European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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In accidental hypothermia, normal signs of death are unreliable. It is generally accepted that a lifeless person is beyond the limits of rescue if plasma potassium (P-potassium) is higher than10 mmol/l. However, the rate of increase in potassium or in other markers after cardiac arrest has not been carefully studied in hypothermic individuals. The aim of this animal study was to assess biochemical changes after anoxic circulatory arrest at hypothermia and at normothermia followed by external cooling. ⋯ This study shows that if cardiac arrest occurs before hypothermia is established, P-potassium increases quickly in contrast to the situation when hypothermia induces cardiac arrest. Thus, a low P-potassium in a hypothermic individual with cardiac arrest indicates that cardiac arrest occurred recently or was secondary to the hypothermic event.
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Brugada syndrome is a well-defined clinical entity with the typical electrocardiographic changes in the right precordial leads (V1 and V2), attributed to mutation in SCN5A gene. Brugada-like electrocardiographic pattern can be replicated by sodium channel-blocking drugs and electrolyte abnormalities. ⋯ The electrocardiogram changes disappeared after sodium bicarbonate administration and normalization of serum potassium. The case highlights the importance of recognizing cocaine and hyperkalemia, as potential triggers of the acquired Brugada sign.
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During the last few years, a growing number of studies have shown the accuracy of lung ultrasound in the diagnosis of pulmonary diseases. The latest developments in lung ultrasound are not because of technological advance, but are based on new applications and discovering the meanings of sonographic artifacts. ⋯ The bedside sonographic recognition of pulmonary diseases practically guides management and reduces the amount of negative radiologic image testings. This review describes some innovative practical applications of B-mode lung ultrasound in the diagnosis of alveolar consolidations and interstitial syndrome in the emergency department.
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Takotsubo cardiomyopathy consists of cardiomyopathy with transient apical ballooning and left ventricular systolic dysfunction in the absence of atheromatous disease of the coronary arteries, accompanied by ECG changes together with elevated cardiac enzymes appearing in a context of emotional or physical stress. A 51-year-old woman was referred to our emergency department for treatment after chest pain associated with acute dyspnoea during diving. On questioning, the patient confirmed that she had twice dived to 35 m without any missed decompression stops and informed us that she had experienced tightening of the chest followed by sudden dyspnoea during her second ascent in a setting of marked emotional stress since the previous evening. ⋯ Coronary angiography revealed healthy coronary arteries. In conclusion, diagnosis of takotsubo cardiomyopathy is based on the guidelines issued at a consensus conference of the Idiopathic Cardiomyopathy Research Committee. This case shows the possibility of this syndrome occurring while diving.
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Comparative Study
Are emergency department visits really a teachable moment? Smoking cessation promotion in emergency department.
To compare the effectiveness of smoking cessation counseling in the emergency department (ED) versus in outpatient clinics (OCs) setting. ⋯ ED-based counseling for smoking cessation was as effective as that performed in the OC setting. Referral of smokers from the ED to a smoking cessation program was unsuccessful in our patient population.