The American journal of emergency medicine
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For reversal of warfarin-induced coagulopathy, FDA labeling of four-factor prothrombin complex concentrate (4F-PCC) endorses a dosing strategy based on body weight and baseline INR. Recent literature suggests lower, fixed doses of 4F-PCC may be equally efficacious. The present evaluation aims to characterize the relationship between 4F-PCC dose and degree of reduction in INR. ⋯ This evaluation found no clinically relevant relationship with 4F-PCC doses and degree of INR reversal. Further prospective study is required to determine optimal dosing schemes of 4F-PCC for warfarin reversal.
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Case Reports
Bilateral tibial tubercle avulsion fractures: A pediatric orthopedic injury at high risk for compartment syndrome.
Adolescent tibial tubercle avulsion fractures represent an uncommon, but clinically significant condition for emergency medicine physicians. Early recognition of the signs and symptoms of this pediatric orthopedic diagnosis are important, as anterior compartment syndrome can occur in up to 10-20% of cases. ⋯ In this article, we present a case with two unique clinical features: bilateral sports related tibial tubercle avulsion fractures and subsequent development of bilateral clinical compartment syndrome. We briefly review the risk factors, presentation, and diagnosis of this rare but clinically important condition.
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Psychogenic fever is a stress-related psychosomatic disease and has been recognized clinically since the early twentieth century. It is common in adolescents or young women with acute or persistent elevation in body temperature. Psychogenic fever can be attenuated by anxiolytic, neuroleptic, or by psychotherapy. ⋯ Psychological stress may present with a range of symptoms, including visual impairment. Physicians should consider the diagnosis of psychogenic fever when patients present with fever of unknown origin and no other abnormal findings.
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Lamotrigine [LTG] is primarily an anti-epileptic drug used to treat seizure disorders, depression, and bipolar disease. It is generally well tolerated with limited side effects reported during routine use. ⋯ Based on pharmacological properties, LTG is a candidate for extracorporeal removal, however, the successful use of HD for the treatment of this poisoning is not well described. We report the case of a 44 year-old female after a LTG overdose that experienced prolonged sedation that was ultimately treated with HD with an excellent response.
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Case Reports
Life-threatening massive empyema: A novel complication of intrathoracic omental herniation.
Intrathoracic omental herniation (ITOH) is the herniation of the omentum through the esophageal hiatus without herniation of the stomach. It is a rare disease and serious complications due to ITOH have not been reported in the literature. Here, we reported the case of 47-year old man who presented to the emergency department with dyspnea and chest pain. ⋯ The patient's vital signs were restored and his symptoms were relieved. He was discharged on hospital day 15 without complications. Emergency physicians should be aware that severe complications of ITOH could develop and that if the patient's symptoms and vital signs worsen, emergency surgery should be considered.