The American journal of emergency medicine
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Randomized Controlled Trial
Accuracy of Trans-Abdominal Ultrasound in a Simulated Massive Acute Overdose.
Toxic ingestions are a common cause of morbidity and mortality in the United States. In 2013, there were nearly 2 million reported ingestions and nearly 1000 deaths from poisonings. There is no well-validated imaging study for confirming the presence of pills in the stomach of an overdose patient. There are case reports of ultrasound used for confirmation of pills in the stomach, and we are aware of one prospective trial to evaluate sonography for this application. ⋯ There is poor sensitivity and specificity for ultrasound detection of pills in the stomach at time 0; these values fell substantially at 60 and 90 minutes post-ingestion. In this pilot study, we did not find ultrasound to be a useful screening tool for detecting pills in the stomach.
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Although cardiac stress testing may help establish the safety of early discharge in patients with suspected acute coronary syndromes and negative troponins, more cost-effective strategies are necessary. We aimed to develop a clinical prediction rule to safely obviate the need for cardiac stress testing in this setting. ⋯ This novel prediction rule based on a combination of readily available clinical characteristics may be a valuable tool to decide whether stress testing can be reliably avoided in patients with acute chest pain and negative troponins.
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Observational Study
Safety and efficacy of pharmacological cardioversion of recent-onset atrial fibrillation: a single-center experience.
The management of patients with recent-onset atrial fibrillation (AF) presenting at emergency departments (EDs) varies widely. Our aim was to describe the management of patients with recent-onset (<48 hours) AF, to determine safety and efficacy of pharmacological cardioversion at the ED, and to evaluate the incidence of thromboembolism or death at 30 days. ⋯ Pharmacological cardioversion followed by discharge after a short observation period is safe. There was no significant difference between the agents used in terms of short-term safety and efficacy. Importantly, the coherence of the ED to recent guidelines regarding first-line therapy is high.
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Observational Study
Prevalence and risk factors for central diabetes insipidus in cardiac arrest survivor treated with targeted temperature management.
Central diabetes insipidus (CDI) is a marker of severe brain injury. Here we aimed to investigate the prevalence and risk factors of CDI in cardiac arrest survivors treated with targeted temperature management (TTM). ⋯ Central diabetes insipidus developed in 12% of cardiac arrest survivors treated with TTM, and those with CDI showed poor neurologic outcomes and high mortality rates. Younger age, nonshockable rhythm, long downtime, and asphyxia arrest were significant risk factors for development of CDI.