The American journal of emergency medicine
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Case Reports
Epinephrine-induced myocardial infarction in severe anaphylaxis: is nonselective β-blockade a contributory factor?
Epinephrine-induced myocardial ischemia in the setting of anaphylaxis is a rare event and is postulated to be due to coronary artery spasm. We report the case of a 43-year-old woman who presented to the emergency department with an anaphylactic reaction triggered by flucloxacillin. ⋯ Subsequent coronary angiography demonstrated normal coronary arteries. In this case report, we discuss the potential role of prior nonselective β-blockade with propranolol in predisposing such patients to ischemic cardiac events following treatment with epinephrine.
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Acute aortic syndrome is a spectrum of diseases that have similar presentation and clinical background and include aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Presented here is an 82-year-old woman with a medical history of diabetes, hypertension, nephrectomy, and chronic renal failure who complained of sudden abdominal pain radiating to epigastrium and back. ⋯ Computed tomography demonstrated an aortic penetrating atherosclerotic ulcer that ruptured into the right pleural space resulting in right hemothorax. A percutaneous endostent was placed with subsequent discharge of the patient 10 days after admission.
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This study aims to determine the source of communication gaps in history of present illness (HPI), medical history, and advanced directives in nursing home (NH) patients transferred to the emergency department (ED). We also attempt to determine if these gaps create differences in patient turnaround time (TAT), disposition decision, or diagnostic testing. ⋯ Emergency department physicians often do not have adequate HPI in patients transferred from NHs. The absence of adequate information does not affect patient TAT, disposition decision, or ED diagnostic testing.
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The link between minor troponin (cardiac troponin I [cTnI]) elevations and atrial fibrillation (AF) is still debated. ⋯ In patients with acute AF, minor cTnI elevations link to short-term adverse events. Known ischemic vascular disease and older age showed prognostic value only in the long term.
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Letter Comparative Study Clinical Trial
Adult intraosseous use in academic EDs and simulated comparison of emergent vascular access techniques.