The American journal of emergency medicine
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Randomized Controlled Trial
Isolated sternal fractures treated on an outpatient basis.
The aim of this study is to investigate the need for admission of patients with isolated sternal fracture (ISF) by prospectively and randomly discharging or admitting them. ⋯ Patients with ISF can be discharged safely as soon as investigations are completed. Extensive myocardial assessment is not needed on the posttraumatic period. Myocardial involvement seems unlikely in patients with ISF, who can be treated with oral analgesics.
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The primary objective was to determine the relationship between advanced age and need for admission from an emergency department (ED) observation unit. The secondary objective was to determine the relationship between initial ED vital signs and admission. ⋯ Among patients placed in an ED observation unit, age 65 years or more is not associated with need for admission. Older adults can successfully be discharged from these units. Systolic pressure 180 mm Hg or greater was the only predictive vital sign. In determining appropriateness of patients selected for an ED observation unit, advanced age should not be an automatic disqualifying criterion.
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Children with both headache and hypertension present a relatively rare condition with a broad range of differential diagnoses in pediatric emergency medicine. Some possible diagnoses are potentially life-threatening conditions and merit aggressive evaluation management. We report a case of a 14-year-old girl who presented with headache and hypertension. ⋯ Ophthalmic evaluation revealed bilateral Kayser-Fleischer rings. Finally, she was diagnosed with Wilson disease. This case emphasizes that children with headache and hypertension merit aggressive evaluation and management.
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Comparative Study
A community-based comparison of trauma patient outcomes between D- and L-lactate fluids.
Ringer's lactate is used for patient resuscitation. Lactate naturally occurs in 2 stereoisometric forms, D- and L-lactate, that are added to fluid in equal amounts. Animal studies have demonstrated potentially deleterious effects of d-lactate on vital organs. Using an administrative database, we examined whether D- or L-lactate volume was associated with mortality in patients with trauma. ⋯ Because early administration of D-lactate was associated with mortality and ventilation, physicians and policy makers should recognize the advantages of L-lactate and encourage research on the quality of d- and l-lactate in case mixes beyond trauma.
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Takotsubo cardiomyopathy (TCM) is an underrecognized transient left ventricular dysfunction that mimics clinically an acute coronary syndrome. It has been linked to emotional stress and several clinical entities that provoke a catecholamine surge in the blood stream. We investigated the case of a young female patient who was admitted to the intensive care unit after a significant blood loss due to miscarriage. ⋯ As a result, TCM worsened further the general condition of the patient. There is a high possibility that TCM and hypovolemia can be closely related, and therefore, the treatment of hypovolemia can be adjusted to new standards. Because it has already been proved that TCM can be induced by emotional stress and various pathological entities, further investigations are necessary.