J Emerg Med
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In this case, a mobile medical ID was used to inform an off-duty clinician of highly relevant medical history when attending a pedestrian during a medical emergency. Mobile medical IDs are available on all major smartphone operating systems and provide information including, but not limited to, medical history, current medications, and allergy status. These can be accessed from lock screens, allowing access for off-duty clinicians to improve the quality of care they could provide while awaiting assistance.
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Primary carnitine deficiency (PCD) is a rare but potentially life-threatening genetic disorder if left untreated. Although some patients remain asymptomatic lifelong, a few patients present with hepatic encephalopathy, hypoglycemia, cardiomyopathy, dysrhythmia, and even sudden death. ⋯ A 25-year-old woman with PCD collapsed suddenly while eating lunch. Bystander cardiopulmonary resuscitation (CPR) was performed for 8 min, with automated external defibrillation once before admission. Upon arrival at our emergency department (ED), she was unresponsive without a pulse or spontaneous breathing. The initial heart rhythm on the electrocardiogram monitor was ventricular fibrillation (VF). The medical staff continued CPR with defibrillation for sustained VF. Return of spontaneous circulation (ROSC) was achieved after a total resuscitation time of 14 min, with defibrillation twice after cardiac arrest. The heart rhythm after ROSC was atrial fibrillation, with a rapid ventricular rate initially and subsequent progression to sinus tachycardia with diffuse ST segment depression and a prolonged QT interval. Her low carnitine level was consistent with her underlying disease. Cardiac magnetic resonance imaging and sonography for detection of cardiomyopathy showed no significant findings. With carnitine supplementation for a few days, her plasma carnitine level returned to 30 μM, with no recurrence of ventricular dysrhythmia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: PCD is rare but could be life-threatening, and compiling detailed histories may help emergency physicians to determine the cause of sudden cardiac death after resuscitation. This information may be used to correct potential underlying problems and prevent recurrence of the condition after treatment.
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Four-factor prothrombin complex concentrate (4F-PCC) is a blood coagulation product indicated for urgent reversal of warfarin. Currently there are no studies using 4F-PCC as a fixed dose to achieve hemostasis with warfarin as well as direct factor Xa inhibitors. ⋯ A fixed-dose regimen of approximately 2000 factor IX units of 4F-PCC may be a reasonable approach to achieve hemostasis in patients receiving warfarin or factor Xa inhibitors. Additionally, utilization of a fixed-dose regimen may lead to significant acquisition cost savings for facilities.
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Shiitake flagellate dermatitis is a shiitake mushroom (SM)-induced toxic dermatosis that is a widely recognized clinical phenomenon in Japan, China, and Korea but is rarely reported outside of Asia. Typically, 24-48 hours after consumption of SM, patients develop severely pruritic, linear, often parallel, infiltrated erythematous lesions, commonly described as being in a "whip-like" pattern. The dermatosis is noted preferentially on the trunk, extremities, and neck. Shiitake flagellate dermatitis is self-limited and typically resolves within days to weeks of its appearance. ⋯ A healthy 36-year-old woman living in the southeastern United States presented with a 48-hour history of pruritic, truncal, morbilliform, flagellate-like efflorescences that extended to her buttocks and thighs. Her hard and soft palates, palms and soles, hair-bearing scalp, and face were also involved. Two days before presentation, the patient ate a store-bought salad preparation that contained raw mushrooms including SMs. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Shiitake dermatitis has a characteristic whip-like pattern that, if identified early by first-line physicians, can relieve concerns for more serious etiologies and expedite appropriate therapy.