J Emerg Med
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Randomized Controlled Trial Comparative Study
GlideScope vs. C-MAC for Awake Upright Laryngoscopy.
Combining video laryngoscopy with awake upright intubation may provide an alternative modality of endotracheal intubation (ETI) that avoids pitfalls associated with traditional ETI. ⋯ GlideScope provides superior views to C-MAC in awake upright laryngoscopy in healthy volunteers.
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Review Case Reports
McConnell's Sign Is Not Specific for Pulmonary Embolism: Case Report and Review of the Literature.
McConnell's sign (right ventricular [RV] free wall hypokinesis with apical sparing on echocardiography) is often described as very specific for the diagnosis of pulmonary embolism (PE). We present the case of a patient who, despite manifesting a classic McConnell's sign, was not found to have a PE. ⋯ A 58-year-old woman presented to the emergency department with a cough, dyspnea, and leg swelling. A bedside focused cardiac ultrasound revealed hypokinesis of the RV free wall, with apical sparing, in the apical four-chamber view. A computed tomography angiogram for PE was negative. Ultrasounds of both lower extremities were negative for deep venous thrombosis, and a D-dimer was only marginally elevated. The patient was ultimately diagnosed with pulmonary hypertension due to chronic obstructive pulmonary disease and systemic lupus erythematosus. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware that McConnell's sign is not completely specific for acute right heart strain from PE.
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In severe sepsis and septic shock, global tissue hypoxia is a key development preceding multi-organ failure and death. ⋯ Initial low OER was associated with severe organ dysfunction that resulted in high mortality with severe sepsis and septic shock. When patients had initial ScvO2 of > 70% but abnormally low OER, their in-hospital mortality was higher than in normal OER patients. Therefore, the OER should be considered when attempting to predict the outcome of septic patients using ScvO2 at an early stage of management for sepsis.