The American journal of emergency medicine
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Pre-existing medical conditions (PEC) represent a unique domain of risk among older trauma patients. The study objective was to develop a metric to quantify PEC burden for trauma patients. ⋯ Our 12-item PEC Risk Score performed well compared with other metrics, suggesting that the classification of trauma-related mortality risk may be improved through its use. Among non-severely injured older trauma patients, the utility of prognostic metrics may be enhanced through the incorporation of comorbidities.
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Left ventricular non-compaction (LVNC) is a cardiomyopathy with altered ventricular wall anatomy. This condition is characterized by the presence of prominent left ventricular trabeculae, a thin compacted layer, and deep intertrabecular recesses that are continuous with the left ventricular cavity and separated from the epicardial coronary. Left ventricular non-compaction can present with acute heart failure, arrhythmias, or sudden cardiac death. We present a case of a common cardiac arrhythmia in the emergency department with a work up consistent with LVNC being the underlying etiology.
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Benzodiazepines are often recommended first-line for management of cocaine and amphetamine toxicity while antipsychotic treatment is discouraged due to the potential for lowering seizure threshold, prolonging the QT interval, and decreasing heat dissipation. We performed a systematic review including animal and human studies to elucidate the efficacy and safety of antipsychotics in managing sympathomimetic toxicity specifically evaluating the effect of treatment on mortality, seizures, hyperthermia, and cardiovascular effects. ⋯ This systematic review represents an exhaustive compilation of the available evidence. There is neither a clear benefit of antipsychotics over benzodiazepines nor a definitive signal of harm noted. We encourage clinicians to adapt treatment based on specific circumstances and characteristics of their individual patients.
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Emergency department presentations of syncope can vary from benign to life-threatening etiologies. Older patients are at increased risk of cardiac causes of syncope. ⋯ He was transferred to the ICU and underwent pacemaker implantation. A high index of suspicion for dysrhythmias should be maintained for any patient presenting to the ED with high-risk syncope.
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No definitive experimental or clinical evidence exists whether brain hypothermia before, rather than during or after, resuscitation can reduce hypoxic-ischemic brain injury following cardiac arrest/cardiopulmonary resuscitation (CA/CPR) and improve outcomes. We examined the effects of moderate brain hypothermia before resuscitation on survival and histopathological and neurobehavioral outcomes in a mouse model. ⋯ Moderate brain hypothermia before resuscitation improved survival and reduced histological neuronal injury, spatial memory impairment, and anxiety-like behaviours after CA/CPR in mice.