J Emerg Med
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Boerhaave's Syndrome (spontaneous esophageal perforation) is an uncommon clinical entity that frequently presents with an antecedent history of marked vomiting followed by chest or abdominal pain. Misdiagnosis is the most important contributing factor in the continuing high morbidity and mortality of this disease. We report an atypical presentation of Boerhaave's Syndrome in an elderly female who presented to the Emergency Department with dyspnea, right sided chest pain, right pleural effusion, and hypovolemic shock without an identifiable antecedent event. ⋯ Only 36 hours after admission did the diagnosis of Boerhaave's Syndrome become evident. She underwent operative repair and, after a prolonged stay, was discharged in relatively good condition 3 months after her admission. The absence of vomiting prior to presentation and the right sided effusion are the distinguishing features of this particular case.
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This is the thirty-second article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Instruction during rotations in traumatology may be conducted at the bedside in difficult and demanding clinical settings. Yet, residents must not only obtain an essential fund of knowledge, but also become comfortable with a variety of life-saving and diagnostic procedures. It is essential for residents to have specific goals and objectives to guide their acquisition of knowledge and skills required to manage major trauma effectively.
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Review Case Reports
Penetrating injury to the oral cavity: a case report and review of the literature.
Penetrating injury to the oral cavity, although rare, may cause serious morbidity and mortality in the pediatric population. Impalement injuries are known to cause delayed vascular injury to the internal carotid artery, leading to significant neurologic sequelae. We present an unusual case of impalement injury and make recommendations regarding the successful evaluation and management of such injuries.
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Angioedema is a well-known complication of medical therapy with angiotensin-converting enzyme (ACE) inhibitors. Isolated uvular angioedema, a rare presentation of angioedema, in a patient taking lisinopril (Zestril) is described in this case report. Management of uvular edema is also reviewed.
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The continuous measurement of arterial oxygen saturation using pulse oximetry (SpO2) has become popular for critically ill hospitalized patients. Its use in the ambulance transfer of similarly ill patients has been infrequently documented. This study examines the use of prehospital pulse oximetry, with special reference to the ability of ambulance attendants to recognize hypoxemia. ⋯ Hypoxemia, defined as SpO2 of less than 90% for more than 1 minute, was detected in 14 patients. Attendants recognized hypoxemia on clinical grounds in only 4 patients (sensitivity = 28%). Forty-one (82%) patients received various amounts of supplemental oxygen; many patients remained hypoxemic despite therapy.(ABSTRACT TRUNCATED AT 250 WORDS)