J Emerg Med
-
Platypnea-orthodeoxia syndrome is a rare disease entity that is characterized by dyspnea and desaturation in the upright position that resolves when the patient is in the supine position. ⋯ An 80-year-old man presented with epistaxis but was noted to be hypoxic and was unresponsive to supplemental oxygenation. His oxygen saturation improved with supine positioning, however, which is consistent with platypnea-orthodeoxia syndrome. This improved with overnight intravenous hydration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with hypoxia and paradoxical improvement in oxygen saturation with supine positioning, consider platypnea-orthodeoxia as a potential cause.
-
Monoballismus is rarely seen clinically, but when observed, it is usually a manifestation of an acute cerebrovascular accident (CVA). We report a case of monoballismus observed in a patient without evidence of a CVA. ⋯ We observed a case of monoballismus in a 60-year-old diabetic patient who had not had a stroke. The movement disorder resolved with improvement of the patient's hyperglycemia. Nonketotic hyperglycemia is an uncommon cause of ballismus. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should include the movement disorder of ballismus among the potential clues that a patient may be suffering an acute CVA. However, noncerebrovascular causes of ballismus exist. The movements manifest by a patient with ballismus should also lead the physician to consider the possibility not only of a CVA, but also neuroleptic malignant and serotonin syndromes.
-
It has been proposed that cricoid pressure can exacerbate an unstable cervical injury and lead to neurologic deterioration. ⋯ Based on the evidence presented, we believe that the application of cricoid pressure to a patient with a globally unstable subaxial cervical spine injury causes small displacements. There may be some benefit to the use of manual posterior cervical spine support for reducing motion at such an injured segment.