J Emerg Med
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Determining whether a patient has a time-critical medical condition requiring helicopter Emergency Medical Services (HEMS) transportation is a challenge with acute ischemic stroke (AIS). Although HEMS is largely accepted as improving outcomes in time-sensitive conditions, overtriage of patients ineligible for acute stroke therapies places patients and providers at unnecessary risk and wastes limited health care resources. ⋯ HEMS transport for AIS patients plays a crucial role in delivering the best evidence-based care. However, a significant percent of patients did not meet criteria for its optimal utilization, most commonly due to expired treatment windows. Furthermore, low flight value transfers were initiated in spite of physician evaluation > 50% of the time. These results represent a unique opportunity to coordinate education and build effective triage paradigms across a system of stroke care.
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Households are increasingly stockpiling and producing hand sanitizer amid the coronavirus disease 2019 (COVID-19) pandemic, which can pose an increased risk for unintentional toxicity among children. Despite guidelines for hand sanitizer production published by the World Health Organization, many turn to streaming media for instruction. ⋯ YouTube may not be an accurate source for effective hand sanitizer concoction. Health care providers and parents should be aware of the increased surge in hand sanitizer exposure among children and should take proper precautionary measures.
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High-quality chest compressions are an important determinant for favorable neurological outcome. Associations of long-term mortality and neurological outcomes with chest compression types still require investigation. ⋯ Comparisons of mechanical and manual chest compressions in terms of survival rates and favorable neurological outcomes showed no significant differences. Further investigation of long-term neurological outcomes with mechanical CPR utilization is required.
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Aortic aneurysm ruptures are associated with high fatality. The timely diagnosis of a ruptured aortic aneurysm can be challenging for the emergency physician when hoarseness of voice is the only presenting symptom. Ortner's syndrome was first reported in 1897 as a case of left recurrent laryngeal nerve paralysis secondary to mitral stenosis and left atrial enlargement. In this case report, we describe a unique association of aortic aneurysm rupture with dysphonia presenting as Ortner's syndrome. ⋯ An 81-year-old man presented to our emergency department (ED) with an acute hoarse voice. Physical examination of his cardiovascular and neurologic systems was normal. Further evaluation with a nasoendoscope revealed a left vocal cord palsy. Consideration of Ortner's syndrome prompted an early call for thoracic imaging. A computed tomogram of the aorta showed a contained aortic aneurysm rupture with an acute hyperdense periaortic hematoma at the aortic arch. As our patient was a poor surgical candidate in view of concurrent comorbidities, he was managed conservatively. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We identified a unique presentation of a painless, ruptured aortic aneurysm. This is a fatal diagnosis that all emergency physicians struggle to make in a timely fashion. The imminent aortic aneurysm rupture, masked by the absence of pain in our patient, could have resulted in a potentially catastrophic event. In the evaluation of a patient with hoarse voice, early consideration of Ortner's syndrome could result in timely diagnosis of a ruptured aortic aneurysm.