The American journal of emergency medicine
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Neuromuscular paralysis without sedation is an avoidable medical error with negative psychologic and potentially physiologic consequences. We determine the frequency of long-acting paralysis without concurrent sedation among patients intubated in our emergency department (ED) or before arrival. ⋯ Absence of concurrent sedation was common among patients receiving long-acting neuromuscular paralysis before arrival or at our ED, despite implementation of a guideline to improve practice.
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Procalcitonin and interleukin 6 (IL-6) are well-known predictors of blood culture positivity in patients with sepsis. However, the association of procalcitonin and IL-6 with blood culture positivity was assessed separately in previous studies. This study aims to examine and compare the performance of procalcitonin and IL-6, measured concomitantly, in predicting blood culture positivity in patients with sepsis. ⋯ Compared with IL-6, procalcitonin better predicts blood culture positivity in patients with sepsis. Using a predefined procalcitonin cut points will predict most positive blood cultures and reduce the need of blood cultures in almost half of patients with sepsis.
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The end-tidal carbon dioxide (ETCO2) measurement was considered as an essential tool for the assessment of several conditions in emergency medicine. However, the diagnostic role of capnography in dyspneic patients still remains unclear. We aimed to analyze the alteration of the ETCO2 levels in chronic obstructive pulmonary disease (COPD) exacerbations and its role in the decision-making process. ⋯ End-tidal carbon dioxide levels were higher in admitted patients when compared with discharged patients on arrival to the ED. ETCO2 measurement has very little contributions while evaluating patients with COPD exacerbation in the ED.
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To describe changes in the prevalence and severity of pain and prescribing of non-opioid analgesics in US emergency departments (EDs) from 2000 to 2010. ⋯ Large increases in opioid utilization in EDs have coincided with reductions in the use of non-opioid analgesics and an unchanging prevalence of pain among patients.
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Abdominal apoplexy was reported by Barber in 1909, and the occurrence rate of the apoplexy is known to be quite rare, but the mortality is high if untreated. We report an unusual case of abdominal apoplexy due to spontaneous rupture of gastric artery. ⋯ The outcome of the patient was poor, and he died on the second day of admission. As in our case, the mortality can be high, so prompt restoration of circulation volume and early diagnosis should be made in similar cases.