The American journal of emergency medicine
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This study examined the variability of blood pressure measurements and prevalence estimates of elevated blood pressure in emergency department (ED) patients using 4 different methods of categorization. ⋯ Determination of elevated blood pressure in ED patients is largely dependent on the method of blood pressure categorization.
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Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is useful for the triage of patients with dyspnea. Our aim was to determine whether NT-proBNP levels could predict in-hospital outcome in breathless elderly patients. ⋯ NT-proBNP higher than 3855 pg/mL is associated with in-hospital mortality in patients aged 75 years and older admitted for dyspnea.
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Case Reports
The "gastric fluid" sign: an unrecognized false-positive finding during focused assessment for trauma examinations.
The FAST exam has become the current standard for free intraperitoneal fluid determination in most emergency departments. Knowledge of false negative and false positive findings is imperative to improve accuracy. We detail a case in which an important false positive findings previously not discussed in the medical literature was noted. The ability of the physician to recognize the "gastric fluid" sign and make the adjustments accordingly could improve the specificity of the FAST exam, preventing non-therapeutic laparotomies.
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Case Reports
Acute respiratory failure associated with polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty.
We report a case of symptomatic polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty to alert clinicians to this potential cause of pulmonary emboli. A 77-year-old woman developed acute respiratory failure after multilevel percutaneous vertebroplasty. She received mechanical ventilatory support and anticoagulation with low-molecular-weight heparin and warfarin. ⋯ Polymethyl methacrylate cement extravasation into the vertebral venous circulation is common during vertebroplasty. Pulmonary embolism caused by cement migration after this procedure is extremely rare, as reported in the literature to date. However, the frequency of this complication may increase secondary to the widespread use of percutaneous vertebroplasty and kyphoplasty for osteoporotic compression fractures.
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Diaphragmatic rupture occurs in 0.8% to 3.6% of patients after blunt or penetrating thoracoabdominal trauma, and the preoperative diagnosis is difficult. The diagnosis of traumatic diaphragmatic rupture may be made on initial presentation or at any time later. Right-sided diaphragmatic rupture is rare and occurs in approximately 5% to 20% of all diaphragmatic disruptions. ⋯ He was referred to our hospital with the signs of herniation of the right diaphragm, which was manifested in the chest x-rays. The definite diagnosis was made through thoracoabdominal computed tomography. The diaphragmatic rupture was repaired via abdominal approach.