The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Comparison of cricoid pressure effect between McGRATH® MAC and Pentax-AWS Airwayscope®: A prospective randomized trials.
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Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates. ⋯ A score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea.
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Chest radiography is the initial choice for thoracic imaging. However, the wide availability of computed tomography (CT) has led to a substantial increase in its use in the emergency department (ED). We evaluated the utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies, and determined if the diagnosis and management decision changed after CT. ⋯ Chest CT may be an appropriate imaging choice in patients presenting to the ED for non-traumatic reasons, particularly for elderly patients and when the radiograph is taken with the AP technique in a supine position.
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Brugada syndrome (BrS) is a genetic heart disorder due to alteration of the ion channels function that causes an impaired in the cardiac conduction system. It is characterized by an abnormal electrocardiogram pattern and may be complicated by malignant ventricular arrhythmias. Pericarditis is an inflammation of the pericardium and 90% of isolated cases of acute pericarditis are idiopathic or viral. Acute pericarditis may appears with chest pain, fever, pericardial friction rub, and cardiac tamponade. Moreover, widespread ST segment changes occur due to involvement of the underlying epicardium. ⋯ Our case report shows that the pericarditis may mimic BrS. Moreover, it is important to underline that a Brugada ECG pattern should only be considered as a sign of electrical heart disease but detailed diagnostic tests are anyway needed.
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Antibiotics are overprescribed for abnormal urine tests including asymptomatic bacteriuria (AB), contributing to rising antimicrobial resistance rates. Pharmacists reviewed urine cultures daily from emergency department (ED) encounters to assess antibiotic appropriateness. We studied antibiotic prescribing practices and assessed compliance to national guidelines, correlations with urine analysis (UA) components, and opportunities for antimicrobial stewardship in the ED. ⋯ Pharmacist intervention in discontinuing or modifying antibiotics for asymptomatic patients with urine cultures reduced unnecessary antibiotic exposure and was a first step in antimicrobial stewardship efforts in the ED. Future work includes limiting urine tests and subsequent antibiotic therapy for non-pregnant asymptomatic patients.