The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of propofol versus alfentanil for moderate procedural sedation in the emergency department.
To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol. ⋯ We found a similar frequency of airway and respiratory adverse events leading to intervention between alfentanil and propofol used for moderate procedural sedation. Both agents appear safe for moderate procedural sedation.
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In emergency medicine (EM), patient care documentation serves many functions, including supporting reimbursement. In addition, many electronic health record systems facilitate automatically populating certain data fields. As a result, in the academic model, the attending's note may now more often recapitulate many of the same elements found in the resident's or physician assistant's (PA) note. We sought to determine the value of additional attending documentation, and how often the attending documentation prevented a downcoding event. ⋯ In this study of an academic medical center documentation model with an EHR, EM attending documentation of the history of present illness, review of systems, physical exam, and medical decision making portions prevented downcoding in a small number of cases. In addition, there was no significant difference in the incidence of prevented downcoding events between residents and PAs.
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Guillain-Barre Syndrome (GBS) is a life-threatening condition in which patients may present to the Emergency Department in respiratory distress leading to death. The early identification and treatment of such a condition is paramount in preventing mortality. While there are many infections associated with GBS, the association with Lyme disease is uncommon. ⋯ In this case we report a 31-year-old male who was diagnosed with Lyme disease and GBS with relevant clinical presentation including progressive numbness and weakness in bilateral hands and feet for the past 1week along with areflexia. Initiation of medical therapy with intravenous immunoglobulin and parenteral ceftriaxone resulted in resolution of his symptoms. The treatment of both diseases early can help prevent further central nervous complications leading to high morbidity and mortality.
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Horton's disease is a systemic inflammatory vasculitis, usually found in persons over 50years old. It affects medium and large-sized arteries stemming from the external carotid, especially the superficial temporal arteries. It can affect extracranial large vessels but only rarely the aorta. Diagnosis of aortitis is difficult and its incidence is probably underestimated. ⋯ In the present case, this patient had Horton's disease, based on 3 criteria of The American College of Rheumatology (age, temporal artery abnormalities and inflammatory syndrome) associated with aortitis. However, aortitis is a rare complication of Horton disease and is a major cause of mortality inasmuch as it can be complicated by aneurysm and dissection. It is unusual to diagnose Horton's disease from aortitis symptoms without complications. The aorta represents the most severe localization of Horton's disease. It should not be ignored in etiological hypotheses regarding febrile abdominal pain in the elderly. Corticosteroids should be started rapidly at high doses and temporal artery biopsy should be planned.
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Idiopathic Intracranial Hypertension (IIH) is a syndrome seen predominantly in obese women of reproductive age group, characterized by signs and symptoms of increased intracranial pressure due to an unknown cause. Some individuals have a more malignant form of disease called fulminant idiopathic intracranial hypertension with rapid worsening of symptoms over days. ⋯ She was managed with prompt surgical intervention. In patients with fulminant idiopathic intracranial hypertension, surgery such as cerebrospinal fluid shunting or optic nerve sheath fenestration should not be delayed to prevent vision loss.