The American journal of emergency medicine
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Multicenter Study
Assessment of emergency physician-performed ultrasound in evaluating nonspecific abdominal pain.
The objective of this pilot study was to lay the groundwork for future studies assessing the impact of emergency physician-performed ultrasound (EPUS) on diagnostic testing and decision making in emergency department (ED) patients with nonspecific abdominal pain (NSAP). ⋯ Emergency physician-performed ultrasound appears to positively impact decision making and diagnostic workup for patients presenting to the ED with NSAP and should be studied further.
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Randomized Controlled Trial Comparative Study
The comparison of heparinized insulin syringes and safety-engineered blood gas syringes used in arterial blood gas sampling in the ED setting (randomized controlled study).
The arterial blood gas measurement process is a painful and invasive procedure, often uncomfortable for both the patient and the physician. Because the patient-related factors that determine the difficulty of the process cannot be controlled, the physician-related factors and blood gas measurement techniques are a modifiable area of improvement that ought to be considered. Many hospitals use insulin syringes or syringes washed with heparin for the purpose of blood gas measurement because they do not have blood gas-specific syringes. In this prospective cross-sectional study, we aimed to compare safety-engineered blood gas syringes and conventional heparinized syringes used during the arterial blood gas extraction process in terms of ease of operation, the physician-patient satisfaction, laboratory appropriateness, and complications. ⋯ In this study, we did not find any significant differences between the conventional heparinized syringes and safety-engineered blood gas syringes in terms of ease of operation, physician and patient satisfaction, and appropriateness of the taken sample. However, patients whose arterial blood gas was extracted by using safety-engineered blood gas syringes felt less pain and experienced fewer infections and hematomas at their puncture site.
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Infectious endocarditis (IE) in febrile injection drug users (IDUs) is a critical diagnosis to identify in the emergency department (ED). A decision tool that identifies patients at very low risk for endocarditis using readily available clinical data could reduce admissions and cost. ⋯ The PRE-IDU instrument predicted IE with high sensitivity and ruled out IE with high negative predictive value. Our logistic regression model provided posttest probabilities ranging from 3% to 20%. The PRE-IDU instrument and the associated model may help guide hospital admission and diagnostic testing in evaluation of febrile IDUs in the ED.
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Case Reports
A patient with altered mental status and possible seizure reveals an atypical aortic dissection upon workup.
Aortic dissection occurs when a tear occurs in the inner muscle wall lining of the aorta, allowing blood to split the muscle layers of the aortic wall apart. It is classically characterized by pain that starts in the upper chest, which then radiates to the upper back and is tearing or ripping in quality. Our objective is to present a case followed by a brief literature review of aortic dissection and uncommon but important features that may be demonstrated. ⋯ The patient did well and was discharged from the hospital 5 days later without any permanent sequalae. Aortic dissection is both rare and life threatening and may present with atypical signs. It is important to note that patients may show no signs of typical features or may even display other symptoms based on other branches from the aorta that have been occluded.
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Clivus fracture (CF), which is usually reported to accompany with head trauma, has high mortality rates. Early diagnosis of CF is rare because of high mortality rates and inadequate urgent radiologic techniques; however, diagnosis rates are increasing with computed tomography images obtained in high resolution and thin sections. In this article, radiologic and clinical features of 2 patients who were detected to have longitudinal CF after head trauma are presented and accompanying pathologies and its importance for prognosis are discussed under the light of literature data composed of a small number of reports.