J Emerg Med
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Review Case Reports
Case Report and Literature Review of a Dissecting Thoracic Aneurysm in a 16-Year-Old Boy Presenting to the Emergency Department.
Aortic dissection is a rare occurrence in the pediatric and adolescent population. It has numerous etiologies, including congenital cardiac abnormalities. Aortic dissection has a high mortality rate; therefore, it is essential for the physician to at least consider this diagnosis in the setting this patient presented within their differential of atypical chest pain in the pediatric and adolescent population. ⋯ It is important to consider aortic dissection as a possibility when assessing the sick adolescent patient. The D-dimer is quite useful as a rapid and inexpensive test in the evaluation and stratification of adolescent chest pain patients in the ED.
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Diarrhea and chest pain are common symptoms in patients presenting to the emergency department (ED). However, rarely is a relationship between these two symptoms established in a single patient. ⋯ Campylobacter-associated myocarditis is rare, but performing the appropriate initial diagnostic testing, including stool cultures, is critical to making the diagnosis. Identifying the etiology of myocarditis as bacterial will ensure that appropriate treatment with antibiotics occurs in addition to any cardiology medications needed for supportive care.
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Emergency department (ED) providers commonly care for seriously ill patients who suffer from advanced, chronic, life-limiting illnesses in addition to those that are acutely ill or injured. Both the chronically ill and those who present in extremis may benefit from application of palliative care principles. ⋯ The Improving Palliative Care in Emergency Medicine project sponsored by the Center to Advance Palliative Care is a resource that assists ED health care providers with the process and structure needed to integrate palliative care into the ED setting.
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The electrocardiogram (ECG) is the most important diagnostic tool for acute myocardial infarction (AMI). T wave inversion (TWI) in lead aVL has not been emphasized or well recognized. ⋯ TWI in lead aVL might signify a mid-segment LAD lesion. Recognition of this finding and early appropriate referral to a cardiologist might be beneficial. Additional studies are needed to validate this finding.
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Luxatio erecta humeri or inferior dislocation of the glenohumeral joint is a rare presentation in the emergency department that is typically caused by a direct loading force on a fully abducted arm. This type of shoulder dislocation represents only 0.5% of all shoulder dislocations, making bilateral cases even more unique. ⋯ Although shoulder dislocations remain a commonly seen injury in the emergency department, it is important to consider that not all dislocations are simply anterior. Signature signs of luxatio erecta are fixed abduction at the shoulder with elbow flexion and forearm pronation. The humeral head should be palpable inferior to the glenoid fossa. The most effective treatments for this injury involve sufficient muscle relaxation for reduction, a methodical approach to reduction, and appropriate immobilization.