The American journal of emergency medicine
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Multicenter Study Comparative Study
Comparison of phenobarbital-adjunct versus benzodiazepine-only approach for alcohol withdrawal syndrome in the emergency department.
To compare a phenobarbital-adjunct versus benzodiazepine-only approach for the management of alcohol withdrawal syndrome in the emergency department (ED) with regard to the need for intensive care unit (ICU) admission, severity of symptoms on ED discharge, and complications. ⋯ Adjunctive phenobarbital use in the ED for alcohol withdrawal syndrome did not result in decreased ICU admission, severity of symptoms, or complications.
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The aim of this study is to compare the radiologic diagnostic performance of arterial phase, portal phase and combined phase computed tomography (CT) for traumatic abdominal injury. In addition, this study is attempted to decrease lifetime attributable risks (LARs) of cancer due to radiation exposure by using optimal CT protocol. ⋯ Single phase CT could be a potential protocol for abdominal trauma patients. Use of single phase CT could significantly decrease the incidence of radiation-associated cancer in the future.
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Case Reports
Anomalous left anterior descending artery diagnosed on pulmonary artery computed tomography.
Typically, the left anterior descending artery (LAD) and left circumflex artery (LCX) arise from the left main coronary artery. However, uncommon coronary anomalies may be found in clinical practice. This case presents with a rare finding where the LAD originates from the right coronary artery (RCA) separately from the LCX and takes an interarterial pathway to reach its perfusion territory. ⋯ However, it is important to realize the different pathways of coronary artery anomalies because those with the inter-arterial subtype, such as our patient, may result in sudden cardiac death. All cases of clinically suspected inter-arterial coronary artery anomalies are recommended to undergo imaging studies to help visualize anatomic features as a guide for further management. This case represents the first reported diagnosis of this type of anomalous coronary artery on CTPA.
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Hiccups are usually benign, while myocardial infarction (MI) has the potential for morbidity and mortality. Here, we report 3 cases of MI, with hiccups being the only symptom on presentation to the emergency department. Attention should be given to patients who present with hiccups and multiple risk factors for acute coronary syndrome, especially those with factors predisposing them to atypical presentations, such as diabetes mellitus, and old age.
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Letter Case Reports
Kasabach-Merritt syndrome arising from a vascular fistula.
A 58-year-old woman presented with gum bleeding, hematuria, and cutaneous ecchymoses. Left hip replacement had been performed five years prior. The overall findings of our work-up were consistent with ongoing DIC triggered by the presence of an arterio-venous left femoral fistula. ⋯ Mortality rate can be as high as up to 40%. The Kasabach-Merritt syndrome could represent the only clinical feature of an otherwise occult vascular fistula. Emergency physicians should be aware of this condition.