J Emerg Med
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We report two patients who presented to the emergency department with pneumothorax related to acupuncture. The first patient developed pleuritic chest pain and shortness of breath while undergoing acupuncture therapy, and the second patient developed similar symptoms 10 min after acupuncture therapy. Neither patient had a previous history of pneumothorax, and both were undergoing acupuncture along the spine, paraspinal region, and shoulders. A review of the literature follows.
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Medical emergencies may arise on board commercial airlines. Although infrequent, such events annually affect a substantial number of air travelers. ⋯ This article examines the incidence of in-flight emergencies, surveys the onboard medical kit, and explores various in-flight medical problems and treatments. It concludes with a discussion of various methods of prevention.
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Review Case Reports
Hematoma of the rectus abdominis muscle: case report and review of the literature.
Hematoma of the rectus abdominis muscle, although a well-described clinical entity, is commonly misdiagnosed. A case of abdominal pain associated with the subjective perception of a "lump," which proved to be a rectus abdominis hematoma, is presented. The pathoanatomy, presenting symptoms, investigation, and treatment options for the condition are reviewed.
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Currently, there is no one drug that is the agent of choice for induction in rapid sequence intubation in the emergency department (ED). All agents currently used as induction agents in the ED offer distinct advantages for various clinical conditions, but each has a significant side effect profile and specific contraindications that limit its use in many common clinical settings. ⋯ Disadvantages include a lack of blunting of sympathetic response to intubation, a high incidence of myoclonus, prominent nausea and vomiting, potential activation of seizures in patients with epileptogenic foci, and impaired glucocorticoid response to stress. Further studies are needed to evaluate the advantages and disadvantages of the use of etomidate for rapid sequence intubation in the ED.
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Blind nasotracheal intubation (BNTI) is an effective procedure for the intubation of trauma patients. The presence of major facial trauma has been considered a relative contraindication due to the perceived risk of intracranial placement. The purpose of the present study was to assess the risk of intracranial placement in patients with facial fractures who undergo BNTI. ⋯ There were no cases of intracranial placement, significant epistaxis requiring nasal packing, esophageal intubation, or osteomyelitis. Three patients (4%) developed sinusitis and eight (10%) developed aspiration pneumonia. We conclude that the presence of facial trauma does not appear to be a contraindication to BNTI.