The American journal of emergency medicine
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Clinical Trial
Interrater reliability of hemodynamic profiling of patients with heart failure in the ED.
Hemodynamic profiling (HP) of patients with heart failure (HF) based on clinical assessment of central congestion and peripheral perfusion has been widely used by cardiologists to help guide therapy and determine prognosis but has never been tested or validated in the emergency department (ED). We hypothesized that the interrater reliability of HP in the ED would be good or greater than 0.6. ⋯ Hemodynamic profiling of patients with HF by emergency physicians in the ED is not highly reliable. One in 5 patients thought to have HF in the ED did not have a final diagnosis of HF.
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Overuse of resources when evaluating pulmonary embolism (PE) is a concern if the D-dimer assay is improperly used in the evaluation of emergency department patients with suspected PE. The pulmonary embolism rule-out criteria (PERC) rule was derived to prevent unnecessary diagnostic testing in this patient population. The objective of this study was to assess the PERC rule's performance in an external population. ⋯ The PERC rule may identify a cohort of patients with suspected PE for whom diagnostic testing beyond history and physical examination is not indicated.
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Aortic dissection is a potentially life-threatening condition that must be diagnosed early and accurately. Here we report a case of type A aortic dissection presenting with seizure and unconsciousness. We thought this rare manifestation should be reported because misdiagnosis of such cases could lead to disastrous results.
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The objective of the study was to determine how many patient-related questions emergency medicine physicians have and how they answer them at the point of care. ⋯ Emergency department physicians in this study pursued and found answers for most questions posed at the point of care. Rapid access to electronic resources and drug-prescribing references were critical for answering questions at the point of care.
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Etomidate is an agent often used by emergency medicine physicians for rapid-sequence intubation induction of critically ill patients because of its reliable pharmacokinetics and cardiovascular stability. Etomidate is known to inhibit endogenous cortisol production through inhibition of 11beta-hydroxylase. Previous studies in undifferentiated emergency department patients and healthy, elective surgical patients have shown this effect to be only transient and not clinically significant. ⋯ It is unknown at this time if any increase in mortality associated with etomidate-induced adrenal suppression would be offset by concomitant corticosteroid administration. Aggressive resuscitation of septic patients with fluids, antibiotics, and vasopressors has been shown to significantly reduce mortality and may allow for the use of alternative agents that had previously been discouraged because of concern for hemodynamic collapse during intubation. A prospective randomized trial in septic patients of etomidate induction with early corticotropin stimulation testing or corticosteroid supplementation vs the use of alternative induction agents with enough power to detect differences in mortality is needed to further address this clinical dilemma.