J Emerg Med
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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.
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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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Intentional massive sodium chloride ingestions are rare occurrences and are often fatal. ⋯ Emergency physicians should consider rapidly lowering serum sodium with hypotonic intravenous fluids as a potential management strategy for acute severe hypernatremia secondary to massive salt ingestion.
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Mycobacterium tuberculosis (TB) infection remains a serious problem in many underdeveloped countries. TB is largely perceived as a disease affecting the pulmonary system, yet despite declining cases of pulmonary TB in the United States (US), extrapulmonary infections are being reported at an increasing proportion of total TB cases. Moreover, due to the insidious nature of extrapulmonary TB (EPTB), it may not be readily recognized by emergency physicians, as it masquerades as more commonly encountered infectious or inflammatory processes. ⋯ Loss of vision may be a presenting complaint for active tuberculosis infection.