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At my request,Andrew immediately came home from work. Ultrasonography (US) is helpful if abnor-mally twisted course of superior mesenteric artery and vein(whirlpool sign) is seen in color Doppler US. An evaluation based on American ThoracicSociety recommendations

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If there is any apparent facial weakness or asym-metry, do not give the patient anything by mouth (NPO).If everything appears normal, have the patient swallowabout 30 oz of water.

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