The American journal of emergency medicine
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Our objective was to determine if implementing a standard lights and sirens (L&S) protocol would reduce their use and if this had any effect on patient disposition. ⋯ Our protocol significantly reduced the use of L&S. Judicious use of L&S has significant implications for transport safety. By allowing for selective transport with L&S usage, we observed no impact in patient disposition.
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Case Reports
Acute myocardial infarction in a 56-year-old female patient treated with sulfasalazine.
Drug rash, eosinophilia, and systemic symptoms (DRESS) syndrome represents one pattern of the cutaneous involvement in type IV hypersensitivity reaction to drugs. It is a severe, delayed, idiosyncratic reaction presented as rash with fever, lymphadenopathy, and visceral involvement. There are several reported cases of sulfasalazine-induced DRESS syndrome, but myocardial involvement was rare. ⋯ We report a case of a 56-year-old woman treated with sulfasalazine for ankylosing spondylitis for 3 weeks, which was discontinued after development of DRESS syndrome. Despite treating her with high dose of steroid and cyclosporine, her symptoms persisted, and ultimately, she developed toxic myocarditis with a misleading presentation of acute ST-elevated myocardial infarction. The diagnosis was made based on postmortem histopathologic finding.
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We report a case of a healthy leisure diver presenting with simultaneous unilateral posterior vitreous detachment and decompression illness. The literature is reviewed for both conditions. There are no known publications associating these 2 entities and leads us to propose that nitrogen bubble formation could have contributed to the etiology of vitreal separation from the retina.
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Letter Multicenter Study
Hematogenous septic arthritis of the hip in adult patients.
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Aortic arch aneurysm occurs more commonly in the aging population. Rapid expansion and symptomatic patients should undergo aneurysm resection regardless of size. An 87-year-old man was brought to our emergency department because of choking on food during his dinner. ⋯ Swallowing is complex neuromuscular activity consisting essentially of 3 phases: oral, pharyngeal, and esophageal. The pharyngeal phase was mainly mediated by the pharyngeal plexuses of both the glossopharyngeal and vagus nerves. Uncoordinated movement of the pharyngeal muscles because of a stretch of the left vagus nerve or its plexus by an enlarging aneurysm may be the possible mechanism of choking in this patient.