The American journal of emergency medicine
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Observational Study
Low-level troponin elevations following a reduced troponin I cutoff: Increased resource utilization without improved outcomes.
The study sought to evaluate changes in mortality and resource utilization in patients with low level troponin elevations following a reduction in the cutoff for normal troponin I (TnI) from 0.5 ng/mL to the 99th percentile (0.06 ng/mL). ⋯ A reduction in the TnI cutoff to the 99th percentile did not change mortality or rates of coronary intervention in ED patients with low level troponin elevations, but significantly increased the use of cardiology resources.
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Direct laryngoscopy can be performed using curved or straight blades, and providers usually choose the blade they are most comfortable with. However, curved blades are anecdotally thought of as easier to use than straight blades. We seek to compare intubation success rates of paramedics using curved versus straight blades. ⋯ Our study found a significant difference in intubation success rates between laryngoscope blade types. Curved blades had higher first attempt and overall success rates when compared to straight blades. Paramedics should consider selecting a curved blade as their tool of choice to potentially improve intubation success.
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Locked-in syndrome (LIS) is an exceedingly rare condition that has been described as a fate worse than death. Unfortunately, exam findings can be subtle and imaging is poorly sensitive, often leading to a delay in diagnosis. ⋯ Patients presenting with sudden onset altered mental status require a very careful physical exam, even if deemed comatose, and should be considered for emergent imaging for stroke. Fortunately, our patient recovered well and was discharged home in good condition.
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We examine recent trends in U.S. emergency department (ED) and hospital care for stroke and transient ischemic attack (TIA). ⋯ Over this nine-year study period, the average age of stroke & TIA patients was unchanged in U.S. hospitals; however, the proportion with Medicaid insurance increased considerably. Stroke incidence increased while TIA decreased slightly. Full inpatient hospitalizations are declining for both conditions, while transfers are on the rise. Average inpatient costs increased dramatically for all three conditions while mortality for stroke & ICH fell significantly.