The American journal of emergency medicine
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To determine the use of end-tidal carbon dioxide (etco2) as an end point of sepsis resuscitation. ⋯ End-tidal carbon dioxide is unlikely to be a useful clinical end point for sepsis resuscitation, although it may be useful as a triage tool in suspected sepsis because baseline values may reflect initial lactate.
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We are reporting a case, which may represent a new entity within the diagnosis of acute myocarditis. The patient was admitted with new onset atrioventricular block, very high troponin I, peaking at 266ng/mL, and normal left ventricular function. We also used a novel computer tomography technique with delayed enhancement to diagnose myocarditis, as the patient with a permanent pacemaker could not have magnetic resonance imaging.
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Comparative Study
Comorbidities and complications influence the diagnosis and management of geriatric supraglottitis.
This study aimed to assess the differences in the clinical characteristics, management, and outcomes of supraglottitis between geriatric and nongeriatric adults over a 30-month period. ⋯ The clinical characteristics and management were similar between the geriatric and nongeriatric supraglottitis patients. Nevertheless, the comorbidities altered the clinical presentations of the geriatric patients and resulted in lower diagnostic accuracy. Additionally, the elevated complication rates of the geriatric patient might have negatively affected their outcomes.
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In an attempt to begin ST-segment elevation myocardial infarction (STEMI) treatment more quickly (referred to as door-to-balloon [DTB] time) by minimizing preventable delays in electrocardiogram (ECG) interpretation, cardiac catheterization laboratory (CCL) activation was changed from activation by the emergency physician (code heart I) to activation by a single page if the ECG is interpreted as STEMI by the ECG machine (ECG machine auto-interpretation) (code heart II). We sought to determine the impact of ECG machine auto-interpretation on CCL activation. ⋯ Cardiac catheterization laboratory activation by ECG machine auto-interpretation does not reduce DTB time and often unnecessarily activates the code heart system compared with emergency physician-initiated activation. This system therefore decreases the appropriateness of CCL activation.
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Emergency department observation units (EDOUs) represent an opportunity to efficiently manage patients with common conditions requiring short-term hospital care. Understanding which patients are ultimately admitted to the hospital after care in an EDOU may enhance patient selection for EDOU care. ⋯ Across the United States in 2009 to 2010, older patient age was a strong predictor of admission after EDOU care, suggesting that older patients are more likely to require inpatient hospital services after EDOU care than younger patients.