European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Case Reports
Frightening dreams and spells: a case of ventricular asystole from Lyme disease.
We present a case of a 20-year-old woman who presented with a febrile illness, frightening dreams and repeated short episodes of apparent seizure activity. Third degree heart block and ventricular asystole were noted on the monitor when the patient experienced a spell during conscious sedation for a lumbar puncture. ⋯ Lyme titres were strongly positive and subsequently confirmed by Western Blot analysis. Cardiac aetiologies and specifically heart block associated with Lyme disease should be considered in patients from endemic areas presenting with fever and unexplained spells or seizure-like activity.
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The diagnosis of elder abuse and neglect is difficult to accomplish, making intervention elusive, primarily because to date there is no set definition of either abuse or neglect. This paper, written primarily from the American viewpoint, addresses definitions; assessment and diagnosis; aetiology of abuse; intervention; prevention and management; ethical and legal considerations; elder abuse and the emergency physician; and future goals.
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Contention over fluid resuscitation is not new. The issues however have changed considerably. The crystalloid/colloid debate has largely reached a stalemate with little to define clear differences between the two especially early in traumatic shock when increased capillary permeability is a minor issue. ⋯ Fluid resuscitation has necessarily become more complex as the potential to do harm has been more clearly demonstrated. The use of resuscitation fluids must now receive as much care and consideration as is currently given to the prescription of potent drugs, weighing the potential benefits of a course of action against its possible side effects. Much research is required to clarify and refine the data on fluid resuscitation but there is little doubt that the conceptual changes which underlie this work on haemorrhagic shock offer the most exciting advances in fluid resuscitation seen in the past 30 years.
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Review Case Reports
Fatal Streptococcus viridans descending mediastinitis: case report and review of the literature.
Mediastinitis is a life-threatening complication of cardiac, neck and oesophageal surgery. It has also been reported following upper digestive and respiratory procedures and as a consequence of oesophageal perforation following the ingestion of foreign bodies. ⋯ We describe the case of a patient with fatal mediastinitis and septic shock. The onset of mediastinitis was preceded by a 2-day course of sore throat and other flu-like symptoms.