The American journal of emergency medicine
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Early diagnostic prediction in patients with small bowel obstruction (SBO) can improve time to definitive management and disposition in the emergency department. We sought to develop a nomogram to leverage point-of-care ultrasound (POCUS) and maximize accuracy of prediction of SBO diagnosis. ⋯ A unique nomogram incorporating patient age, physician pretest probability of SBO, and POCUS measurements of small bowel diameter and the presence of free intraperitoneal fluid between bowel loops was developed to accurately predict the diagnosis of SBO in the emergency department. The nomogram should be externally validated in a novel cohort of patients at risk for SBO to better assess predictability and generalizability.
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Observational Study
The NACA score as a predictor of ventricular cardiac arrhythmias - A retrospective six-year study.
Helicopter Emergency Medical Service (HEMS) conducts the evaluation of a patient's condition using NACA score before transporting the patient to hospital. The conditions inside the rescue helicopter limit or even make it impossible to conduct some medical procedures. An appropriate classification of the patient may lead to a lower possibility of occurrence of adverse events during the flight. The aim of the research was to evaluate the correlation of NACA score with the cardiac arrhythmia that may be life threatening. ⋯ NACA score allows to predict the risk of occurrence of ventricular arrhythmia of the myocardium as well as cardiac arrest. The possibility of occurrence of a life-threatening rhythm is significantly higher in patients classified as NACA IV or higher.
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Tonsillectomy is a common and relatively safe pediatric surgery. However, common and emergent complications from this procedure include hemorrhage, airway obstruction, and local infection. A rare but equally emergent complication is infection from hematogenous spread. We present a rare case of septic arthritis in a 6-year-old female of the ankle 3 days following tonsillectomy.
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We validated prior emergency department (ED) assessments of the chest pain score accelerated diagnostic pathway (EDACS-ADP) in Korean patients. This score is designed to discriminate patients at a low risk of a major adverse cardiac event (MACE) from those with a potentially more serious condition. ⋯ The sensitivity and negative predictive values for the EDACS-ADP were high in Korean patients presenting at the ED. However, the MACE rate among low-risk patients is higher than that considered acceptable by the majority of ED physicians for patients that are to be discharged without further evaluation. Further studies may be warranted for the successful application of the EDACS-ADP.
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Case Reports
High dose vitamin C induced methemoglobinemia and hemolytic anemia in glucose-6-phosphate dehydrogenase deficiency.
Investigational use of intravenous vitamin C has been on the rise, but its side effects may be underreported. A 75-year-old woman presented with acute onset of jaundice, dark urine and shortness of breath after receiving 30 g of vitamin C infusion as an unconventional therapy for her hemifacial spasm. Diagnosis of methemoglobinemia and hemolytic anemia was made clinically and confirmed on laboratory tests. ⋯ When administered at physiological dose, vitamin C can be used as an alternative to methylene blue in treatment of methemoglobinemia in patients with G6PD deficiency. However at supraphysiological dose vitamin C can paradoxically lead to hemolytic anemia in the same group of patients. Physicians should be alert of these potential complications of high dose vitamin C.