The American journal of emergency medicine
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Zinc phosphide is a highly toxic rodenticide that reacts with hydrochloric acid in the stomach to form phosphine gas. Ingestion of zinc phosphide can result in consequential toxicity even when ingested in small quantities. Clear guidelines are lacking on appropriate personal protective equipment for providers to avoid additional exposure. ⋯ Clinicians should be aware of the potential clinical ramifications to patients who ingest zinc phosphide and the potential risks of caring for such patients. To prevent additional exposure, providers should don appropriate personal protective equipment and contact HAZMAT (or local health department) to safely remove additional zinc phosphide.
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Acute headache is a common emergency department (ED) chief complaint that usually has a benign course. Rare etiologies such as subarachnoid hemorrhage (SAH) can lead to extensive disability or even death. If suspected, SAH requires an intricate and intensive diagnostic investigation. ⋯ However, 3 days later upon re-presentation to the ED with the same symptoms, an LP was positive for increasing red blood cell count in subsequent tubes. She was transferred to a facility with interventional neurology capabilities where digital subtraction angiography showed a left anterior choroidal saccular aneurysm for which she underwent coiling. Given recent changes in SAH clinical practice guidelines, this case highlights the importance of understanding the current limitations of CT imaging, understanding the risks and benefits of both CT and LP, and always maintaining a high suspicion for especially lethal and disabling conditions such as SAH.
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Flexible bronchoscopy has been safely used for decades in ambulatory and critical care settings to aid in the diagnosis and treatment of tracheobronchial tree disorders. Although emergency physicians have the requisite skills to operate and interpret flexible bronchoscopy, no reports exist on the use of bronchoscopy by emergency physicians apart from endotracheal tube placement and confirmation. ⋯ At our institution, emergency physicians can safely and effectively use flexible bronchoscopy to diagnose and treat critically ill patients.
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Observational Study
Therapeutic anticoagulation using heparin in early phase severe coronavirus disease 2019: A retrospective study.
Although several reports recommend the use of systemic anticoagulation therapy in patients with severe coronavirus disease 2019 (COVID-19) pneumonia, appropriate target population and timing of administration are unknown. We assessed association between therapeutic anticoagulation administration with unfractionated heparin and outcomes in patients with severe COVID-19 pneumonia, assuming that anticoagulant administration effects are influenced by therapy timing. ⋯ Late administration of therapeutic-dose anticoagulation in patients with severe COVID-19 pneumonia was significantly associated with worse outcomes than early administration.
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Acute head and neck cancer (HNC) bleeding is a life-threatening situation that frequently presents to the emergency department (ED). The purpose of the present study was to analyze the risk factors for the 30-day mortality in patients with HNC bleeding. ⋯ The results of this study may aid physicians in the evaluation of short-term survival in HNC bleeding patients and provide critical information for risk stratification and medical decisions.