The American journal of emergency medicine
-
Prognostic systems are complex. So it is necessary to find tools, which are easy to use and have good calibration and discrimination. ⋯ The TIMI scale discriminated hospital mortality correctly for STEMI. It performed better than Killip alone and similar to a simple model that included age and Killip. The 2-variable model consists of a simple scale with 5 categories.
-
Acute severe hypophosphatemia can be life threatening and is associated with mortality and impaired cardiac and respiratory function. Several conditions including decreased absorption or increased urinary phosphate excretion, shifts from the extracellular to intracellular compartments, and phosphate consumption by rapidly proliferating cells are known to induce moderate to severe acute hypophosphatemia. Although hypophosphatemia and/or phosphate depletion in patients with acute or chronic myeloid leukemia have been reported in the literature, hypophosphatemia due to acute lymphoblastic leukemia (ALL) is very rare. ⋯ On the second day of treatment, the patient began to improve, and the patient gradually fully recovered within 5 days. We suggested that this hypophosphatemia was induced by a shift of phosphorus into leukemic cells that rapidly replicated in the tissues and excessive cellular phosphate consumption by rapidly proliferating cells. Serum phosphate levels should always be monitored,especially in suspected life-threatening manifestation in relapsed ALL.
-
Ultrasound of the inferior vena cava (IVC) is a noninvasive and rapidly obtainable method of intravascular volume assessment; however not all patients can lie supine for this procedure. In this study we assess whether patient positioning affects IVC diameter metrics. ⋯ IVC metrics do not change significantly based on patient position. For those patients who are unable to lay completely supine, a semi-upright measurement of the IVC for volume status may be an accurate alternative.
-
Bosworth described an unusual fracture dislocation of the ankle with fixed posterior fracture dislocation of the fibula. This ankle fracture variant is often not recognized in initial radiographs and requires a computed tomographic scan for verification. It is usually not reducible by the closed method, and repeated trials induce more damage. The purpose of this study was to verify the usefulness of simple external oblique radiographs for diagnosis of Bosworth-type fracture. ⋯ An external oblique radiograph provides useful information that can differentiate Bosworth-type fracture from other reducible bimalleolar fractures.
-
Extracorporeal shock wave lithotripsy (ESWL) is considered the treatment of choice for most renal and upper ureteral stones. Although extensive data have documented its safety, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and rupture of aortic aneurysms. Here, we report a 41-year-old woman who underwent ESWL for a calculus at the right renal pelvis and immediately developed acute pancreatitis after the procedure. Although the possibility of post-ESWL acute pancreatitisis extremely low, physicians must be aware of this complication in emergency departments.