The American journal of emergency medicine
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We describe the case of a 75-year-old man affected by a chronic obstructive pulmonary disease and chronic renal failure admitted to our emergency department for dyspnea and interscapular stabbing pain. Chest radiography showed diffuse parenchymal consolidation in the lower right lung with bronchiectasis, but the treatment for infection disease did not improve the clinical conditions of the patient. ⋯ Because the presence of chronic renal failure limited the execution of a helical computed tomographic pulmonary angiography, a pulmonary scintigraphy was performed confirming the diagnosis of pulmonary embolism. Our case suggested that chest ultrasonography can be a valuable tool for early detection of pulmonary embolism and to establish immediately an appropriate therapy.
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Laryngopyocoeles are rare entities that present as airway obstruction or as neck masses. We present a unique case of a laryngopyocoele in a young patient with a sore throat. A 22-year-old man presented to the emergency department with a sore throat of 1-week duration. ⋯ The patient was admitted to the intensive care unit for airway monitoring and treated conservatively with intravenous antibiotics. The collection did not resolve by day 4, and the patient was taken to the operating room for incision and drainage of the laryngopyocoele. The patient made an uneventful recovery.
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Case Reports
Recurrent vasodilator-refractory acute coronary syndrome as the exclusive manifestation of Graves disease.
Whether recurrent acute coronary syndrome could be the exclusive manifestation of Graves disease remains unreported. We describe a premenopausal woman who had angiographically normal coronary arteries yet had 3 episodes of acute coronary events in forms of unstable angina, ST elevation, and non-ST elevation myocardial infarction despite the active therapy of calcium-channel blockade. She was finally diagnosed as with Graves disease, treated with antithyroid medication, and free from any angina relapse for up to 18 months. Thus, recurrent coronary events might be the only manifestation of subclinical hyperthyroidism in patients with angiographically normal coronary arteries and could only be prevented by antithyroid agents instead of conventional vasodilators.
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The aims of this study are to determine the electrocardiographic (ECG) manifestations of the symptomatic patients with isolated tramadol toxicity and to predict seizures based on ECG parameters. ⋯ Tramadol toxicity shows ECG changes consistent with sodium channel blockade and potassium channel blockage effects. The risk of development of seizures cannot be predicted based on the changes of ECG parameters at presentation.
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ST elevation is usually treated in cardiac catheterization laboratory with an aim for myocardial salvage by restoration of adequate coronary blood flow enhancing both early and long-term survival. Maximum benefit is achieved if therapy is initiated in the first hour after treatment onset, thus ushering the concept of door-to-balloon time. We present an interesting case of a patient whose ST elevation resolved after bronchoscopy for a lung whiteout.