The American journal of emergency medicine
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Field sepsis alerts have the ability to expedite initial ED sepsis treatment. Our hypothesis is that in patients that meet EMS sepsis alert criteria there is a strong relationship between prehospital end-tidal carbon dioxide (ETCO2) readings and the outcome of diagnosed infection. ⋯ While ETCO2 predicted the initial ED lactate levels it did not predict diagnosed infection, admission to the hospital or ICU admission in our patient population but did predict mortality.
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Observational Study
Characterizing the impact of snowfall on patient attendance at an urban emergency department in Toronto, Canada.
We sought to determine whether addition of a snowfall variable improves emergency department (ED) patient volume forecasting. Our secondary objective was to characterize the magnitude of effect of snowfall on ED volume. ⋯ The addition of a snowfall variable results in improved model performance in short-term ED volume forecasting. Snowfall is associated with a modest, but statistically significant reduction in ED volume.
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Supraventricular Tachycardias are the most common cardiac rhythm disturbances in pregnant patients. Adenosine is the recommended medication to treat these arrhythmias in part because the medication is projected to be metabolized prior to crossing the placenta and producing any fetal effects. Reported here is a case of a pregnant patient treated with adenosine in which the fetal heart activity was monitored through point of care ultrasonography with documentation of no fetal impact from this medication. This is the first documentation of a lack of fetal effect from adenosine.
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Psychogenic fever is a stress-related psychosomatic disease and has been recognized clinically since the early twentieth century. It is common in adolescents or young women with acute or persistent elevation in body temperature. Psychogenic fever can be attenuated by anxiolytic, neuroleptic, or by psychotherapy. ⋯ Psychological stress may present with a range of symptoms, including visual impairment. Physicians should consider the diagnosis of psychogenic fever when patients present with fever of unknown origin and no other abnormal findings.
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Case Reports
Life-threatening massive empyema: A novel complication of intrathoracic omental herniation.
Intrathoracic omental herniation (ITOH) is the herniation of the omentum through the esophageal hiatus without herniation of the stomach. It is a rare disease and serious complications due to ITOH have not been reported in the literature. Here, we reported the case of 47-year old man who presented to the emergency department with dyspnea and chest pain. ⋯ The patient's vital signs were restored and his symptoms were relieved. He was discharged on hospital day 15 without complications. Emergency physicians should be aware that severe complications of ITOH could develop and that if the patient's symptoms and vital signs worsen, emergency surgery should be considered.