J Emerg Med
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Posterior sternoclavicular dislocations can be challenging diagnostically, as traumatic force often happens to the lateral shoulder rather than directly to the sternoclavicular joint. Shoulder radiographs do not illustrate the sternoclavicular joint well, and can miss the diagnosis. This injury, however, has the potential for life-threatening complications due to proximity of mediastinal structures that might also be injured. ⋯ The following case illustrates a delayed diagnosis of posterior sternoclavicular dislocation. It also shows how point-of-care ultrasound can diagnose a dislocation, confirm persistence of a dislocation diagnosis when patients are transported from a referring facility, as well as educate the patient and family. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Point-of-care ultrasound can be used to rapidly diagnose posterior sternoclavicular dislocations and to provide patients education about their injury.
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It has been suggested that an adult 8.0 endotracheal tube (ETT) connected to a neonatal meconium aspirator would improve suctioning during emergent endotracheal intubation compared to the Yankauer suction instrument, the standard tool used by emergency physicians. ⋯ Compared to the Yankauer, an adult 8.0 ETT connected to a meconium aspirator was superior in suctioning liquids of varying viscosities and should be considered when encountering a difficult airway due to copious secretions, blood, or emesis.
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Review
Best Clinical Practice: Emergency Medicine Management of Stable Monomorphic Ventricular Tachycardia.
Ventricular tachycardia (VT) and ventricular fibrillation are the causes of approximately 300,000 deaths per year in the United States. VT is classified based on hemodynamic status and appearance. Stable, monomorphic VT treatment is controversial. ⋯ Optimal management of stable, monomorphic VT includes direct current cardioversion. If medical management is chosen, procainamide is most efficacious, though current literature suffers from poor design.
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Colchicine poisoning is an uncommon but serious form of drug intoxication. It may produce life-threatening systemic effects. In toxic doses it produces nausea and vomiting and bone marrow suppression, often leading to sepsis, hypocalcemia, adult respiratory distress syndrome, and direct cardiotoxic effects. ⋯ Among drug intoxications, colchicines can lead to severe clinical conditions. All patients suspected of having colchicine intoxication should be managed in the pediatric intensive care unit regardless of the actual degree of poisoning.