences between imaging scanners should be considered.
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Case Reports
Priapism following erector spinae plane block for the treatment of a complex regional pain syndrome.
Erector spinae plane block (ESPB) is a novel block where local anesthetic is deposited between the erector spinae muscle and the underlying transverse process. Safety of this technique is emphasized in the majority of reports, but with a continued increase of its use, the number of related complications and side effects is likely to expand. We report the case of a patient treated with ESPB for a complex regional pain syndrome, complicated by the development of a priapism.
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Observational Study
Benzodiazepines vs barbiturates for alcohol withdrawal: Analysis of 3 different treatment protocols.
Alcohol withdrawal treatment varies widely. Benzodiazepines are the standard of care, with rapid onset and long durations of action. Recent drug shortages involving IV benzodiazepines have required incorporation of alternative agents into treatment protocols. Phenobarbital has similar pharmacokinetics to select benzodiazepines frequently used for alcohol withdrawal. The objective of this study is to describe the effectiveness and safety of our institutional protocols during three time periods utilizing benzodiazepines and barbiturates for the acute treatment of alcohol withdrawal in the emergency department. ⋯ During benzodiazepine shortages, phenobarbital is a safe and effective treatment alternative for alcohol withdrawal. Incorporating phenobarbital into a benzodiazepine based protocol or as sole agent led to similar rates of ICU admission, length of stay, and need for mechanical ventilation in patients treated for alcohol withdrawal in the emergency department.
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Syncope is a common emergency department (ED) chief complaint, with many known but also unknown causes. Here we present a novel ED presentation of a young woman with new-onset hyperthyroidism that masqueraded as a syncopal event with head trauma. ⋯ Persistent tachycardia during her ED course after an unremarkable full trauma evaluation prompted ordering of additional lab testing, which revealed evidence of thyrotoxicosis. Here we consider the possibility of thyroid dysfunction resulting in syncope.