The American journal of emergency medicine
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Computed tomography (CT) has been used in diagnosing acute appendicitis since late 1990s. Appropriate use of CT has not been studied prospectively in patients with suspected acute appendicitis and relative low Alvarado score. ⋯ Computed tomography scan is necessary for patients with relatively low Alvarado score when leukocytosis is noted. In female patients without leukocytosis, further large-scale prospective studies are necessary to change the current diagnostic strategy.
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Acute carbamate intoxication can cause cardiac manifestations. We present the case of a 53-year-old man who had been a heavy smoker, admitted to our hospital for recent anterior wall myocardial infarction complicated with congestive heart failure. Percutaneous transluminal coronary angioplasty with stent implantation, coronary artery bypass graft, and mitral annuloplasty were performed, but refractory heart failure and ventricular arrhythmia were still noted. ⋯ The donor was a 50-year-old man who had died of brain death due to carbamate intoxication, and the crossmatch before transplantation was negative. The recipient died 24 hours after the operation due to acute left ventricular dysfunction. This report reviews the cardiac manifestations of acute carbamate intoxication and the possibility of heart transplantations from donors who died of carbamate intoxication.
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Aortic intramural hematoma is a contained aortic wall hematoma without a demonstrable intimal flap. It is similar to aortic dissection, but the pathology and pathophysiology are different. We report a patient with a chronic descending thoracic aortic intramural hematoma presenting with acute rupture and periaortic hematoma along with concomitant acute ST-elevation myocardial infarction that proved to be catastrophic without intervention. We discuss the diagnostic and therapeutic dilemma.
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Gastrostomy tube (g-tube) dislodgement is a common problem in special needs children. There are no studies on the frequency of complications after g-tube replacement for children in a pediatric emergency department (ED). ⋯ For children undergoing g-tube replacement in a pediatric ED, misplacement and associated complications were rare. Confirmatory imaging was associated with a considerably longer LOS. In the presence of clinical confirmation, confirmatory imaging may be judiciously used.
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Human serum albumin (HSA) is used as a plasma expander; however, albumin is readily eliminated from the intravascular space. The objective of this study was to establish the effects of various-sized polymerized HSAs (PolyHSAs) during small-volume resuscitation from hemorrhagic shock on systemic parameters, microvascular hemodynamics, and functional capillary density in the hamster window chamber model. Polymerized HSA size was controlled by varying the cross-link density (ie, molar ratio of glutaraldehyde to HSA). ⋯ Pharmacokinetic analysis of PolyHSA(60:1) indicates reduced clearance and increased circulatory half-life compared with monomeric HSA and other PolyHSA formulations. In conclusion, HSA molecular size and solution viscosity affect central hemodynamics, microvascular blood flow, volume expansion, and circulation persistence during small-volume resuscitation from hemorrhagic shock. In addition, PolyHSA can be an alternative to HSA in pathophysiological situations with compromised vascular permeability.