J Emerg Med
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Review Case Reports
Acute Spontaneous Subdural Hematoma in a Middle-Aged Adult: Case Report and Review of the Literature.
Acute spontaneous subdural hematomas (ASSDH) occur by a variety of pathological processes and are less common than trauma-related acute subdural hematomas (SDH). Both types are usually seen in the elderly, and only 22 cases of ASSDH in patients aged < 40 years have been reported in the medical literature. ⋯ Given the rarity of SDH in nonelderly patients, this case suggests a broader differential diagnosis for nontraumatic headaches to include arterial and even neoplastic origins. Our literature review confirms the paucity of reported incidences of ASSDH, yet reminds medical providers to closely monitor for developing neurological symptoms and initiate prompt medical intervention when necessary.
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Children's pain is frequently underrecognized and undertreated. This study focuses exclusively on children's perspectives of and satisfaction with their pain management in the emergency department (ED). ⋯ Despite continued pain upon discharge, most children were satisfied with their pain management. However, it is important that emergency physicians not interpret patient satisfaction as equivalent to adequate provision of analgesia. The relationship between children's pain management and self-reported satisfaction needs to be further explored.
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Current guidelines recommend avoiding atrioventricular-nodal blocking agents (AVNB) when treating tachydysrhythmias in Wolff-Parkinson-White syndrome (WPW) patients. ⋯ In this sample of WPW-associated tachydysrhythmia patients, many were treated with AVNBs. The composite outcome was similarly met after use of either AVNB or NAVNB, and no malignant dysrhythmias were observed.
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Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. ⋯ A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management.
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Management of critically ill patients in austere environments is a logistic challenge. Availability of oxygen cylinders for the mechanically ventilated patient may be difficult in such a context. A solution is to use a ventilator able to function with an oxygen concentrator. ⋯ The ability of an oxygen concentrator to deliver high FiO2 when used with a turbine ventilator makes this method of oxygen delivery a viable alternative to cylinders in austere environments when used with a turbine ventilator. However, FiO2 has to be monitored continuously because delivered FiO2 decreases when minute ventilation is increased.