J Emerg Med
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Review Case Reports
Streptococcal Necrotizing Myositis: A Case Report and Clinical Review.
Streptococcal necrotizing myositis, also known as gangrenous myositis, is a very rare and severe soft tissue infection that predominately involves skeletal muscle and, eventually, superficial fascia and surrounding tissues. The presentation is often nonspecific until the rapidly progressing clinical course becomes apparent. A high morbidity and mortality rate has been reported in the small number of cases since 1900. Despite several attempts to better define the different entities causing necrotizing myositis, no single definitive causal relationship has been defined. ⋯ A high level of suspicion for necrotizing myositis must be maintained for a patient with unexplained severe muscle pain and soft tissue swelling accompanied by systemic inflammatory response syndrome.
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Review Case Reports
Can Anticoagulated Patients be Discharged Home Safely from the Emergency Department after Minor Head Injury?
Anticoagulated patients have increased risk for bleeding, and serious outcomes could occur after head injury. Controversy exists regarding the utility of head computed tomography (CT) in allowing safe discharge dispositions for anticoagulated patients suffering minor head injury. ⋯ The literature does not support mandatory admission for all anticoagulated patients after minor head injury, but further studies are needed to identify the higher-risk patients for delayed bleeding to determine appropriate management.
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Reducing delays in time to treatment is a key goal of ST-elevation myocardial infarction (STEMI) emergency care. Emergency medical services (EMS) are a critical component of the STEMI chain of survival. ⋯ Active EMS engagement in STEMI treatment was associated with significantly lower D2B and total coronary reperfusion times.
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Observational Study
Physiologic Effects of a New-Generation Conducted Electrical Weapon on Human Volunteers.
Conducted electrical weapons (CEWs) are used by law enforcement to restrain or repel potentially violent persons. The TASER X2 CEW is a next-generation device with new technology, including new electrical waveform and output specifications. It has not previously been studied in humans. ⋯ There was no evidence of dangerous physiology found in the measured parameters. The physiologic effects of the X2 CEW are similar to older-generation CEWs. We encourage further study to validate these results.
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Case Reports
Partial Hydatidiform Mole With False-Negative Urine Human Chorionic Gonadatropin Test in the Emergency Department.
Hydatidiform mole (molar pregnancy) is a benign tumor of placental trophoblastic cells, which release human chorionic gonadotropin (hCG). Several case reports have described complete hydatidiform moles with false-negative urine qualitative hCG tests. These negative pregnancy tests have been attributed to the hook effect. We report an unusual presentation of a partial mole and review an alternative explanation for the negative hCG test. As partial moles are usually not associated with a large proliferation of trophoblastic cells, levels of hCG are commonly < 100,000 mIU/mL. The most common presentation of a hydatidiform mole is vaginal bleeding. Hydatidiform mole is associated with a risk of malignant transformation and disseminated disease. ⋯ In addition to the hook effect, we present another possible explanation for the false-negative test; namely the inability of some assays to detect hCG-degradation products, which may be higher in clinical samples from patients with hydatidiform mole. This case underscores the importance of knowing the limitations of the commonly used hCG assays.