The American journal of emergency medicine
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Optimization of the detection of atrial fibrillation following stroke is mandatory. Unfortunately, access to long-term cardiac monitoring is limited in many centers. The aim of this study was to assess the potential usefulness of three routine biological markers, troponin, D-dimers and BNP, measured in acute stroke phase in the selection of patients at risk of cardio-embolic stroke. ⋯ High BNP value measured within 48 h after stroke admission is an independent predictor of cardiac stroke mechanism. Its measurement might be used to improve the selection of patients for whom further cardiologic investigations such as continuous long term ECG monitoring would be the most useful. BNP should be added to the standard admission-work-up for stroke patients.
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Healthcare providers and law enforcement utilize spit socks to prevent exposure to communicable diseases transmitted by bodily fluid projection from agitated individuals. There are cases in which death is reported due to breathing being limited by a spit sock. There are no formally published studies on their use and safety. The aim of this study was to evaluate whether wearing a spit sock causes a clinically significant impact on breathing. ⋯ In healthy subjects there were no clinically significant changes in the physiologic parameters of breathing while wearing a spit sock.
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Review Case Reports
Mesenteric venous thrombosis presenting as gastrointestinal bleeding, a challenging diagnosis.
Acute mesenteric venous thrombosis (MVT) is an uncommon cause of intestinal ischemia and is associated with high morbidity and mortality. Patients with acute MVT often present with gastrointestinal (GI) bleeding and other unspecific findings making the diagnosis challenging. This condition requires emergent treatment. ⋯ Physicians should suspect acute MVT in patients with GI bleed while also considering other factors such as, a past medical history of pro-thrombotic conditions, past surgical history of splenectomy, symptoms of nausea, vomiting, abdominal pain, physical exam findings of abdominal tenderness and abdominal distention and a laboratory workup indicating leukocytosis and an increased plasma lactic acid level. An increase in the yield of accurate diagnosis of acute MVT is possible if physicians in the ED accurately interpret all these findings. The authors herein present a case of acute MVT in a patient whose initial complaint was GI bleeding and provide a thorough review of the literature of cases of acute MVT presenting with GI bleed.
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Meta Analysis
Interleukin-6 as a diagnostic marker for infection in critically ill patients: A systematic review and meta-analysis.
The ability of blood levels of interleukin (IL)-6 to differentiate between infection and non-infection in critically ill patients with suspected infection is unclear. We assessed the diagnostic accuracy of serum IL-6 levels for the diagnosis of infection in critically ill patients. ⋯ Blood levels of IL-6 have a moderate diagnostic value and a potential clinical utility to differentiate infection in critically ill patients with suspected infection.
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Emergency Medicine providers are grappling with the dual challenges of adequately treating pain while avoiding the risks associated with opioid pain relievers. The aggressive treatment of pain with opioids for the last three decades has resulted in an epidemic of opioid use disorder and opioid related mortality. This editorial discusses the findings in a study of emergency department (ED) opioid prescribing by Yang et al. and explores the changing landscape of opioid prescribing in emergency medicine. We specifically discuss risks associated with opioid prescribing, strategies to reduce risks while improving pain management, the role of advanced practice providers in ED opioid prescribing, and the importance of further education on opioid sparing pain management strategies.