The American journal of emergency medicine
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Case Reports
Reduced pain perception in patients with schizophrenia; A missed case of hand fracture.
Altered pain perception among patients with schizophrenia is often underrecognized in the medical community. The cause is not known, and medical professionals are not sure whether these patients experience less pain or are simply unable to express it. ⋯ We report a case of a patient with schizophrenia who presented voluntarily to the emergency department (ED) with a hand fracture that went unrecognized in the ED and further discuss the implications of reduced pain perception. Additionally, we summarize existing hypotheses regarding the source of this reduced pain perception in this population.
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Angiotensin converting enzyme inhibitor-induced angioedema is typically easily recognizable in the emergency department. Angioedema lateralizing to one side, however, is infrequently reported, rare, and has the same potential of progression to airway compromise. We present of a case of an 80-year-old man with angioedema of the lower lip that had regressed prior to significant progression of right sided angioedema of the tongue and oropharynx.
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Case Reports
Chronic myeloid leukemia presenting as compartment syndrome with acute loss of upper limb function.
Hematological malignancies rarely present with spontaneous haematomas (Lakhotia et al., 2015 [1]). Although cutaneous and mucous membrane bleeds do occur in chronic myeloid leukemia (CML) due to quantitative or qualitative platelet abnormalities, deep soft tissue bleeds are rare (Lakhotia et al., 2015 [1]). We report the case of a 49 year old man presenting with an acute hematoma of the left biceps brachii causing compartment syndrome of his left upper limb leading to flaccid paralysis. He underwent surgical evacuation of the hematoma and investigations revealed that he had CML with leukemic infiltration in the biceps brachii.
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Multicenter Study Observational Study
Fixed-dose prothrombin complex concentrate for emergent warfarin reversal among patients with intracranial hemorrhage.
Four-factor prothrombin complex concentrate (4PCC) is the preferred reversal agent for warfarin reversal, although the ideal dose is unknown. Fixed-dose 4PCC offers simplified dosing compared to standard-dosing algorithms with potentially lower risks of thromboembolic complications given lower doses are typically utilized. ⋯ A fixed-dose 4PCC regimen of 2000 units among patients with ICH was as effective as standard-dose 4PCC for INR reversal among patients with ICH. However, fixed-doses of 2000 units at times exceeded standard 4PCC doses which may be contradictory to the goals of fixed-dose 4PCC for warfarin reversal.