J Emerg Med
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Thermal epiglottitis is a rare but potentially life-threatening disease. Diagnosis requires a thorough history and high clinical level of suspicion, particularly in children. Thermal epiglottitis from steam inhalation can have a slow onset without oropharyngeal signs of thermal injury, findings that can hide the clinical diagnosis. ⋯ A thorough history and physical examination together with a high level of suspicion and aggressive, collaborative airway management is vital in preventing catastrophic airway obstruction in atypical forms of epiglottitis.
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To measure emergency department (ED) crowding, the emergency department occupancy ratio (EDOR) was introduced. ⋯ The EDOR is associated with increased 1- to 3-day mortality even after controlling for potential confounders.
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Clinical outcomes in ST-segment elevation myocardial infarction (STEMI) are related to reperfusion times. Given the benefit of early recognition of STEMI and resulting ability to decrease reperfusion times and improve mortality, current prehospital recommendations are to obtain electrocardiograms (ECGs) in patients with concern for acute coronary syndrome. ⋯ Prehospital STEMI identification allows for prompt catheterization laboratory activation, leading to decreased reperfusion times.
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Among currently available surgical options for the first stage of surgery for infants with hypoplastic left heart syndrome (HLHS), the hybrid procedure is relatively new and less well known among primary care and emergency physicians. This procedure involves placement of a stent within the ductus arteriosus to maintain systemic blood flow and bands around both pulmonary arteries to prevent pulmonary overcirculation. As the number of infants undergoing this procedure increases, emergency physicians will likely encounter them in their practice and should be familiar with their unique physiology and potential complications. ⋯ This case highlights the potential of infants who undergo the hybrid procedure for HLHS to present to the ED with high acuity and, accordingly, the importance of adding this disease process to the vast burden of knowledge facing ED physicians.
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Abdominal pain is an uncommon presentation of lead toxicity in the emergency department (ED). However, making the diagnosis is important in avoiding unnecessary testing and the long-term sequelae of lead toxicity. ⋯ These cases demonstrate a rare but significant cause of abdominal pain in the ED. Although history-taking in the ED is necessarily brief, these cases underscore the importance of obtaining an occupational history.