J Emerg Med
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Case Reports
Instability of gait as an extrapulmonary sequela in acute Legionella pneumonia: a case report.
Legionnaires disease is a potentially fatal infection often associated with permanent pulmonary fibrosis in survivors. Although neurological complications are not infrequent, chronic peripheral neuropathy in the absence of pulmonary abnormalities is an uncommon consequence of Legionnaires disease. ⋯ The outcome of this case confirms that the early exudative phase of ARDS in the absence of bronchial dilatation on chest CT scan is not always related to pulmonary fibrosis in survivors at follow-up. It also demonstrates that peripheral neuropathy can persist despite tailored treatment.
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Cardiac rupture is an unusual cause of chest pain and sudden cardiovascular collapse. This diagnosis may be easily forgotten while managing a patient in extremis in the initial minutes of evaluation and resuscitation in the emergency department (ED). ⋯ Typical ultrasonographic findings of cardiac rupture were present in this patient, who presented in extremis with chest pain. Early bedside echocardiography can be helpful in directing the initial care of critically ill patients.
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It has been estimated that up to one-quarter of spinal cord injuries may be significantly worsened during extrication or early treatment after a motor vehicle accident. ⋯ In this study, no decrease in neck movement occurred for certain extrication events that included protection and assistance by the paramedics. Future work should further investigate this finding.
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The use of multidisciplinary algorithmic pathways is one strategy to improve efficiency and quality of care in Emergency Departments (EDs). To this end, in the fall of 2005, we implemented algorithmic pathways for evaluation of ED patients with common gynecologic complaints. ⋯ Algorithmic pathways had a positive impact on patient care as measured by the average amount of time our patients spent in the ED. Gynecologic care in the ED was standardized, and length of stay for patients with gynecologic complaints decreased. The implementation of algorithms resulted in more consistent care with earlier initiation of pertinent studies, while facilitating more rapid critical decision-making by providers from both departments. Further analysis is required to examine cost-effectiveness as well as patient safety and provider satisfaction issues.