The American journal of emergency medicine
-
Little has been documented regarding hypersensitivity reactions with rivaroxaban or other factor Xa inhibitors. We report the development of a hypersensitivity reaction to rivaroxaban in a 64-year-old African American male patient who presented to the emergency department and was subsequently evaluated in dermatology consultation and follow-up. This case highlights the vigilance required by health care workers in recognizing potential adverse effects of newer anticoagulation therapy and in making medication changes where necessary.
-
Randomized Controlled Trial Comparative Study
Comparison of local anesthetic effect of lidocaine by jet injection vs needle infiltration in lumbar puncture.
Usual routes of drug administration are often painful and invasive. Nowadays, using jet injection has been introduced successfully, as a noninvasive and painless method of anesthetic delivery in performing different procedures. ⋯ Injecting lidocaine by jet injector is less painful than infiltrating it by needle and syringe.
-
Review
Procalcitonin-guided therapy for the initiation of antibiotics in the ED: a systematic review.
Procalcitonin (PCT) is a new biomarker with a higher accuracy in the diagnosis of bacterial infections. Utilization of PCT may reduce the number of unnecessary antibiotics prescribed to patients and consequently may decrease the rise in antibiotic resistance. The aim of this systematic review is to determine if a PCT-guided algorithm can safely reduce the number of antibiotics prescribed to all patients with a suspected of infection in the emergency department (ED). ⋯ Procalcitonin-guided therapy in the ED is only studied in subpopulations, where it was effective and safe in adult patients with respiratory tract infections and not effective but safe nonetheless in specific pediatric populations. Nonadherence is a significant problem in prospective PCT-guided therapy studies. There is not enough evidence to use PCT-guided therapy in a general ED population.
-
Review Case Reports
The emergency management of ventricular assist devices.
Heart failure is a common condition in the United States. When medical therapy fails, ventricular device (LVAD) therapy may be required. With increasing use of LVADs, emergency physicians should understand how to manage problems that may arise with these devices. ⋯ With an increasing number of LVADs, emergency physicians should expect to see patients with complications directly or indirectly related to LVADs. This review provides physicians with an extensive review of LVAD physiology and the evaluation and management of potential complications related to the device.
-
Per the American Heart Association guidelines, blood pressure (BP) should be less than 185/110 to be eligible for stroke thrombolysis. No studies have focused on prehospital BP and its impact on door to needle (DTN) times. We hypothesized that DTN times would be longer for patients with higher prehospital BP. ⋯ Higher prehospital BP is associated with prolonged DTN times and DTN time remains prolonged if prehospital BP greater than or equal to 185/110 is untreated before ED arrival. Prehospital BP control could be a potential area for improvement to reduce DTN times in patients with acute ischemic stroke.