The American journal of emergency medicine
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Review Meta Analysis
Prognostic role of copeptin after traumatic brain injury: A systematic review and meta-analysis of observational studies.
Copeptin, the C-terminal portion of provasopressin, has emerged as a novel prognostic marker in neurocritical care, such as in traumatic brain injury (TBI). The aim of this study was to quantitatively assess the prognostic significance of initial plasma copeptin levels in the neurological outcome and mortality after traumatic brain injury. ⋯ The present meta-analysis suggests that early measurement of plasma copeptin levels can provide better prognostic information about the functional outcome and mortality in patients with TBI.
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Randomized Controlled Trial Comparative Study
Differences in test ordering between nurse practitioners and attending emergency physicians when acting as Provider in Triage.
To compare diagnostic test ordering practices of NPs with those of physicians in the role of Provider in Triage (PIT). ⋯ NPs in the PIT role ordered slightly less diagnostic tests than attending physicians. This slight difference did not affect time spent in an ED bed. By the end of the ED stay, there was no significant difference in total test categories ordered between provider types. PIT staffing with NPs does not appear to be associated with excess test ordering or prolonged ED patient stays.
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Constipation is a common cause of abdominal pain in children presenting to the emergency department (ED). The objectives of this study were to determine the diagnostic evaluation undertaken for constipation and to assess the association of the evaluation with final ED disposition. ⋯ The diagnostic evaluation of children diagnosed with fecal impaction in the ED varied. Abdominal imaging may be avoided if children receive a DRE. When children presenting to the ED with abdominal pain had an abdominal radiograph, they were more likely to be admitted.
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Case Reports
The misleading electrocardiogram - Midventricular Takotsubo masquerading as anterior wall STEMI.
Midventricular Takotsubo cardiomyopathy (TC) is a relatively rare variant of stress induced cardiomyopathy, wherein there is akinesis of only the mid-ventricular segment with or without hyperkinesis of apical and basal ventricular segments. The ECG findings of TC typically do not include ST segment elevation in V1-V2 and are unlikely to be associated with reciprocal changes in inferior leads. ⋯ In our patient, the ECG had changes strongly suggestive of STEMI, however had normal coronaries on cardiac catheterization. This case highlights the importance of carefully analyzing the ECG in emergency situations for differences between TC and STEMI and when in doubt, cardiac catheterization should be pursued.