The American journal of emergency medicine
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Compartment syndrome (CS) is a condition associated with intra-compartment pressures exceeding the perfusion pressure of the tissue. This condition can occur in any body compartment surrounded by fascia, however CS of some regions like the thenar and hypothenar is extremely rare. Acute CS is often caused by major trauma and idiopathic acute CS is sparsely reported in literature. ⋯ We hypothesized several causes for the etiology of the condition (e.g. rhabdomyolysis, rheumatologic disease-related condition, other systemic diseases, trauma, infection), but all could be rejected based on laboratory or clinical findings. Remarkable is that the patient experienced a comparable episode in his other hand two years earlier. Although the acute CS is of unknown origin in the presented case, the development of acute CS in both hands over time suggests a predisposing factor in idiopathic acute CS that is far from being elucidated.
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Cardiac cephalalgia is an uncommon symptom occurring in coronary artery disease. It is difficult to identify cardiac cephalalgia and link it to coronary artery disease because these patients present with only a headache and no typical symptoms of angina, such as chest pain, radiating pain, or chest tightness. Currently, the diagnostic value of cardiac cephalalgia in acute myocardial infarction is still under debate. ⋯ Passage of the guide wire and radiocontrast agent increased the intensity of the headache, which disappeared once the right coronary artery was opened. As of one month into follow-up, the headache had not recurred. These observations strongly indicate a close association between cardiac cephalalgia and acute myocardial infarction, and they could help diagnose acute myocardial infarction related to headaches.
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Early antibiotics are fundamental to sepsis management. Second-dose antibiotic delays were associated with increased mortality in a recent study. Study objectives include: 1) determine factors associated with delays in second-dose antibiotic administration; 2) evaluate if delays influence clinical outcomes. ⋯ Factors associated with delayed second-dose antibiotics include ED boarding, antibiotics requiring more frequent dosing, receiving 30 mL/kg fluid, and renal failure. Delays in second-dose administration were not associated with mortality or other outcomes.
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Epistaxis is a routine complaint in Emergency Medicine and presents most commonly in adults and children and its incidence increases with age. It is rare in infants and neonates. ⋯ The patient was stabilized using topical tranexamic acid, nasal packing with ketamine sedation, and sent to a tertiary care center for definitive management. He required advanced airway management in the OR for definitive airway management for airway-obstructing hemangioma excision.
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To determine the rate at which commercially-insured patients fill prescriptions for naloxone after an opioid-related ED encounter as well as patient characteristics associated with obtaining naloxone. ⋯ Few patients use insurance to obtain naloxone by prescription following opioid-related ED encounters. Clinical and policy interventions should expand distribution of this life-saving medication in the ED.