The American journal of emergency medicine
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ST-elevation myocardial infarction (STEMI) is an emergency situation in which immediate measures for myocardial reperfusion are needed. The diagnosis is based on the recognition of ST-segment elevation in the electrocardiogram (ECG). In case of coronary artery occlusion, ST-segment elevation is caused by an injury current from the ischemic myocardium. ⋯ Laboratory tests revealed severe hypocalcemia caused by a deficiency of vitamin D. After calcium replacement therapy, the ECG normalized, and the patient was discharged in good condition. Only a few case reports on hypocalcemia-induced ST-segment elevation exist, and the mechanism remains unknown.
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A clinical feature of bilateral popliteal arterial dissection without involving the descending aorta, bilateral iliac, as well as femoral arteries has never been reported in the past literature. We report a 56-year-old man with hypertension and coronary artery disease who presented to our emergency department with complaints of bilateral knee pain after long-distance walking. Physical examination was notable for elevated blood pressure, but there was no palpable pulsation over dorsalis pedis arteries on his feet. ⋯ Abdominal aorta, bilateral iliac, and femoral arteries remained intact with only arteriosclerotic change. Minimally invasive endovascular stent grafting was then performed. The patient had an uneventful recovery.
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Primary aldosteronism was the most common form of endocrine hypertension resulting in hypertension, metabolic alkalosis, and hypokalemia. Ventricular arrhythmia in association with primary hyperaldosteronism is an uncommon presentation that has previously been described in literature. We presented one case of torsades de pointes due to primary hyperaldosteronism.
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Diabetic ketoacidosis with hypothermia is underrecognized, and the mortality rate is high at between 30% and 60%. The cause of hypothermia in diabetic ketoacidosis patients is speculative and has multiple factors. Insulin deficit is the most important factor that leads to a lack of substrate for cellular heat production. ⋯ Hypothermia may also aggravate uncontrolled diabetes mellitus and complicate treatment because insulin secretion is impaired and exogenous administered insulin is less effective at low temperatures. We present a case, the first in the literature, of severe diabetic ketoacidosis with marked hypothermia and cardiovascular instability that was successfully resuscitated by venoarterial extracorporeal membrane oxygenation support. Based on this report, we suggest that portable venoarterial extracorporeal membrane oxygenation should be considered to treat patients with severe diabetic ketoacidosis and hypothermic cardiocirculatory instability.
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In case of failure of peripheral vascular access, classical alternatives are central venous or intraosseous access. We report a new site of vascular access necessitating no specific material. A 53-year-old patient with cirrhosis-induced coagulopathy, portal hypertension, and collateral abdominal portosystemic circulation required parenteral antibiotherapy. ⋯ After skin preparation, a 20-gauge peripheral venous catheter was inserted in a dilated subcutaneous vein of abdominal wall. To our knowledge, it is the first human report of insertion of a catheter in a superficial vein of abdominal wall. It could be an alternative approach for vascular access after failure of peripheral venipuncture in patients with portal hypertension.