J Emerg Med
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There is no clinical guidance for the indications of neuroimaging in patients with isolated vertigo. The differential diagnosis of isolated vertigo can be challenging for emergency physicians. ⋯ We suggest that patients unresponsive to ED treatment, 65 years or older, and with two or more vascular risk factors, should alert physicians for central causes and increase the yield of neuroimaging.
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Early and successful management of the airway in the prehospital and hospital settings is critical in life-threatening situations. ⋯ The VL method is rapid and easier to see the vocal cords and perform successful ETI. Therefore, it might be preferred in out-of-hospital ETI applications.
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Lateral canthotomy is a vision-saving procedure. However, the low incidence of orbital compartment syndrome and the expense of simulators to practice this procedure can lead to low confidence and delays in the performance of the procedure by emergency physicians. ⋯ This simple task trainer is practical, inexpensive, quickly assembled, and useful as a tool for practicing emergency medicine providers.
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BRASH syndrome, a relatively new entity, has been described in the recent literature. It is defined as a combination of bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia. Although it is apparent that clinical symptomatology includes shock, it is still unclear whether all patients will initially present with all five components mentioned in the BRASH acronym. ⋯ An elderly woman presented to our Emergency Department (ED) with hyperkalemia, acute renal failure, and metabolic acidosis with bradycardia, which was refractory to antikalemic measures and atropine. The montage of clinical features put together showed a clear picture of BRASH syndrome, which helped us to streamline the management and achieve a better patient outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Renal failure with various metabolic derangements is commonly seen in the ED. We should be aware of this new clinical entity, as its incidence will certainly increase, and the management is a bit different. Prognosis is excellent with timely recognition and management of this rare clinical entity.