The American journal of emergency medicine
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Vibrio vulnificus typically causes septicemia and necrotic wound infection. Among V vulnificus–related complications, acute nonthrombotic myocardial damage has not been reported. The most effective antibiotic treatment of V vulnificus infection includes combination of a third-generation cephalosporin and a tetracycline or its analogue. ⋯ A 67-year-old diabetic man acquired V vulnificus infection via a fish-stunning wound on the right foot. The patients developed septicemia and hemorrhagic bullous necrotic wounds and followed by acute nonthrombotic cardiac injury with low cardiac output. After initial resuscitation, we applied dobutamine inotropic therapy with combination of cefpirome and ciprofloxacin or minocycline, which achieved a good clinical outcome.
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Botulinum toxin (Botox) injection into the lower esophageal sphincter (LES) has been used for the treatment of achlasia cardia since the 1990s. Currently it is indicated for patients who are not candidates for definitive therapy like Heller's myotomy or pneumatic dilation and in those who have recurrence of symptoms after definitive treatments. ⋯ The purpose of this case is to highlight one of the under-reported adverse effects of Botox. Anaphylactic reactions to Botox are very rare with only one other case being reported and have not been emphasized enough to be widely known in clinical practice.
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Shared decision making (SDM) is a process whereby patients and clinicians work together to make informed medical decisions that incorporate patient values. Recent data suggest that, for patients with low pretest probability of pulmonary embolism (PE), doubling the standard d-dimer cutoff may reduce the need for imaging with minimal increase in missed PE diagnoses. We used an SDM approach to determine patient preferences regarding this diagnostic approach. ⋯ When presented with a hypothetical scenario, more than one-third of patients deferred imaging for PE based on low clinical probability and a d-dimer less than twice the normal threshold. An SDM approach is acceptable to patients and may decrease imaging for PE.
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Clinical Trial
Electromyography activity of selected trunk muscles during cardiopulmonary resuscitation.
Understanding trunk muscle activity during chest compression may improve cardiopulmonary resuscitation (CPR) training strategies of CPR or prevent low back pain. This study investigates the trunk muscle activity pattern of chest compression in health care providers to determine the pattern alternation during chest compression. ⋯ We suggest that the muscle power training for the pectoralis major, erector spinae, and rectus abdominis could be helpful for health care providers. Keeping muscle activity balance of bilateral gluteus maximus and maintaining the same level of EMG ratios might be the keys to prevent low back pain while performing CPR.
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The purposes of the study are to investigate the renal function in ventricular fibrillation (VF) and asphyxiation cardiac arrest in a swine model and to estimate the value of novel biomarkers in the acute kidney injury (AKI) after cardiac arrest. ⋯ Acute kidney injury at early stage of postresuscitation is common in different causes of cardiac arrest. Asphyxiation has more severe kidney injury and gets worse prognosis.