JACEP
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A patient with hiccups was found to have an abdominal aortic aneurysm that subsequently ruptured. We believe that a leaking abdominal aortic aneurysm led to an ileus-induced distention of the splenic flexure of the colon with consequent diaphragmatic irritation and phrenic nerve stimulation. This led to persistent hiccups as a result of repetitive stimulation of the reflex arc mediating hiccups. Persistent hiccups require investigation for an underlying organic etiology, and a leaking abdominal aortic aneurysm should be included in the differential diagnosis.
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A retrospective study of 117 cases of pelvic fracture was undertaken to determine the incidence of associated abdominopelvic injury. Fractures of the pubic rami were found to be most common. Seventeen patients (15%) had significant intra-abdominal or genitourinay injury. ⋯ Seventy-three of 84 (87%) patients who had urinalyses in the emergency department had microscopic or gross hematuria. Of these, only those with gross hematuria had significant urologic injury. There were four fatalities.
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Benign intracranial hypertension, an unusual case of headaches, was associated with pregnancy in a gravid female with the chief complaint of headache. Symptoms resolved after three days of prednisone therapy. ⋯ The only symptom may be headache and the only physical sign, papilledema. Therefore, neurological examination must include visualization of the fundi.
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In 38 critically burned patients with symptomatic hypovolemia being treated by intravenous fluids, the accuracy of colloid oncotic pressure (COP) calculated from the refractometrically-determined serum total protein (TPRI) was compared with COP values determined by a commercially-available clinical oncometer. Sera were obtained randomly from seven patients receiving Ringer's lactate solution, five receiving a hypertonic solution (240 mOsm Na+) and 26 receiving a hypertonic solution containing albumin (12.5 gm/liter, HALFD method). There was poor correlation between COP measure and that calculated from RI in patients receiving colloid-free fluid, but high correlation (r = 0.925) in patients receiving HALFD. There was high correlation (r = 0.951) between measured COP and values calculated from TPRI in patients receiving hypertonic fluid, colloid containing hypertonic fluid, or no fluid:COP = 4.08 (TPRI)--4.61.