Annals of emergency medicine
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Comparative Study Clinical Trial
Serum progesterone testing to predict ectopic pregnancy in symptomatic first-trimester patients.
This study was conducted to prospectively measure the accuracy of serum progesterone levels to detect ectopic pregnancy. ⋯ Given similar disease prevalence, roughly one fourth (178/716) of symptomatic patients can be classified as low risk (0%, 95% confidence interval 0 to 2%) for having an ectopic pregnancy using a progesterone cutoff of 22 ng/mL. Whether implementation of rapid progesterone testing can safely expedite care and reduce the need for urgent diagnostic evaluation or admission remains to be determined.
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We report the case of a 49-year-old man in whom a diagnosis of Brugada syndrome was made after he presented to the emergency department for evaluation of a syncopal episode. The diagnosis was made by ECG changes, after the characteristic findings of peculiar downsloping ST-segment elevation in leads V(1) and V(2) and QRS morphology resembling a right bundle branch block were identified. Emergency physician recognition of this syndrome and its ECG findings is essential, because without treatment the incidence of sudden cardiac death in these patients is high.
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Comparative Study Clinical Trial
Necessity of radiographs in the emergency department management of shoulder dislocations.
To determine the necessity of radiographs in the emergency department management of patients with suspected shoulder dislocation. ⋯ Physicians are highly accurate in the clinical determination of shoulder dislocation and relocation. Radiographs should be obtained when the physician is uncertain of dislocation or reduction. Prereduction films should be obtained for patients with a blunt traumatic mechanism of injury, and postreduction for those found to have a fracture-dislocation. However, postreduction films add little in patients without fractures, and neither prereduction nor postreduction films are likely to affect the ED management of patients with recurrent dislocation by an atraumatic mechanism. Prospective validation of the derived algorithm is suggested.
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[Wyer PC, Rowe BH, Guyatt GH, Cordell WH. The clinician and the medical literature: when can we take a shortcut? Ann Emerg Med. August 2000;36:149-155.].
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[American College of Emergency Physicians. School bus safety. Ann Emerg Med. August 2000;36:179.].