J Emerg Med
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The 2010 Advanced Cardiac Life Support guidelines stated that routine sodium bicarbonate (SB) use for cardiac arrest patients was not recommended. However, SB administration during resuscitation is still common. ⋯ SB use was not associated with improvement in ROSC or survival-to-discharge rates in cardiac resuscitation. In addition, mortality was significantly increased in the North American group with SB administration.
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Review Case Reports
Arterial Gas Emboli Secondary to Portal Venous Gas Diagnosed With Point-of-Care Ultrasound: Case Report and Literature Review.
Portal venous gas (PVG) is a rarely observed clinical finding generally associated with intestinal ischemia. The proper clinical response to the finding of PVG depends somewhat on the setting in which it is observed. Here we describe a case in which extensive arterial gas emboli (AGE) were encountered during point-of-care ultrasound (POCUS) and subsequent computed tomography (CT) identified PVG secondary to gastric wall ischemia as the likely source. ⋯ A 69-year-old woman with history of metastatic colon cancer presented to the emergency department (ED) with altered mental status. On arrival, she was hypotensive, hypothermic, cachectic, and with abdominal distension. POCUS was performed to evaluate the source of the patient's hypotension, revealing the presence of PVG, as well as gas bubbles in all four chambers of the heart and the aorta. CT scan revealed gastric wall ischemia and confirmed the presence of significant air emboli throughout the portal venous system. Given the overall poor prognosis, the decision was made to forego further chemotherapy or surgery and the patient died later that week while under hospice care. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: AGE can occur in the setting of PVG. This may cause multi-organ failure by disrupting blood flow to organs, especially in patients with circulatory dysfunction, such as shock. Depending on the setting in which it is diagnosed, early detection of PVG may expedite earlier assessments of a patient's negative prognosis or initiation of attempted life-saving treatment. In this case report, we show that POCUS can be used to obtain an expedited diagnosis in a critically ill patient.
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There is a significant variability in survival rates for cardiopulmonary resuscitation (CPR) in out of-hospital cardiac arrest (OHCA), and some data indicate that ultrasound improves CPR. ⋯ Our study has demonstrated that CPR in OHCA can be improved using ultrasound and changing the position of the hands. This finding was connected with the ETCO2 and confirmed by chest CT scans.
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Despite the demonstrated benefits of regular screening, a large proportion of the adult female population are out of compliance with recommendations from specialty societies regarding breast and cervical cancer. ⋯ Our results indicate that RAs can identify large numbers of women who should undergo BCCS screening across a variety of emergency department settings.
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Traumatic tension pneumocephalus is a rare complication after craniofacial fractures that can cause devastating neurologic deficits if not managed promptly and effectively. ⋯ A 38-year-old man with no past medical history presented to the Emergency Department (ED) after a motor vehicle crash. He was noted to have an open frontal scalp laceration. Computed tomography (CT) revealed a right frontal subdural hematoma and right medial frontal contusion. There was also a frontal bone fracture extending through the frontal sinus with mild underlying pneumocephalus. He was monitored for cerebrospinal fluid (CSF) leak and was subsequently discharged on postinjury day 9. He re-presented to the ED 14 days post injury with lethargy, confusion, headache, and swelling around his scalp laceration. A CT scan was obtained that revealed a large-volume intraparenchymal pneumocephalus (pneumocerebri) with mass effect and midline shift. The patient was started on 100% oxygen and admitted to the intensive care unit. He was taken to the operating room for evacuation of the pneumocerebri, repair of dural defect, placement of a vascularized pericranial graft, and placement of a lumbar drain. His lumbar drain was removed on postoperative day 3 and he was discharged home neurologically intact on postoperative day 6. At 1 month follow-up he had no evidence of CSF leak and was neurologically intact. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case is presented to increase awareness among emergency physicians that traumatic tension pneumocephalus, and in this case, pneumocerebri, is a rare life-threatening neurosurgical emergency in patients with severe craniofacial fractures after blunt or penetrating head trauma. Early temporizing measures in the ED, such as 100% oxygen via nonrebreather face mask, and urgent neurosurgical consultation are indicated to prevent neurologic deterioration.