J Emerg Med
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Meta Analysis
Diagnosing Achilles Tendon Rupture with Ultrasound in Patients Treated Surgically: A Systematic Review and Meta-Analysis.
Achilles tendon rupture is a common injury with increasing incidence due to the rising popularity of high-velocity sports, continued physical activity of the aging American population, and use of fluoroquinolones and steroid injections. The diagnosis can often be missed or delayed, with up to 20% misdiagnosed, most commonly as an ankle sprain. ⋯ The results from our study suggested that a negative ultrasound result may have the potential to rule out a complete, as well as a partial, Achilles tendon rupture.
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Background Hair-thread tourniquet syndrome (HTTS) is the constriction of an appendage or tissue by a hair thread, which can cause ischemia and necrosis of distal tissues. Depilatory agents have the potential to release the hair tourniquet without exposing the patient to the risks of surgery.
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The administration of sedation and neuromuscular blockade to facilitate extraglottic device (EGD) placement is known as rapid sequence airway (RSA). In the emergency department (ED), EGDs are used largely as rescue devices. In select patients, there may be significant advantages to using EGDs over laryngoscopy as the primary airway device in the ED. ⋯ The practice of RSA with the ILMA in the ED is associated with a high rate of successful oxygenation, ventilation, and intubation with infrequent complications, even when performed by physicians with few experiences in the approach.
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Case Reports
Seizures: A Rare Presentation of Autonomic Dysreflexia in a Young Adult with Complete Spinal Cord Injury.
Autonomic dysreflexia (AD) is a common complication for individuals with cervical or upper-mid thoracic spinal cord injury (SCI). It is a life-threatening emergency; however, it is rarely encountered by many emergency physicians, thus, ongoing awareness of the topic is necessary. ⋯ An 18-year-old man with cervical spinal cord injury presented to the Emergency Department with headache, nausea, elevated blood pressure, and seizures. He was treated with antiepileptics and transferred to the pediatric intensive care unit (PICU). The PICU care team recognized AD as the cause of the seizure, secondary to a clogged suprapubic catheter causing overdistension of his bladder. Once replaced, over 1 liter of urine drained from his bladder and his autonomic symptoms resolved. He became hypotensive and required fluid resuscitation, but no further seizures occurred. Why Should an Emergency Physician Be Aware of This? Although rare, AD can result in seizures, intracerebral hemorrhage, or even death if not recognized or treated appropriately. Emergency physicians should recognize headaches, facial flushing, and sweating as early symptoms of AD, along with acute elevation in blood pressure (noting that baseline blood pressure may be lower in individuals with SCI). Management involves evaluating and treating noxious stimuli below the level of neurologic injury. Symptom management alone, without resolution of the underlying issue, can add to morbidity and mortality.
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Burns are a common condition presenting to the emergency department; the majority are thermal burns. The treatment for thermal burns and chemical burns differs greatly, and prompt recognition of a chemical burn is necessary. An often unrecognized and underestimated type of chemical burn is an alkali burn from wet cement. ⋯ A 7-year-old boy was transferred from an outside facility for evaluation of burns after exposure to wet cement. The patient underwent partial decontamination at the outside facility with polyethylene glycol and, to prevent ongoing alkali burns, the patient necessitated further decontamination with irrigation. Burn surgery was consulted for additional evaluation. The patient required no further intervention and the patient was discharged to home and made a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Serious morbidity and mortality can occur from unrecognized cement burns, and early decontamination and evaluation by a burn surgeon is necessary. It is critical that emergency physicians both recognize and appropriately treat this condition in a timely manner to prevent adverse outcomes.