An Unusual Case of Alternating Ventricular Morphology on the 12-Lead Electrocardiogram.

BACKGROUND: One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions. CASE REPORT: We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose. A systematic approach to the electrocardiogram led to the rare diagnosis of Wolff-Parkinson-White (WPW) alternans. We review the differential diagnosis of this dysrhythmia and the initial evaluation of a patient with the WPW pattern present on their electrocardiogram. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be prepared to use a systematic approach to an undifferentiated dysrhythmia to identify potentially life-threatening conditions.

Vitamin C and D Deficiency in Urban America: A Case Report.

Introduction: Scurvy is caused by vitamin C deficiency and manifests with a variety of symptoms including generalized fatigue, apathy, anemia, myalgias, easy bruising, and poor wound healing. It is generally thought of as a disease of the past, especially in developed countries. However, vitamin C deficiency still occurs, especially in patients with lack of access to fruits and vegetables. Other micronutrient deficiencies, including vitamin D deficiency, are also prevalent and can cause a multitude of signs and symptoms including osteomalacia, muscle weakness, and increased risk of many chronic illnesses. Case Report: Here we present a case of vitamin C and D deficiency in a previously healthy 26-year-old man during the coronavirus disease 2019 pandemic in urban America. Conclusion: Severe nutritional deficiencies still exist today. Emergency clinicians should be aware of the signs and symptoms to promptly diagnose and initiate treatment.

Changing The Playbook For Immigrant Health.

Philadelphia's response to welcoming Afghan evacuees during the COVID-19 pandemic suggests the need for a new approach to immigrant health care.

An EMS Response to Refugees Arriving at an International Airport: A Report From the Field.

Following Afghanistan's fall in August 2021, many refugees were settled in the United States as part of Operation Allies Welcome. They were flown from Kabul to the Middle East and Europe before continuing to the U.S. By late September Philadelphia was the sole destination. From there refugees were transported to Safe Haven military bases around the country. Philadelphia International Airport became the site of a months-long operation involving city, state, federal, and private agencies engaged in processing, medical screening, and COVID-testing of arriving refugees. The Philadelphia Fire Department played an integral role. Minor medical conditions were treated onsite. Higher acuity patients were transported to nearby hospitals. The goal was to maintain flow of refugees to their next destination while addressing acute medical issues. Between August 28, 2021, and March 1, 2022, the airport processed 29,713 refugees. Philadelphia's experience may serve as a guide for planning future such refugee operations.

The 2017 International Joint Working Group recommendations of the Indian College of Cardiology, the Academic College of Emergency Experts, and INDUSEM on the management of low-risk chest pain in emergency departments across India.

There have been no published recommendations for the management of low-risk chest pain in emergency departments (EDs) across India. This is despite the fact that chest pain continues to be one of the most common presenting complaints in EDs. Risk stratification of patients utilizing an accelerated diagnostic protocol has been shown to decrease hospitalizations by approximately 40% with a low 30-day risk of major adverse cardiac events. The experts group of academic leaders from the Indian College of Cardiology and Academic College of Emergency Experts in India partnered with academic experts in emergency medicine and cardiology from leading institutions in the UK and USA collaborated to study the scientific evidence and make recommendations to guide emergency physicians working in EDs across India.

Dengue, Zika and Chikungunya: Emerging Arboviruses in the New World.

The arboviruses that cause dengue, chikungunya, and Zika illnesses have rapidly expanded across the globe in recent years, with large-scale outbreaks occurring in Western Hemisphere territories in close proximity to the United States (U.S.). In March 2016, the Centers for Disease Control and Protection (CDC) expanded its vector surveillance maps for A. aegypti and A. albopictus, the mosquito vectors for these arboviruses. They have now been shown to inhabit a larger portion of the U.S., including the heavily populated northeast corridor. Emergency physicians need to further familiarize themselves with these diseases, which have classically been considered only in returning travelers but may soon be encountered in the U.S. even in the absence of travel. In this paper, we discuss the presentation and treatment of dengue, Zika, and chikungunya, as well as special challenges presented to the emergency physician in evaluating a patient with a suspected arbovirus infection.

Are one or two dangerous? Camphor exposure in toddlers.

Serious pediatric toxicity resulting from exposure to small amounts of camphor-containing products has long been a problem. Twenty years ago the United States Food and Drug Administration took several actions in an attempt to ameliorate this risk. Despite these changes, camphor remains commonly available in many nonprescription vaporized or topical "cold" medications, topical musculoskeletal anesthetic "rubs" and "cold sore" preparations, though its efficacy is largely unproven. Data from the American Association of Poison Control Centers demonstrate that camphor continues to be a common source of pediatric exposures. A review of the literature reveals persistent reports of toxicity resulting from exposure to relatively small amounts. In the pediatric population, exposure to as little as 500 mg is cited as a cause of mortality. More commonly, 750 to 1000 mg are associated with the development of seizures and death. Currently available products with 10% camphor contain 500 mg in 5 mL. It is concluded that small doses are dangerous. In children less than 6 years of age, exposure to 500 mg or more requires rapid triage to the closest health care facility.