The American journal of emergency medicine
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The purpose of this study was to demonstrate the computed tomography (CT) features of pulmonary tuberculosis in patients with acute clinical manifestations. The emergent CT images of 46 non-AIDS patients with acute clinical presentations of pulmonary tuberculosis (TB) were analyzed. The distribution and characterization of the pulmonary and pleural lesions were specifically focused. ⋯ On followup, 12 patients (26%) developed acute respiratory failure. Patients presenting with multifocal pulmonary consolidation, with or without cavitations, on CT should undergo early pulmonary TB workup. These findings could help early detection for pulmonary TB.
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Correctly identifying and appropriately triaging patients who present to the ED with the broad range of symptoms suggestive of acute cardiac ischemia (ACI: unstable angina pectoris [UAP] and acute myocardial infarction [AMI]) remains one of the greatest challenges in EM. Although a number of diagnostic technologies have been described to aid in this triage process, each of these tests or technologies has limitations. We report a case series in which either the use of adjuncts with unknown performance or tests with known but not considered limitations could have contributed to the failure to appropriately triage and treat patients with ACI. ⋯ The limitations of a negative exercise electrocardiographic stress test (ETT) are illustrated in the second case. Finally, the limitations of a negative coronary angiogram, the "gold standard" test for symptomatic coronary artery disease, are discussed. We review the literature on technologies to aid in the evaluation of patients who present to the ED with symptoms suggestive of ACI.
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Response time is a very important factor in determining the quality of prehospital EMS. Our objective was to model the response by Israeli ambulances and to offer model-derived strategies for improved deployment of ambulances to reduce response time. Using a geographic information system (GIS), a retrospective review of computerized ambulance call and dispatch logs was performed in two different regional districts, one large and urban and the other rural. ⋯ Before using the GIS model, mean response times in the Carmel and Lachish districts were 12.3 and 9.2 minutes, respectively, with 34% and 62% of calls responded within 8 minutes. When ambulances were positioned within the modeled polygons, more than 94% of calls met the 8-minute criterion. The GIS simulation model presented in this study suggests that EMS could be more effective if a dynamic load-responsive ambulance deployment is adopted, potentially resulting in increased survival and cost-effectiveness.