J Emerg Med
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Multiple studies illustrate the benefits of waveform capnography in the nonintubated patient. This type of monitoring is routinely used by anesthesia providers to recognize ventilation issues. Its role in the administration of deep sedation is well defined. Prehospital providers embrace the ease and benefit of monitoring capnography. Currently, few community-based emergency physicians utilize capnography with the nonintubated patient. ⋯ Capnography is a quick, low-cost method of enhancing patient safety with the potential to improve the clinician's diagnostic power.
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First described in Japanese literature in 1991, Takotsubo cardiomyopathy (TCM), or "broken heart" syndrome, continues to be described in novel circumstances. Commonly mistaken for acute coronary syndrome (ACS) due to similar clinical symptoms and electrocardiogram changes, it usually affects postmenopausal women and those in acute emotional or physical stress. Named for the resemblance of apical ballooning and dyskinesis to the Japanese octopus trap, the pathogenesis is poorly understood. Believed to be associated with catecholamine surges during extreme stress, TCM has been reported with grieving, lightning strikes, burns, injuries, and anesthesia. We describe a unique case occurring after a significant motor-vehicle collision (MVC) without apparent injury. ⋯ TCM presents a diagnostic challenge to the emergency physician. In a patient of this age and mechanism, alternate intrathoracic pathologies, such as ACS, aortic injury, pulmonary contusion, and pneumothorax must be considered.
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Carbon monoxide (CO) is regarded as a leading cause of morbidity and mortality. It endangers not only patients, but also health care professionals, especially emergency medical services (EMS) personnel because CO exposure is often unknown at the time EMS is called. ⋯ In the prehospital setting, hazardous environments always have to be considered as potential causes of a patient's altered status. Together with the correct use of modern equipment, such as permanently switched-on CO detectors, this can help avoid harm to both patients and staff.
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Approximately 2% of angioedema (AE) patients have a hereditary or an acquired deficiency of the complement 1 (C1) esterase inhibitor (C1 INH) gene. Some case reports indicate an association between angiotensin-converting enzyme inhibitor (ACEI) use and exacerbation of hereditary AE (HAE). ⋯ The risk of exacerbating HAE by ACEI might be present, but we did not find any association in this retrospective study. Further studies are needed to determine the existence of this association.