J Emerg Med
-
Case Reports
Evaluation of Left Ventricular Function by Bedside Ultrasound in Acute Toxic Myocarditis.
Myocarditis can be difficult to diagnose in the Emergency Department (ED) due to the lack of classic symptoms and the wide variation in presentations. Poor cardiac contractility is a common finding in myocarditis and can be evaluated by bedside ultrasound. ⋯ Cardiac ultrasound findings of severely reduced global function measured by endocardial fractional shortening were seen in this patient and supported the diagnosis of myocarditis. Endocardial fractional shortening is a useful means of easily evaluating and documenting left ventricular function and can be performed at the bedside in the ED.
-
Base excess is considered a predictor of mortality and severity of injury in trauma patients. Base excess had been widely examined in different settings. Only few studies have examined the role of base excess in pediatric trauma patients. ⋯ The admission base excess in pediatric trauma patients seems to be a weak prognostic factor in our facility.
-
Cannabinoid hyperemesis syndrome (CHS) was initially described in 2004 and remains an under-recognized clinical entity that occurs in chronic heavy marijuana smokers. ⋯ Our report suggests that frequent habitual smoking of synthetic cannabinoids can cause cannabinoid hyperemesis syndrome.
-
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.
-
There are no guidelines for the management of accidental insulin administration. We hypothesized that home monitoring of asymptomatic patients (pts) was safe following unintentionally insulin administration. ⋯ Based on a retrospective analysis of a single PCC's cases, home observation of asymptomatic patients after unintentional administration of a wrong insulin formulation appears safe.