The American journal of emergency medicine
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Observational Study
Gonorrhea and chlamydia in the emergency department: Continued need for more focused treatment for men, women and pregnant women.
Delay in current nucleic acid amplification testing for Neisseria gonorrhoeae and Chlamydia trachomatis has led to recommendations for presumptive treatment in patients with concern for infection and unreliable follow-up. In the urban setting, it is assumed that many patients have unreliable follow-up, therefore presumptive therapy is thought to be used frequently. We sought to measure the frequency of disease and accuracy of presumptive treatment for these infections. ⋯ Inaccuracy of presumptive treatment was common for these sexually transmitted infections. There is an opportunity to improve diagnostic accuracy for treatment.
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Observational Study
Presenting phenotypes of acute heart failure patients in the emergency department: Identification and implications.
There is little known about the baseline hemodynamic (HD) profiles (beyond pulse/blood pressure) of patients presenting to the Emergency department (ED) with acute heart failure (AHF). Assessing these baseline parameters could help differentiate underlying HD phenotypes which could be used to develop specific phenotypic specific approaches to patient care. ⋯ Three distinct clusters were defined using novel noninvasive presenting HD monitoring technology in this cohort of ED AHF patients. Further studies are needed to determine whether phenotypic specific therapies based on these clusters can improve outcomes.
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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.