The American journal of emergency medicine
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Situs inversus with dextrocardia is both a clinical and diagnostic challenge for emergency physicians to properly identify acute coronary syndrome. While dextrocardia itself does not independently increase the risk of coronary artery disease, mirrored symptoms, including right-sided and rightward radiating chest pain in any patient with cardiac risk factors should raise suspicion for acute coronary syndrome. ⋯ The authors present a case of a 66-year-old man with dextrocardia who presented with shortness of breath and hypotension. Rapid application of a reversed electrocardiogram resulted in the timely diagnosis of ST-segment elevation myocardial infarction and activation of the cardiac catheterization laboratory resulting in the preservation of this patient's life.
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Observational Study
Efficacy and safety of corticosteroids for septic shock in immunocompromised patients: A cohort study from MIMIC.
Corticosteroids have been widely used as adjunct therapy for septic shock for many decades, but both the efficacy and safety remain unclear. The study was designed to investigate overall benefits and potential risks of corticosteroids in immunocompromised patients with septic shock. ⋯ Corticosteroids therapy for the maintenance of blood pressure was not associated with improved mortality or hemodynamic stability in overall immunocompromised population with septic shock. Future randomized clinical trials are required to validate the effects of corticosteroids for septic shock in the special immunocompromised population.
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Case Reports
Usage of airway ultrasound as an assessment and prediction tool of a difficult airway management.
Airway assessment is important in emergency airway management. A difficult airway can lead to life-threatening complications. A perfect airway assessment tool does not exist and unanticipated difficulty will remain unforeseen. ⋯ Ultrasound predictors of the difficult airway include the inability to visualize the hyoid bone, short hyomental distance ratio, high pretracheal anterior neck thickness and large tongue size. Besides airway assessment, ultrasound can also help to predict endotracheal tube size, confirm intubation and guide emergency airway procedures such as cricothyroidotomy and tracheostomy. Point of care ultrasound of the upper airway can be used in airway assessment to identify distorted airway anatomy, pathological lesions and guide treatment decisions.
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A mycotic aneurysm is a life-threatening disease that usually presents with nonspecific symptoms. A prompt diagnosis is essential because of the risk of aneurysm rupture and high mortality rate. We describe a case of an abdominal mycotic aortic aneurysm presenting as chronic constipation for 3 weeks, without fever or abdominal pain. Point-of-care ultrasound has the ability to detect silent abdominal aortic aneurysms and serves as a follow-up tool for patients under medical treatment.