The American journal of emergency medicine
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Case Reports
Iatrogenic STEMI in a male trauma patient due to coronary artery compression by a left sided chest tube.
Iatrogenic ST segment elevation myocardial infarction (STEMI) after insertion of a left sided thoracic tube is a rare insertional complication. We present a case of coronary artery compression of the left anterior descending artery (LAD) caused by a left sided chest tube placed after blunt thoracic trauma with pneumothorax resulting in a STEMI. A 53-year-old male patient with severe blunt thoracic trauma presented in the emergency department. ⋯ Complications after chest tube insertion can occur in up to 30 % of patients. However, no similar case with iatrogenic ST segment elevation myocardial infarction due to compression of a coronary artery has been reported in the literature so far. Knowledge of the possible complications of an intervention is important and a 'high level of suspicion' is required in order to recognize and resolve them quickly.
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Use of opioids for treatment of headache in the emergency department (ED) is associated with an increased 1-year risk of opioid-related adverse events. ⋯ Opioid prescriptions are associated with ED revisits, hospitalizations and LTU in headache patients, without improved efficacy. These findings support the growing notion that opioids are not indicated for ED headache management.
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In this study, we aimed to explore the association between the choice of empirical antibiotic therapy and outcomes in ED patients with sepsis. ⋯ Empirical combination antibiotic therapy was not associated with reduced mortality in ED patients with sepsis. Compared with cephalosporins, penicillins and vancomycin, quinolone mono-antibiotic therapy was significantly associated with a decreased risk of in-hospital mortality, especially in patients with respiratory tract infections.
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Diagnosis of cryptococcal meningitis is typically aided through CSF analysis obtained via lumbar puncture (LP), revealing elevated WBCs, increased protein, decreased glucose, and increased opening pressure. While CSF culture confirms the diagnosis, it takes days, prompting reliance on these adjuncts. AIDS from Human Immunodeficiency Virus is less commonly diagnosed in the emergency setting due to advances in testing and treatment. ⋯ This case underscores that C. neoformans can present with normal CSF studies, delaying diagnosis and treatment, highlighted by the fact that this patient went undiagnosed in the preceding 3.5 weeks. CSF cryptococcal antigen and opening pressure are critical diagnostic tools, enabling timely antifungal therapy. Given the high mortality rate, early empirical treatment is essential, especially in high-risk patients, even when CSF findings seem normal.