J Emerg Med
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Case Reports
Asymptomatic Chronic Epidural Hematoma in a Child As a Result of Extracranial Decompression.
Epidural hematoma (EDH) in children is a diagnostic challenge due to its nonspecific clinical presentation. Asymptomatic chronic epidural hematoma is a very rare entity. Reports of spontaneous decompression into the subgaleal spaces are limited with acute epidural hematomas in the literature. ⋯ An initially minimal but expanding EDH in a child can remain asymptomatic even in the later phases, owing to the spontaneous decompression through a skull fracture.
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Comparative Study Observational Study
Ultrasound-Guidance Can Reduce Adverse Events During Femoral Central Venous Cannulation.
Ultrasound-guidance for internal jugular central venous cannulation (CVC) has become the recommended best practice and has been shown to improve placement success and reduce complications. There is a dearth of studies that evaluate emergency point-of-care ultrasound guidance of femoral CVC. ⋯ Our experience shows that ultrasound guidance for femoral CVC might decrease complications and improve placement success, although we cannot recommend this approach without additional data. We recommend a larger study to further evaluate this technique.
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Recently, high-dose insulin (HDI) and intravenous lipid emulsion (ILE) have emerged as treatment options for severe toxicity from calcium-channel blocker (CCB) and beta blocker (BB). ⋯ HDI effectively reverses CS induced by CCBs and BBs due to its inotropic effects, uptake of glucose into cardiac muscle, and peripheral vasodilatation. ILE is theorized to sequester agents dependent on lipid solubility from the plasma, preventing further toxicity. To our knowledge, these are the first two successful cases reported using the combination of HDI and ILE for reversing CS induced by intentional ingestions of CCBs and BBs.
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Case Reports
Intragastric Balloon in the Emergency Department: An Unusual Cause of Gastric Outlet Obstruction.
Obesity has become a worldwide epidemic and is associated with significant morbidity and mortality. Many strategies to promote weight loss, including medications and surgical techniques, have been developed; however, few have proven effective. As the rates of obesity and associated complications continue to climb, there is growing pressure on the medical community to develop less invasive procedures that can provide lasting weight loss results. ⋯ With an increasingly mobile and obese global population, emergency physicians should be aware of weight loss procedures such as the IGB and appropriate time-sensitive management of high-risk complications.
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Inferior vena cava thrombosis is a rare but important cause of acute low back pain and lumbar radiculopathy. Failure to diagnose and treat this condition could result in propagation of the thrombosis, resulting in fatal pulmonary embolism. ⋯ Inferior vena cava thrombosis is a rare cause of acute lumbar radiculopathy, but is in the differential diagnosis to consider, especially in those patients at increased risk of thrombosis.