J Emerg Med
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Neurological abnormalities in melioidosis are rare but may manifest as an acute stroke, and in the emergency department (ED), an inappropriate stroke treatment may threaten a patient's life. ⋯ In light of this case, patients with identifiable risk factors, especially underlying diabetes, a history of positive soil contact, and those who lived in an endemic area or ever traveled to an endemic area, and who present themselves with fever and neurologic deficit or multi-organ involvement, should have melioidosis considered in the differential diagnosis.
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Obtaining vascular access is difficult in certain patients. When routine peripheral venous catheterization is not possible, several alternatives may be considered, each with its own strengths and limitations. ⋯ Although further study of this technique is required, we believe this procedure may be a valuable option for ED patients requiring rapid vascular access.
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Standard practice has been to admit children for an observation period after enema-reduced intussusception. However, the utility of such routine practice has not been clearly justified. ⋯ Given the low early recurrence rate for enema-reduced intussusception and the minimal risk of adverse outcomes, ED observation for a 6-h period seems to be a safe alternative to inpatient management. These results support previous work and suggest that these patients can be managed on an outpatient basis.
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Knee dislocation is an uncommon but serious injury that has traditionally been associated with high velocity injuries such as motor vehicle accidents. More recently, individual cases of obese individuals sustaining knee dislocation from a low velocity mechanism have been noted. Associated injuries of knee dislocation are common and include popliteal vessel damage requiring surgical repair and injuries to the peroneal nerve. Prompt diagnosis and reduction is essential to reduce the risk of these complications. ⋯ This is the first series of such injuries that we are aware of and highlights a potential future increase in incidence of these major injuries as body mass in society increases, placing more strain on health care resources. Practitioners in the Emergency Department need to be aware that serious injury can be present in morbidly obese patients that have sustained no more than a fall from standing height. Prompt investigation and management is essential.
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Case Reports
Reverse Takotsubo cardiomyopathy in the setting of anaphylaxis treated with high-dose intravenous epinephrine.
Takotsubo cardiomyopathy is seen, though rarely, in anaphylaxis treated with epinephrine. Stress cardiomyopathy is most likely to occur in middle-aged women. The underlying etiology is believed to be related to catecholamine release in periods of intense stress. Catecholamines administered exogenously, and those secreted by neuroendocrine tumors (e.g., pheochromocytoma) or during anaphylaxis have been reported to cause apical ballooning syndrome, or takotsubo syndrome. However, reverse takotsubo stress cardiomyopathy is rarely seen or reported in anaphylaxis treated with epinephrine. ⋯ Inappropriately high doses of intravenous epinephrine can trigger stress cardiomyopathy. Emergency physicians should be familiar with the diagnosis, grading, and appropriate treatments of anaphylaxis to avoid this unnecessary complication.