J Emerg Med
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Brachial plexus neuritis is a rare neurologic disease that may be overlooked in emergency medicine because other conditions are much more common. We report a case of brachial plexus neuropathy due to cytomegalovirus infection. The diagnosis was based on history, clinical findings, laboratory tests, and electromyography. Early diagnosis and adequate treatment is important to avoid unnecessary investigation, prevent complications (especially adhesive capsulitis of the shoulder), and reassure the patient.
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Comparative Study Clinical Trial
Cardiac output measurement with an esophageal doppler in critically ill Emergency Department patients.
Cardiac output (CO) is a principal determinant of perfusion in many critically ill patients. The objectives of this study were to determine whether physicians' estimates of CO, or cardiac index (CI), are accurate compared with CO/CI measured by esophageal doppler, and to estimate the physician time necessary for Emergency Department (ED) CO/CI measurement. We prospectively evaluated a convenience sample of critically ill, adult ED patients. ⋯ The mean time for optimal doppler signal was 5.7+/-4.3 min. Physicians' estimates of CI were inaccurate compared with measured CI. Esophageal doppler measurement of CO/CI appears to be practical from a physician time standpoint.
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A 27-year-old male of Malaysian descent presented to the Emergency Department (ED) with rapidly progressive flaccid paralysis that quickly compromised his respiratory effort. The patient was found to have a serum potassium of 1.9 meq/L, and was diagnosed as having an acute paralytic episode secondary to thyrotoxic periodic paralysis. The paralytic attack was aborted with a combination of potassium replacement and parenteral propranolol in large doses. We report the use of a rarely described, yet possibly more effective, therapy for an acute attack of thyrotoxic periodic paralysis.