The American journal of emergency medicine
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Case Reports
Point of care ultrasound needle guidance to assist diagnosis of acute gluteal compartment syndrome.
Gluteal compartments can be difficult to assess for acute compartment syndrome (ACS) compared to other fascial compartments due to their anatomy and rarity of presentation. Point-of-care ultrasound (POCUS) needle guidance may assist in obtaining accurate compartment pressure measurements within the gluteal compartments. We present a case in which a 69-year-old woman presented following a fall resulting in a superior prosthetic hip dislocation. ⋯ The patient was subsequently taken for emergent fasciotomy and hematoma evacuation. There has been limited investigation into compartment pressure measurement under US guidance versus a palpation/landmark-guided technique. This case shows the feasibility of US needle guidance when assessing compartment pressures for this uncommon diagnosis.
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Out-of-hospital cardiac arrest (OHCA) is a leading cause of death, and research has identified limitations in analyzing the factors related to the incidence of cardiac arrest and the frequency of bystander cardiopulmonary resuscitation. This study conducts a cluster analysis of the correlation between location-related factors and the outcome of patients with OHCA using two machine learning methods: variational autoencoder (VAE) and the Dirichlet process mixture model (DPMM). ⋯ This methodology can facilitate the development of a regionalization strategy that can improve the survival rate of cardiac arrest patients in different regions.
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This study described characteristics of wounds caused by animal exposures and evaluated patient factors and wound factors associated with wound infiltration of human rabies immune globulin (HRIG). ⋯ Upon presentation for rabies PEP, most patients did not have severe wounds and did not require emergency services or complex wound management. Wounds on the face, head, torso, hands, or fingers and abrasions were less likely to receive HRIG infiltration.
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Case Reports
Don't go barking up the wrong tree: Thinking beyond infection in a toddler with stridor.
A toddler presented to the emergency department with persistent stridor and barky cough for 4 weeks and progressive dysphagia for 1 week. During this time, he had sought medical attention 6 additional times and had been treated for pneumonia, wheezing and croup, receiving antibiotics and several courses of steroids without improvement. ⋯ However, bedside laryngoscopy demonstrated bilateral vocal cord paralysis. Further imaging revealed an intracranial posterior fossa mass which provided the unifying diagnosis for his persistent symptoms.
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The effectiveness of advanced airway management (AAM) for out-of-hospital cardiac arrest (OHCA) has been reported differently in each region; however, no study has accounted for the regional differences in the association between the timing of AAM implementation and neurological outcomes. ⋯ A delay in AAM performance was negatively associated with CPC 1-2 in both shockable and non-shockable cohorts. Moreover, a delay in AAM performance at the prefecture level was negatively associated with CPC 1-2 in the non-shockable cohort.