The American journal of emergency medicine
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Comparative Study
Variation in hospital admission rates between a tertiary care and two freestanding emergency departments.
Recently, freestanding emergency departments (FSEDs) have grown significantly in number. Critics have expressed concern that FSEDs may increase healthcare costs. ⋯ In our healthcare system, FSEDs showed a trend towards a 20% lower admission rate for chest pain, COPD, asthma and CHF.
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Acute cardiopulmonary distress in pregnancy always carries exceptionally arduous challenge for physicians. Here we report a patient who sustained spontaneous chordae tendineae rupture complicated with severe mitral regurgitation and acute pulmonary edema during peripartum period. ⋯ However, certain physiological stress, including hormone changes related matrix remodeling, increased cardiac output during pregnancy or labor pain may precipitate to this condition. Literature reviews from previously reported cases showed that those who were diagnosed chordae tendineae rupture at very preterm period all had preterm delivery.
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Black widow species (Latrodectus species) envenomation can produce a syndrome characterized by painful muscle rigidity and autonomic disturbances. Symptoms tend to be more severe in young children and adults. We describe black widow spider exposures and treatment in the pediatric age group, and investigate reasons for not using antivenom in severe cases. ⋯ In our study, most symptomatic black widow envenomations were minor. Relatively few patients received antivenom, but antivenom use was associated with shorter symptom duration among moderate and major outcome groups.
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We report a 24year old female who presented with sudden and severe headaches after recent carbon monoxide poisoning. Imaging revealed an acute cerebral venous thrombosis. ⋯ However, little data is available regarding the correlation between carbon monoxide poisoning and cerebral venous thrombosis. This case demonstrates that such a correlation should be considered in acute intracerebral thrombotic events.
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In out-of-hospital cardiac arrest (OHCA) patients resuscitated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), known as extracorporeal cardiopulmonary resuscitation (ECPR), bleeding is a common complication. The purpose of this study was to assess the risk factors for bleeding complications in ECPR patients. ⋯ D-dimer levels may predict major bleeding in ECPR patients, suggesting that hyperfibrinolysis may be related to bleeding.