The American journal of emergency medicine
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Comparative Study
Age-associated time delays in the treatment of acute myocardial infarction with primary percutaneous transluminal coronary angioplasty.
Multiple studies have shown that age is a significant factor associated with suboptimal treatment for acute myocardial infarction (AMI). We performed a retrospective pilot study using a chart review of patients who presented with AMI who were subsequently treated with percutaneous transluminal coronary angioplasty (PTCA) from November 1995 to January 1997 at our institution. Ninety-four patients met inclusion criteria, with 5 excluded for insufficient data. ⋯ Statistical analysis was performed using analysis of variance ( P = 0.04). In this study, age was associated with treatment delays. There was a parabolic relationship of age with time, with a greater time delay occurring in "younger" and "older" patients.
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Review Case Reports Historical Article
Evolution of our knowledge of sudden death due to commotio cordis.
Commotio cordis refers to circulatory arrest due to a nonpenetrating blow to the chest. First discovered in 1932 in a study using large rabbits, it came to the attention of clinicians who encountered children dying suddenly from a chest blow while engaging in sports activities. This review traces the history of commotio cordis, establishes the conditions necessary for sudden death from a nonpenetrating chest blow, and presents the first ECG record showing that a chest blow landing in the ventricular vulnerable period can produce ventricular fibrillation. The conditions necessary for sustaining ventricular fibrillation and numerous examples of sudden death by commotio cordis are presented.
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Dental examination is very important in any patient presenting with craniofacial trauma. Avulsed teeth must be accounted for as they can be found in distant anatomical sites with potential life-threatening complications.
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To establish a clinical pathway for outpatient enoxaparin therapy in deep venous thrombosis (DVT) and then characterize its implementation and barriers to use. ⋯ The establishment of an organized DVT pathway for outpatient enoxaparin may facilitate home therapy; however, there will remain reasons that make hospital admission unavoidable in some patients.
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Comparative Study
Can ruptured appendicitis be detected preoperatively in the ED?
The purpose of this study is to determine which clinical symptoms/signs and computed tomography (CT) signs can help in distinguishing ruptured from simple appendicitis. ⋯ Besides some clinical findings, CT scan can accurately determine appendiceal rupture in acute appendicitis and can further demonstrate the presence of local inflammatory mass, facilitating management decision in the emergency department (ED).