The American journal of emergency medicine
-
Phenytoin has a narrow therapeutic window, and when managing cases of toxicity, clinicians are very wary of this fact. Typically, if patient presents with symptoms suggestive of phenytoin toxicity, total serum phenytoin is promptly ordered. ⋯ Herein, we describe a case of an elderly male patient who presented with drowsiness, gait changes, and elevated liver enzymes and a normal total serum phenytoin level of 18 ng/dL (normal, 10-20 ng/dL). After taking his albumin level into account, his free phenytoin level was calculated to be 27 ng/dL, and the phenytoin was discontinued leading to resolution of his symptoms as well as a return of his liver function panel values to baseline.
-
Although ultrasound is regarded as the first choice imaging modality for evaluating a pediatric neck mass, neck computed tomography (CT) is necessary for urgent surgical conditions such as deep neck infections. Our aim was to evaluate the diagnostic effectiveness of and proper patient selection for neck CT as a method for the initial evaluation of pediatric neck masses in the emergency department. ⋯ Computed tomography could be considered as the first diagnostic modality when an urgent surgical condition such as a deep neck infection is highly suspected.
-
N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been used in the evaluation on heart function in many heart diseases. However, little is known in patients with acute carbon monoxide poisoning (ACOP). Left ventricular ejection fraction (LVEF) can be applied as a preliminary test method to measure the left ventricular function. In the present study, we investigate the clinical significance of NT-proBNP combined with LVEF on heart function in 68 patients with ACOP. ⋯ There are an increased level of NT-proBNP and a decrease of LVEF, which represents a clear sign of heart malfunction by ACOP. Combined NT-proBNP and LVEF detection technique has a significant advantage in the diagnosis of patients with myocardial contraction function damage after ACOP.
-
Performance of percutaneous coronary intervention (PCI) within 90 minutes of hospital arrival for ST-segment elevation myocardial infarction patients is a commonly cited clinical quality measure. The Centers for Medicare and Medicaid Services use this measure to adjust hospital reimbursement via the Value-Based Purchasing Program. This study investigated the relationship between hospital performance on this quality measure and emergency department (ED) operational efficiency. ⋯ Better performance on measures associated with ED efficiency is associated with more timely PCI performance.
-
Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is often a debilitating condition characterized by headaches, blurry vision, nausea, and vomiting. Lumbar puncture (LP) is an essential component of the diagnostic and therapeutic approach; however, the procedure itself can cause postlumbar puncture headache. In addition to the clinical presentation, the use of bedside ultrasound to measure the optic nerve sheath diameter may aid in differentiating the 2 conditions. We hereby report a case of a 33-year old woman with known IIH who presented with recurrent headache after the initial therapeutic LP.