Clinical medicine (London, England)
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The patient in case 1 was a 50-year-old man who presented to the emergency department of the local hospital with chest pain and syncope for 3 hours due to acute myocardial infarction. He underwent cardiopulmonary resuscitation (CPR) followed by extracorporeal membrane oxygenation (ECMO), and intestinal perforation was detected on day 9. The patient in case 2 was a 58-year-old man who was admitted to the hospital with abdominal pain lasting for 3 days. ⋯ We believe that this case report will be important to alert clinicians to the possibility of this complication and to encourage early detection and intervention to improve prognosis. Conventionally, the gastrointestinal tract has received secondary attention in patients receiving ECMO support because the vital organs tend to be considered first. However, this case report illustrates the importance of monitoring gastrointestinal function in patients undergoing ECMO.
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We present a case of a man who experienced recurrent ischaemic stroke secondary to an elongated styloid process compressing the cervical carotid artery.
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Management of pain in older people should follow the biopsychosocial model, addressing the heterogeneity in their physiological changes, psychological and cognitive aspects, and impact on their social interactions. When deciding on pharmacological treatment, special attention should be given to the side effect profile, drug-drug and drug-disease interactions, as well as route and timing of medication administration. The principle of 'start low, go slow' should be followed, and regular reviews of drug effectiveness and tolerability are required. With the adjunct of non-pharmacological interventions, the treatment plan should be tailored to individual needs, with the aim to ameliorate the burden of pain while preserving quality of life.