The American journal of emergency medicine
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Skin and soft tissue infections, such as cellulitis, are commonly diagnosed in the emergency department and these patients are often admitted to the hospital for intravenous antibiotic therapy. Oritavancin is a novel antibiotic approved for the treatment of skin and soft tissue infections that is administered as a one-time infusion. While oritavancin has demonstrated comparable efficacy with multi-dose parenteral antibiotics in clinical trials and has been proposed as an alternative to admission for emergency department patients, there is a paucity of available real world effectiveness data. In this case series, we describe the characteristics and outcomes of ten patients with high-risk skin and soft tissue infections who received oritavancin and were discharged from the emergency department.
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Case Reports
Malperfusion-associated transient monoplegia as an initial manifestation of aortic dissection.
Acute aortic dissection (AD) is a life-threatening emergency. The most common symptom of AD is chest pain, more frequently associated with Type-A AD per the Stanford classification, while Type-B AD is associated with back and abdominal pain. Conversely, monoplegia is an uncommon symptom of AD. ⋯ Monoplegia in type-B AD can develop due to spinal-cord or lumbosacral-plexus ischemia. Malperfusion, determined by the balance of the pressure in the false and true lumens and subsequent end-organ ischemia, may produce transient or persistent symptom patterns. Emergency physicians need to suspect AD when a patient presents with monoplegia or transient symptom patterns of unknown etiology.
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Case Reports
A case of extrapleural hematoma that was not detectable on initial CT in a patient with pneumonia.
Extrapleural hematoma (EH) is an uncommon and occasionally life-threatening condition. Huge EH can cause potentially fatal respiratory and circulatory disturbances. The usual causes of EH are chest trauma, iatrogenic injury, and rupture of a thoracic aortic aneurysm. ⋯ The pathophysiology of the relationship between pneumonia and EH is unclear. This case suggests that EH cannot be ruled out by initial CT findings soon after an episode suggestive of hemorrhage and can occur as a complication of pneumonia. Therefore, patients in whom EH is suspected should be followed up closely.
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The reduction in patients presenting with ST-elevation myocardial infarction (STEMI) during the COVID19 crisis could have resulted from fears about developing COVID-19 infection in hospital. Patients who delay presenting with STEMI are more likely to develop mechanical complications, including acute ischemic mitral regurgitation (MR). ⋯ Early identification of this mechanical complication using transthoracic echocardiography in the Emergency Department enabled the team to target her optimisation. Ultimately these patients require urgent surgery to repair the mitral valve and revascularize the myocardium but they are often too unwell to undergo surgery and even when it is feasible the outcomes are poor.