The American journal of emergency medicine
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Several chemotherapeutic agents are known to be cardiotoxic. One of them, 5-fluorouracil (5-FU), has been associated with coronary ischemia and reversible vasospasm. In this report, we describe a 54-year-old man with rectal cancer who developed chest pain during 5-FU infusion. ⋯ The final diagnosis was coronary artery spasm with moderate global left ventricular dilatation suggestive of nonischemic cardiomyopathy. During 3days of hospitalization, the patient remained pain free and therefore was discharged. To our knowledge, this is the first case report in the emergency medicine literature demonstrating a coronary vasospastic event associated with 5-FU cardiac toxicity.
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Observational Study
Feasibility of upright patient positioning and intubation success rates at two academic emergency departments.
Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions. ⋯ In our study emergency medicine residents had a high rate of success intubating in the upright position. While this does not demonstrate causation, it correlates with recent literature challenging the traditional supine approach to intubation and indicates that further investigation into optimal positioning during emergency department intubations is warranted.
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Critically ill patients require significant time and care coordination in the emergency department (ED). We hypothesized that ED crowding would delay time to intravenous fluids and antibiotics, decrease utilization of protocolized care, and increase mortality for patients with severe sepsis or septic shock. ⋯ With increased ED crowding, time to critical severe sepsis therapies significantly increased and protocolized care initiation decreased. As crowding increases, EDs must implement systems that optimize delivery of time-sensitive therapies to critically ill patients.
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Overcrowding in the Emergency Department is a problem with many strategies for intervention such as the physician in triage (PIT). This brief evaluation is designed to minimize diagnostic uncertainty and expedite the work up when the patient is seen in the Emergency Department. We hypothesized that this would increase CT imaging which would be increasingly negative as the pressure to maintain throughput rises on busy days in the Emergency Department. ⋯ There is no difference in CT ordering patterns for abdominal pain by PIT between HD5 and LD5. Likewise CT ordering patterns do not demonstrate a difference in percentage of clinically relevant CTs.