The American journal of emergency medicine
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Comparative Study Clinical Trial
ABC/2 estimation in intracerebral hemorrhage: A comparison study between emergency radiologists and emergency physicians.
We aimed to define levels of agreement (LOA) between emergency radiologists (RAD) and emergency medicine (EM) physicians for estimating bleed volume in intracranial hemorrhages (ICH) using ABC/2 formula. ⋯ Excellent level of agreement was found between emergency physicians and emergency radiologists for estimating ICH bleed volumes using ABC/2 formula.
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Clinical Trial
Association of optic nerve sheath diameter measurement withhyponatremia in emergency department.
Investigation of association of ONSD with hyponatremia in symptomatic patients. ⋯ Ultrasonic imaging of ONSD measurement in the emergency department appears to reflect changes consistent with ICP changes in hyponatremia and change in serum sodium.
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Although seizure is one of the common causes of stroke mimics and can be an initial manifestation of acute stroke, accurate diagnosis of seizure during acute stroke management is frequently difficult. The objective of this study was to analyze the frequency, characteristics and results of neuroimaging including CT perfusion in patients with seizures manifesting initially as stroke-like symptoms. ⋯ Seizure is a frequent final diagnosis in acute stroke management. However, careful interpretation of clinical features and results of perfusion imaging is necessary to avoid unnecessary thrombolysis in patients with seizure as a stroke mimic and thrombolysis failure due to delayed diagnosis of seizure as an initial manifestation of stroke.
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Case Reports
Delusional parasitosis as presenting symptom of occipital lobe cerebrovascular accident.
Delusional parasitosis manifests as a fixed, false belief that an individual is infested by living organisms. Primary delusional parasitosis is a psychiatric disorder with the delusion as an isolated manifestation, whereas secondary delusional parasitosis is a delusion occurring secondary to a psychiatric disorder, substance use, or medical illness. A 62-year-old woman with no psychiatric history presented to the Emergency Department with two to three months of "whole body itching" and seeing small insects crawling on her skin and in her hair. ⋯ She was admitted for two days, and ultimately was discharged on aspirin and atorvastatin for secondary prevention. An emergency physician should remain vigilant in his/her assessment of patients with seemingly psychiatric symptoms, in particular elderly patients with no known psychiatric illnesses. Neuroimaging should be amongst studies considered in the evaluation of elderly patients presenting with new onset psychiatric complaints.
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Reversal of oral factor Xa (FXa) inhibitors, such as apixaban, remains a controversial topic. However, the controversy goes beyond what reversal agent to utilize. ⋯ A paucity of literature exists regarding the utilization of low molecular weight heparin (LMWH) anti-Xa assays and thromboelastography for identifying coagulopathies associated with oral FXa inhibitors. We report a case of apixaban induced coagulopathy utilizing thromboelastography and a LMWH anti-Xa assay as a guide for reversal.