J Emerg Med
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The use of continuous positive airway pressure (CPAP) assisted ventilation in the emergency department(ED) has been well described. ⋯ The addition of CPAP to our pre-hospital respiratory distress protocol did not improve physiologic variables.There were no differences in overall and ICU LOS between groups. Persons with apparent continued ventilatory assistance appeared to have improved rates of intubation and ICU LOS [corrected].
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Rocky Mountain spotted fever (RMSF) is a well-described, potentially lethal, tick-borne zoonotic infection and has very effective therapy. However, the diagnosis might not be made early enough, often leading to worse outcomes. ⋯ We present this case to raise awareness of RMSF in patients who present with a nonspecific febrile illness in tick-endemic areas in the United States. Early diagnosis and treatment with doxycycline before day 5 of illness is essential and can prevent morbidity and mortality.
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Observational Study
Factors associated with adverse events resulting from medical errors in the emergency department: two work better than one.
The Emergency Department (ED) is an environment at risk for medical errors. ⋯ In our study, the involvement of more than one physician was associated with a lower risk of adverse events.
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Lumboperitoneal shunts are commonly placed as treatment for a variety of conditions, and complications can be significant. ⋯ Physicians should be aware of this potentially devastating complication of shunt placement so that prompt and appropriate treatment can be initiated.
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Cardiac valve injury after blunt chest trauma is extremely rare, and the tricuspid valve is most commonly affected because of the anterior location of the right ventricle. Tricuspid valve insufficiency can range from a subclinical presentation to acute cardiac failure. ⋯ Consideration of screening for anatomical heart injuries in blunt trauma patients with new onset dysrhythmias is recommended to explain hypotension not attributable to hemorrhage.