J Emerg Med
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Case Reports
An Interesting Cause of Wide Complex Tachycardia: Ashman's Phenomenon in Atrial Fibrillation.
Ashman's phenomenon is an aberrant intraventricular conduction abnormality that occurs in response to a change in QRS cycle length. In atrial fibrillation, Ashman's phenomenon will present as a long RR cycle followed by a short RR cycle, with the subsequent QRS complex manifesting a right bundle branch block morphology. This morphologic variation can create difficulty with electrocardiographic interpretation, and can alter management in patients with this dysrhythmia. ⋯ Ashman's phenomenon should be suspected in atrial fibrillation when there is a long cycle followed by a short cycle, with the subsequent QRS complex manifesting a right bundle branch block pattern. Emergency physician awareness of this phenomenon may improve diagnostic certainty and have an impact on dysrhythmia management.
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Acute limb ischemia is both a limb-threatening and life-threatening disease process. Nontraumatic acute peripheral arterial occlusion is most commonly caused by a thrombosis or an embolism. ⋯ A focused examination of the aorta, iliac vessels, and femoral artery bifurcation with bedside ultrasonography may help to localize peripheral arterial occlusions and can assist the emergency physician in seeking timely surgical consultation and management.
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Infantile botulism is the result of ingestion of Clostridium botulinum spores, and is the most common form of infection with botulism in the United States. Ninety percent of cases occur in infants <6 months old. The infants typically present with vague symptoms such as hypotonia and poor feeding. This article reports an infant with confirmed infantile botulism that presented to the Emergency Department (ED) with complaints of decreased feeding and absence of bowel movements for >1 week. ⋯ Awareness of the symptoms of botulism and a high degree of clinical suspicion is needed to make a prompt diagnosis.
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Alcohol use in college-age individuals is associated with increased injury risk. Many college drinkers end up in the emergency department (ED) as a result of their drinking, providing a unique opportunity to intervene. ⋯ Seven studies were identified that measured the outcomes of ED interventions for alcohol use in the college-age population. The studied interventions showed promise but had variable success. More research is needed to establish short- and long-term efficacy, specifically in high-risk underage college students.