The American journal of emergency medicine
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Plasma ammonia measurement is a simple yet important screening in the ED for patients with unexplained stupor or delirium. Acute hyperammonemia is a medical emergency for which immediate steps must be taken to minimize permanent brain damage. Although the most common causes of hyperammonemia are severe abnormal liver function, the absence of liver disease in some cases has been observed. ⋯ Once a specific diagnosis was reached, protein restriction, essential amino acid supplementation, efficient chemotherapy, and valproic acid and 5-FU level discontinuance were instituted. In this report, the clinical presentation, pathogenesis, and diagnostic workup for various hyperammonemia causes are discussed. Every EP should understand that the clinical symptoms for hyperammonemia and prognosis are related to early diagnosis.
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Many rapid d-dimer assays are commercially available with wide ranges of reported sensitivities, often based on small sample sizes. This has limited their intended use as rapid and inexpensive tests to evaluate pulmonary embolism in the low-risk patient. We sought to determine the sensitivity of the STA-Liatest D-Di d-dimer assay in our ED. ⋯ Using the exact method, the sensitivity of this assay was calculated to be 100% with a 95% confidence interval (CI) of 91.4% to 100%. Our results suggest that the STA-Liatest D-Di d-dimer assay could have an adequate sensitivity to be used to rule out pulmonary embolism in low-risk patients. Further prospective studies with larger sample sizes are required to validate this observation.
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The objective of this study was to determine the rate of positive ED diagnostic evaluations and significant interventions during the hospitalization of infants after an apparent life-threatening event (ALTE). The study was performed at a single, tertiary care children's hospital. Patients under 6 months of age were identified for a potential ALTE from the ED chief complaint log. ⋯ Risk factors for significant medical interventions included prematurity, a positive medical history, and age >60 days. The overall rate of either positive ED diagnostic evaluations or significant medical interventions during hospitalizations of infants after an ALTE is low. A majority of these patients can be best managed with a limited ED diagnostic evaluation and a period of observation.
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Letter Case Reports
Multiple organ dysfunction syndrome associated with Salmonella typhi infection.