J Emerg Med
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Case Reports
Diagnosis of Aortic Dissection Presenting as ST-Elevation Myocardial Infarction using Point-Of-Care Ultrasound.
Aortic dissections can present with a broad spectrum of signs and symptoms, making them difficult to diagnose in the emergency department (ED). Aortic dissections can cause occlusion of the coronary arteries, mimicking an acute ST-elevation myocardial infarction (STEMI). Emergency point-of-care ultrasound (POCUS) may be a useful diagnostic tool to help differentiate aortic dissection from a primary myocardial infarction. ⋯ A 69-year-old man with no medical history presented to our ED complaining of chest pain. His electrocardiogram revealed new and dynamic ST-segment elevations consistent with a septal myocardial infarction. While the patient was being prepared for the cardiac catheterization laboratory, the treating emergency physician performed a POCUS study. The scan revealed an echogenic flap in the ascending aorta, significant aortic regurgitation, and intimal flaps in the carotid artery and abdominal aorta. The diagnosis of a type A aortic dissection was confirmed with computed tomography angiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Differentiating an acute STEMI from an aortic dissection can be extremely difficult in the ED. It is important not to delay reperfusion therapy for patients with a true STEMI; however, the same treatment can be lethal for patients with aortic dissection. Emergency POCUS is a fast and accessible test that has been shown to have high specificity for the diagnosis of aortic dissection in the ED. POCUS may be a useful tool to help emergency physicians diagnose aortic dissection presenting with STEMI.
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Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. ⋯ Capnography demonstrates benefit in cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Further study is required in patients with seizure, trauma, and respiratory conditions. It should only be used in conjunction with other patient factors and clinical assessment.
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Many trauma centers have adopted routine head-to-pelvis computed tomography (CT) imaging for the evaluation of adults with blunt trauma. ⋯ During multiple anatomic region CT imagng for adult blunt trauma evaluation, the yield for CSI in >1 region is low. In low-risk populations, selective CT imaging of anatomic regions (instead of reflexive head-to-pelvis CT imaging) may be more appropriate.
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Cricothyroidotomy is a lifesaving procedure required in up to 2% of emergent airways. Emergency medicine training programs frequently instruct this procedure via cadaver training, but cadaver cost and availability limit the opportunity for all trainees to perform the critical initial skin incision. Cadaver autografting is a novel way to simulate all steps of the procedure. ⋯ Autografted cadaver tissue while simulating cricothyroidotomy was perceived to be a useful adjunct by the majority of participating emergency medicine trainees.