The American journal of emergency medicine
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Nonurgent visits to emergency departments (ED) are a controversial issue; they have been negatively associated with crowding and costs. We have conducted a critical review of the literature regarding methods for categorizing ED visits into urgent or nonurgent and analyzed the proportions of nonurgent ED visits. We found 51 methods of categorization. ⋯ The proportions of nonurgent ED visits varied considerably: 4.8% to 90%, with a median of 32%. Comparisons of methods of categorization in the same population showed variability in levels of agreement. Our review has highlighted the lack of reliability and reproducibility.
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Case Reports
The double lung point: an unusual sonographic sign of juvenile spontaneous pneumothorax.
Lung ultrasound is extremely useful in the bedside diagnosis of pneumothorax. The lung point, which is the sonographic demonstration of the point on the chest wall where the pleural layers adhere again, represents the limit of the pneumothorax extension and allows estimation of its volume. This sonographic sign is not only highly accurate in ruling-in pneumothorax but also helps the clinician in deciding whether to place a chest tube. ⋯ The double lung point is explained by the fact that the air is not free in the pleural space but forms a bulla surrounded by adherent pleural layers. In this case, the ultrasound examination could be confounding and the clinician should be aware of it. This phenomenon is quite rare in the juvenile spontaneous pneumothorax, being more frequent in case of secondary pneumothorax.
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Taxine, a yew tree toxin, is highly cardiotoxic. We report the case of a patient who developed severe cardiac failure and ventricular fibrillation after consuming yew leaves and who made a full recovery after extracorporeal life support. Yew poisoning can be added to the list of potential indications of extracorporeal life support for refractory toxic cardiogenic shock.
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Often, patients are brought in to the emergency department after ingesting large amounts of cocaine in an attempt to conceal it. This act is known as body stuffing. The observation period required to recognize potential toxic adverse effects in these patients is not well described in the literature. ⋯ One hundred six patients met final inclusion criteria as adult cocaine stuffers. No patients developed life-threatening symptoms, and no patients died during observation. In our medical setting, stuffers could be discharged after a 6-hour observation period if there was either complete resolution or absence of clinical symptoms.