The American journal of emergency medicine
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Occult pneumothoraces (PTXs), which are not visible on chest x-ray, may progress to tension PTX. The aim of study was to establish the prevalence of large occult PTXs upon admission of patients with severe blunt trauma, according to prehospital mechanical ventilation. ⋯ Six percent of studied patients with severe trauma had a large and occult PTX as soon as admission despite a normal chest x-ray result. The observed sizes and rates of occult PTX were comparable regardless of the initiation of early mechanical ventilation.
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A 46-year-old male patient with tetralogy of Fallot presented to the emergency department with progressive dyspnea for 3 days. The dyspnea was refractory to treatment for tet spells. ⋯ Chronic hypoxemia-induced secondary polycythemia and the consequent increase in blood hyperviscosity predisposed this patient to PE. This case reminds us of the similarity in clinical presentation between PE and tet spells.
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Point-of-care testing for urine human chorionic gonadotropin (hCG) allows rapid diagnosis of pregnancy and pregnancy-related disorders at the bedside. Urine hCG test kits use enzyme-linked immunosorbent assay technology and incorporate 2 types of monoclonal antibody in a sandwich structure. There have been case reports in a variety of disease states reporting interference with this method leading to false-positive results. ⋯ This initial test result reverted to a true-negative result after 48 hours, suggesting the transient passage of an interferent into the urine at the time of initial testing. This may have been a molecule produced as part of the host inflammatory response or from bacterial synthesis of an interferent with hCG-like antigenic structure. It is important that clinicians are aware of the mechanisms and limitations of urine hCG testing and maintain a low threshold to undertake early serum hCG testing to confirm diagnosis.
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Ambulance diversion presents a dilemma pitting the ethical principles of patient autonomy and beneficence against the principles of justice and nonmaleficence. The guiding priority in requesting ambulance diversion is to maintain the safety of all patients in the emergency department as well as those waiting to be seen. ⋯ More importantly, the discussion must focus on addressing the operational inefficiencies within our health systems that lead to conditions such as patient boarding, high waiting room congestion, and ambulance diversion. Addressing these inefficiencies has a greater potential impact on ambulance diversion than simply banning or restricting the practice for practical or ethical considerations.